Strict glycemic control in diabetic pregnancy-implications for second-trimester screening for Down syndrome.
OBJECTIVE
Studies in the early 1990s showed that the normal levels of the biochemical markers used to screen for Down syndrome in the second trimester of pregnancy differ between healthy women and women with insulin-dependent diabetes mellitus (IDDM). Thereafter, most laboratories adopted correcting factors to adjust for these differences. However, the current validity of these factors in light of the recent improvements in glycemic control in diabetic pregnancy has not been investigated.


METHODS
The sample consisted of 35 pregnant women with strictly controlled IDDM and 40 healthy controls matched for age and gestational week. All women had singleton pregnancies and were followed till delivery.


RESULTS
Comparison of the triple test results between the two groups after adjustment with the traditional corrective factors yielded no significant differences in serum levels of any of the markers (unconjugated estriol, human chorionic gonadotrophin, alpha-fetoprotein).


CONCLUSIONS
These results suggest that the recent improvement in glycemic control of pregnant women with IDDM changes the metabolic milieu that might cause the biochemical differences with healthy pregnant patients.
Peled
Y
Y
Perinatal Division and WHO Collaborating Center for Perinatal Care, Center for Women's Health, and Department of Medical Genetics, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
Gilboa
Y
Y
Perri
T
T
Shohat
M
M
Chen
R
R
Bar
J
J
Hod
M
M
Pardo
J
J
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D006063:Chorionic Gonadotropin / Q000097:blood; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis*; D004964:Estriol / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000188:drug therapy; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards*; D012016:Reference Values; D000509:alpha-Fetoproteins / Q000032:analysis
D015415:Biomarkers; D006063:Chorionic Gonadotropin; D004964:Estriol; D006442:Glycated Hemoglobin; D000509:alpha-Fetoproteins