Glycemic thresholds for spontaneous abortion and congenital malformations in insulin-dependent diabetes mellitus.
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.
Rosenn
B
B
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio.
Miodovnik
M
M
Combs
C A
CA
Khoury
J
J
Siddiqi
T A
TA
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
D001786:Blood Glucose; D006442:Glycated Hemoglobin