Diabetes In Early Pregnancy

早孕糖尿病项目的设计目的是：1)研究母体器官发生过程中的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一个或多个特定致畸因素；2)比较糖尿病妇女和非糖尿病对照组受试者的早期胎儿损失率。我们发现，在器官发生时期之前接受治疗的糖尿病女性取得了比后来接受治疗的女性更好的结果；但她们的结果仍然比非糖尿病对照组的受试者差。器官发生过程中母体血糖水平的差异不能解释在整个怀孕期间被跟踪的女性后代中的畸形。这些结果表明，较晚进入的女性(在器官发生过程中没有受到医疗监督)可能控制力较差。这导致了由于高血糖或相关因素造成的畸形。早期进入糖尿病组的结果强烈表明，还有其他致畸机制存在。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，丢失的风险急剧增加；总体失去妊娠的风险低于预期，仅为16%。自完成这些初步分析以来，已经完成了一些相关研究(见以前的报告)。这项研究正在收尾。仍有一些与轻微畸形有关的分析正在进行，但本财年没有新的发现可供报告。

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 women with diabetes 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 women with diabetes 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). This study is winding down. There is still some analysis being performed relating to minor malformations, but there are no new findings to report for this fiscal year.