Glycemia Control Vital In Pre and Early Pregnancy Among Type 1 Diabetics

posted 12/06/02

A significant relation between adverse outcome of pregnancy and poor glycaemia control in early pregnancy in type 1 diabetics is shown in an investigation by British clinicians, published in the current BJM.

This study was carried out by Dr Rosemary Temple and colleagues at the Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital, Norwich.

They found that there was four-fold increase in adverse outcome, a four-fold increase in spontaneous abortion, and a nine-fold increase in major congenital malformation among 158 first pregnancies in women with type 1 diabetes who had a glycated hemoglobin concentration above 7.5 percent at booking into the prenatal unit.

The clinicians point out that, while recent studies among British women with type 1 diabetes have shown an increased risk of congenital malformation and perinatal mortality, methods of glycemia control meant no conclusions were reached about the relation between outcome and such control.

Dr Temple and colleagues measured glycated hemoglobin concentration at booking for prenatal care. Women were divided into two groups according to their glycated hemoglobin concentration: those with values less than 7.5 percent (mean of normal range plus 5 standard deviations) were defined as having fair control, and those with values more than 7.5 percent were defined as having poor control.

Among the 158 women, 32 pregnancies had an adverse outcome, with 18 (7 percent) spontaneous abortions, 8 (3 percent) major congenital malformations (6 neural tube defects), 4 stillbirths, and 2 neonatal deaths. Adverse outcome was significantly higher (relative risk 4.3) in the poor control group than the fair control group.

The researchers conclude: "Our findings suggest that good glycemia control around the time of conception is necessary to optimize outcome of pregnancy in diabetic women. Diabetic women and their care givers need to be advised of the risks and encouraged to optimize glycemia control before and during pregnancy."

Source: Diabetes In Control Dot Com: BMJ 2002; 325:1275-6.

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