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）。这项研究正在逐渐结束。目前仍在进行一些与轻微畸形有关的分析，但本财政年度没有新的发现报告。

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.