Malformations in infants of diabetic mothers. Teratology 25:385-94. 1982.
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TLDR
A large-scale prospective study is required to determine early fetal loss rates, correlate metabolic status during organogenesis with outcome, and assess the effect of diabetic control on malformation rates as mentioned in this paper.Abstract:
Maternal insulin-dependent diabetes has long been associated with congenital malformations. As other causes of mortality and morbidity have been eliminated or reduced, malformations have become increasingly prominent. Although there is not universal agreement, the great majority of investigators find a two- to threefold increase in malformations in infants of insulin-dependent diabetic mothers. This increase is not seen in infants of gestational diabetics. It probably is not present in women whose diabetes can be controlled by diet or oral hypoglycemic agents. The risk does not appear to be primarily genetic since diabetic fathers do not have an increased number of malformed offspring. Most studies show a generalized increase in malformations involving multiple organ systems. Multiple malformations seem to be more common in diabetic than non-diabetic infants. Caudal regression has the strongest association with diabetes, occurring roughly 200 times more frequently in infants of diabetic mothers than in other infants. The teratogenic mechanism in diabetes is not known. Hyperglycemia may be important but human studies focusing on the period of organogenesis are lacking. Hypoglycemia has also been suggested based mainly on animal experiments. Insulin appears unlikely. Numerous other factors including vascular disease, hypoxia, ketone and amino acid abnormalities, glycosylation of proteins, or hormone imbalances could be teratogenic. None has been studied in sufficient detail to make a judgment. A large-scale prospective study is required to determine early fetal loss rates, correlate metabolic status during organogenesis with outcome, and assess the effect of diabetic control on malformation rates.read more
Citations
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Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis
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References
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Journal ArticleDOI
Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers.
Edith Miller,John W. Hare,John P. Cloherty,P J Dunn,Ray E. Gleason,J. S. Soeldner,John L. Kitzmiller +6 more
TL;DR: Fetal malformations occur before eight weeks of gestation (postmenstrual dates), when most diabetic pregnant women have not yet come to medical attention, and there has been no objective method to assess control.
Journal ArticleDOI
Malformations in Infants of Diabetic Mothers Occur Before the Seventh Gestational Week: Implications for Treatment
TL;DR: Developmental morphologic dating shows that the significantly more common congenital malformations in infants of diabetic mothers occur before the seventh week of gestation, which suggests that any therapeutic intervention aimed at decreasing the incidence of congenital Malformations must be instituted during the critical early period.
Journal ArticleDOI
Experimental production of congenital maiformations in mammals by metabolic procedure.
Harold Kalter,Josef Warkany +1 more
Journal ArticleDOI
The outcome of diabetic pregnancies in relation to the mother's blood sugar level.
TL;DR: The increased survival rate was parallelled by a decreased morbidity in the infants, and the perinatal mortality rate sank from 23.6 per cent in the group with a mean blood sugar level above 150 mg per 100 ml.