title: Glycemic thresholds for spontaneous abortion and congenital malformations in insulin-dependent diabetes mellitus.
abstract: OBJECTIVE
  To test the hypothesis that women with insulin-dependent (type I) diabetes have a threshold of glycemic control in early pregnancy for increased risks of spontaneous abortion and congenital malformations.
  
  
  METHODS
  Receiver-operating characteristic (ROC) curves were formed for the occurrence of abortion and malformations as a function of the median first-trimester preprandial blood glucose concentration and the first measured glycohemoglobin concentration in pregnant women with type I diabetes.
  
  
  RESULTS
  Fifty-two of the 215 women (24%) who enrolled before 9 weeks' gestation had spontaneous abortions. Six percent of the women enrolled before 14 weeks had infants with major congenital malformations. Thresholds for an increased risk of abortion and malformations were a median first-trimester blood glucose concentration of 120-130 mg/dL or an initial glycohemoglobin concentration of 12-13% (6.2-7.5 standard deviations above the normal mean).
  
  
  CONCLUSIONS
  Type I diabetic women with initial glycohemoglobin concentrations in pregnancy above 12% or median first-trimester preprandial glucose concentrations above 120 mg/dL have an increased risk of abortion and malformations. Below these glycemic thresholds, the risks are comparable to those in nondiabetic women.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio.
authors.forename: B
authors.initials: B
authors.lastname: Rosenn
authors.forename: M
authors.initials: M
authors.lastname: Miodovnik
authors.forename: C A
authors.initials: CA
authors.lastname: Combs
authors.forename: J
authors.initials: J
authors.lastname: Khoury
authors.forename: T A
authors.initials: TA
authors.lastname: Siddiqi
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D000013:Congenital Abnormalities / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011254:Pregnancy in Diabetics / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin