DIABETES IN EARLY PREGNANCY

妊娠早期糖尿病项目的目的是1)研究母体在器官发生过程中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或因素；2)比较糖尿病妇女和非糖尿病对照组的早期胎儿丢失率。我们发现，在器官发生期之前接受治疗的糖尿病女性比那些在器官发生期之后接受治疗的女性取得了更好的效果；但他们的结果仍然不如非糖尿病对照组。在器官发生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随访的妇女后代的畸形。这些结果表明，进入较晚的妇女（在器官发生期间没有医疗监督）可能控制较差。这导致了由于高血糖或相关因素导致的畸形。早期进入的糖尿病组的结果强烈提示存在其他致畸机制。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不高于对照组妇女；随着糖尿病控制的恶化，损失的风险急剧增加；而流产的总体风险也低于预期，只有16%。由于这些初步分析已经完成，一些有关的研究也已经完成（见以前的报告）。抗精子抗体已被证明不是第一次早期妊娠丢失的主要因素（与妊娠后期反复妊娠丢失相反）。抗磷脂抗体与妊娠早期流产之间的关系分析显示没有关联。在正常妊娠的前三个月空腹血糖的降低在进一步的分析中得到证实。以上结果已发表。其他正在进行的分析包括检查妊娠糖尿病妇女在妊娠头三个月的胰岛素需求，以及分析糖尿病母亲的婴儿发生轻微畸形和正常变异的模式。-妊娠期糖尿病，妊娠早期，高血糖-人类受试者&人类受试者：访谈，问卷调查或仅调查

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