DIABETES IN EARLY PREGNANCY

妊娠早期糖尿病项目旨在1）检查器官形成期间母体糖尿病控制与后代畸形之间的关系，并在可能的情况下确定糖尿病代谢状态中的特定致畸因素; 2）比较糖尿病女性和非糖尿病对照受试者的早期胎儿丢失率。我们发现，在器官形成期之前接受护理的糖尿病女性比那些后来接受护理的女性取得了更好的结果;但他们的结果仍然比非糖尿病对照组差。在器官形成过程中母体葡萄糖水平的差异并不能解释在整个怀孕期间跟踪的女性后代的畸形。这些结果表明，进入较晚（在器官形成过程中没有接受医疗监督）的女性可能控制能力较差。这导致高血糖症或相关因素导致畸形。早期糖尿病组的结果强烈表明存在其他致畸机制。关于早期胎儿丢失，我们发现代谢控制良好的糖尿病妇女自然流产的风险并不比对照组妇女高;随着糖尿病控制恶化，流产的风险急剧增加;流产的总体风险低于预期，仅为16%。由于这些主要分析已完成，许多相关研究也已完成（见既往报告）。抗精子抗体已被证明不是首次早孕流产的主要因素（与晚期妊娠中的复发性流产相反）。抗磷脂抗体和早期妊娠丢失之间的关系分析显示没有关联。在进一步的分析中证实了正常妊娠的前三个月空腹血糖的降低。上述结果已经公布。其他正在进行的分析包括检查妊娠糖尿病妇女在头三个月期间的胰岛素需求，以及分析糖尿病母亲的婴儿的轻微畸形和正常变异的发生模式。- 妊娠期糖尿病、妊娠早期、高血糖-人类受试者和人类受试者：仅访谈、问卷调查或调查

The Diabetes in Early Pregnancy Project was designed 1) to examine the relationship between maternal diabetic control during organogenesis and malformations in the offspring, and to identify, if possible, a specific teratogenic factor or factors in the diabetic metabolic state; and 2) to compare early fetal loss rates in women with diabetes and in non- diabetic control subjects. We found that diabetic women who came into care before the period of organogenesis achieved better results than those who came in later; but their results were still poorer than for non-diabetic control subjects. Differences in maternal glucose levels during organogenesis did not explain the malformations in the offspring of the women who were followed throughout pregnancy. These results suggest that women who entered late (and were not under medical supervision during organogenesis) probably had poor control. This resulted in malformations due to hyperglycemia or related factors. The results from the diabetic group entering early strongly suggest that other teratogenic mechanisms were present. Regarding early fetal losses, we found that diabetic women in good metabolic control were at no higher risk for spontaneous abortion than control women; the risk of loss increased dramatically as diabetic control worsened; and the overall risk of losing a pregnancy was lower than expected, only 16%. Since these primary analyses were completed, a number of related studies have been completed (see previous reports). Anti-sperm antibodies have been shown not to be a major factor in first time early pregnancy losses (in contradistinction to recurrent pregnancy loss in later pregnancy). An analysis of the relationship between anti- phospholipid antibodies and first trimester pregnancy loss showed no association. A reduction in fasting plasma glucose during the first trimester of a normal pregnancy was demonstrated in a further analysis. The above results have been published. Other ongoing analyses include an examination of insulin requirements of pregnant diabetic women during the first trimester and an analysis of patterns of occurrence of minor malformation and normal variation in the babies of diabetic mothers. - diabetes in pregnancy, first trimester pregnancy, hyperglycemia - Human Subjects & Human Subjects: Interview, Questionaires, or Surveys Only