Diabetes In Early Pregnancy

妊娠早期糖尿病项目的目的是：1）检查在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妇女比那些后来接受护理的妇女取得了更好的结果;但她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）。关于妊娠早期胰岛素的需求存在相当大的混乱。我们从第五周开始检查了糖尿病妇女的胰岛素剂量，以确定在前三个月胰岛素需求是否确实下降。总体而言，我们发现在妊娠7 - 11周期间胰岛素需求量显著下降。这种下降在那些在次优控制下开始怀孕的人中最为明显。我们推测，在这组中，当医生试图改善其妊娠早期的代谢控制时，胰岛素需求的生理性降低可能会因最初的胰岛素过度治疗而加重。

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). There is considerable confusion regarding insulin requirements in early pregnancy. We examined insulin doses in our women with diabetes beginning at week five to determine whether there is, in fact, a fall in insulin requirements during the first trimester. Overall, we found a significant drop in insulin requirements occurring in the period from seven to eleven gestational weeks. The fall was most pronounced in those starting pregnancy in sub-optimal control. We hypothesize that the physiologic decrease in insulin requirements may be accentuated in this group by initial over-treatment with insulin when physicians attempt to improve their metabolic control in early pregnancy.