Outcome of fetuses in women with pregestational diabetes mellitus.
OBJECTIVE
To investigate the effects of pregestational diabetes on pregnancy outcome.


METHODS
Data of 126 women with pregestational diabetes prospectively collected and controlled in a single tertiary center. HbA(1C) levels at early pregnancy were registered. Adverse pregnancy outcome was defined as spontaneous abortion, congenital defect, stillbirth, or neonatal death.


RESULTS
There were 10 spontaneous abortions (7.9%) and 17 fetuses with congenital anomalies (13.4%), including 8 major malformations (6.3%). Compared with pregnancies with a favorable outcome, a higher HbA(1C) concentration in early pregnancy was observed in pregnancies with adverse perinatal outcome [mean (SD): 6.3 (1.6) vs. 7.2 (1.7), P=0.001]. A positive correlation between increased maternal HbA(1C) levels and the rate of fetal malformations was observed, and the group of women with poor metabolic control (early maternal HbA(1c) concentration >7%) showed a 3 to 5-fold increase in the major malformation rate. Cardiovascular and genitourinary defects accounted for 58.8% of the anomalies, and the ultrasound examinations detected seven of them (41.2%). For major malformations, the detection rate was 50% (4/8). Perinatal mortality rate was 26 per thousand (3/116). There was almost 5-fold increase in the total pregnancy loss rate in the poor control group compared with the group with fair control [22.2% vs. 5.3%, OR (95% CI): 5.1 (1.4-17.1)]. Only 11.9% of mothers used a preconception care program.


CONCLUSIONS
Pregestational diabetes mellitus is a significant risk factor for the developing fetus. Spontaneous abortions and congenital defects are more common when a poor metabolic control is present in early pregnancy. It is most important to improve access to preconception care programs for achieving a good metabolic control in early pregnancy. Ultrasound examinations have a low performance for detecting congenital defects in diabetic pregnancies.
Galindo
Alberto
A
Department of Obstetrics and Gynecology, Hospital Universitario,"12 de Octubre", Madrid, Spain. agalindo.hdoc@salud.madrid.org
Burguillo
Antonio Garcia
AG
Azriel
Sharona
S
Fuente
Pedro de la
Pde L
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D016742:Preconception Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology
D006442:Glycated Hemoglobin