Congenital malformation continues to be a major problem for infants of diabetic mothers. Over a seven-year period, 199 insulin-requiring diabetic mothers were delivered at Vanderbilt University Medical Center. Con genital anomalies were identified in 26 (13%) newborns. There was no significant difference in the incidence of fetal anomalies between the various categories of White's classification of maternal diabetes mellitus. A review of proposed etiologies of anomalies in diabetic pregnancies is presented, and suggestions are made for the manage ment of women with dia betes desiring to conceive.
Get full access to this article
View all access options for this article.
References
1.
White P.: Pregnancy complicating diabetes. Am J Med1949; 7:609-616.
2.
Pedersen J., Pedersen LM: Prognosis of the outcome of pregnancies in diabetics: A new classification . Acta Endocrinol1965; 50:70-78.
3.
Diamond MP, Salyer SL, Vaughn WK, et al: Continuing neonatal morbidity in infants of women with class A diabetes. South Med J1984; 77:1386-1389.
4.
Diamond MP, Vaughn WK, Salyer SL, et al: Efficacy of outpatient management of insulin-dependent diabetic pregnancies. J Perinat1985; 5:2-8.
5.
Karlsson K., Kjellmer I.: The outcome of diabetic pregnancies in relation to the mothers' blood sugar level. Am J Obstet Gynecol1972; 112:213-220.
6.
Jovanovic L. , Peterson CM: Optimal insulin delivery for the pregnant diabetic. Diabetes Care1982; 5(Suppl 1):24-37.
7.
Diamond MP, Cotton RB, Vaughn WK, et al: Reassessment of White's classification and Pedersen's prognostically bad signs of diabetic pregnancies in insulin-dependent diabetic pregnancies . Submitted for publication.
8.
Molsted-Pedersen L., Tygstrup J., Pedersen J.: Congenital malformations in newborn infants of diabetic women—correlation with matemal diabetic vascular complications . Lancet1964; 1:1124-1126.
9.
Soler NG, Walsh CH, Malins JM: Congenital malformations in infants of diabetic mothers. Q J Med1976; 45:303-313.
10.
Ayromlooic C., Mann LI, Weiss RR, et al: Modem management of the diabetic pregnancy . Obstet Gynecol1977; 49:137-143.
11.
Mills JL: Malformations in infants of diabetic mothers. Teratology1982; 25:385-394.
12.
Cousins L.: Congenital anomalies among infants of diabetic mothers: Etiology, prevention, prenatal diagnosis. Am J Obstet Gynecol1983 ; 147:333-338.
13.
Bennett PH, Webner C., Miller M.: Pregnancy, metabolism, diabetes, and the fetus. Ciba Symposium #63 Exerpta Medica 1979, New York.
14.
Chung CS, Myrianthopoulos NC: Effect of maternal diabetes on congenital malformations, in Bergsman, D (ed): Factors Affecting Risks of Congenital Malformations. New York, Stratton Intercontinental Medical Book Corp, 1975, pp 22-35.
15.
Simpson JL, Elias S., Martin AO, et al: Diabetes in pregnancy, Northwestem University series (1977-1981) I. Prospective study of anomalies in offspring of mothers with diabetes mellitus . Am J Obstet Gynecol1983; 146:263-270.
16.
Pedersen JF , Molsted-Pedersen L: Early fetal growth delay detected by ultrasound marks increased risk of congenital malformation in diabetic pregnancy. Br Med J1981; 283:209-210.
17.
Hare JW: Diabetes control to reduce congenital malformations. Contemp Obstet Gynecol1982; 20:85-96.
18.
Landhauer W.: "Rumplessness" of chicken embryos produced by the injection of insulin and other chemicals. J Exp Zool1945; 98:65-77.
19.
Duraiswami DK : Insulin-induced skeletal abnormalities in developing chickens. Br Med J1950; 2:384-390.
20.
Kalter H., Warkany J.: Experimental production of congenital malformations in mammals by metabolic procedure. Physiol Rev1959; 39:69-115.
21.
Smithberg M., Runner MN: Teratogenic effects of hypoglycemic treatments in inbred strains of mice. Am J Anat1963; 113:479-498.
22.
Hannah RS, Moore KL: Effect of fasting and insulin on skeletal development in rats. Teratology1971; 4:135-139.
Watanabe G. , Ingalls TH: Congenital malformations in the offspring of alloxan diabetic mice. Diabetes1963; 12:66-72.
25.
Deuchar EM: Embryonic malformations in rats resulting from maternal diabetes: Preliminary observations. J Embryol Exp Morphol1977; 41:93-99.
26.
Eriksson U. , Dahlstrom E., Larsson KS, et al: Increased incidence of congenital malformation in the offspring of diabetic rats and their prevention by maternal insulin therapy. Diabetes1982; 30:1-6.
27.
Horii N., Watanabe G., Ingalls TH: Experimental diabetes in pregnant mice: Prevention of congenital malformations in offspring by insulin. Diabetes1966; 15:194-204.
28.
Miller E., Hare JW, Cloherty JP, et al: Elevated maternal hemoglobin A1C in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med1981; 304:1331-1333.
29.
Lavin JP, Jr, Lovelace DR, Miodovnik M., et al: Clincal experience with 107 diabetic pregnancies. Am J Obstet Gynecol1983; 147:742-752.
30.
Diamond MP, Salyer SL, Vaughn WK, et al: Continued neonatal morbidity of infants of class A diabetics . South Med J1984; 77:1386-1388.
31.
Navarrete VN , Rojas CE, Alger CR, et al: Subsequent diabetes in mothers delivered of a malformed infant. Lancet1970; 2:993-994.
32.
Navarrete VN , Torres IH, Rivera IR, et al: Matemal carbohydrate disorder and congenital malformations. Diabetes1967; 16:127-130.
33.
Hagbard L.: The "pre-diabetic" period from an obstetric point of view. Acta Obstet Gynecol Scand1958; 37:497-518.
34.
Milunsky A. : Glucose intolerance in the parents of children with Down's Syndrome. Am J Ment Defic1970 ; 74:475-478.
35.
Fuhrmann K. , Reiher H., Semmler K., et al: Prevention of congenital malformations in infants of insulin-dependent diabetic mothers. Diabetes Care1983; 6:219-223.
36.
Gabbe SG: Management of diabetes mellitus in pregnancy. Am J Obstet Gynecol1985; 153:824-827.
37.
Milunsky A. , Alpert E., Kitzmiller JL, et al: Prenatal diagnosis of neural tube defects VIII. The importance of serum alpha-fetoprotein screening in diabetic pregnant women. Am J Obstet Gynecol1982; 142:1030-1032.
Smithells RW , Seller MJ, Harris R., et al: Further experience of vitamin supplementation for prevention of neural tube defect recurrences. Lancet1983; 1:1027-1031.
40.
Laurence KM , James N., Miller MH, et al: Double-blind randomized trial of folate treatment before conception to prevent recurrence of neural tube defects. Br Med J1981; 282:1509-1511.
41.
Blank CE, Kumar D., Johnson M.: Multivitamins and prevention of neural tube defects: A need for detailed counselling . Lancet1984; 1:291.
42.
Pedersen JF , Molsted-Pedersen L: Early growth retardation in diabetic pregnancy. Br Med J1979; 1:18-19.
43.
Pedersen JF , Molsted-Pedersen L: Early fetal growth delay detected by ultrasound marks increased risk of congenital malformation in diabetic pregnancy. Br Med J1981; 283:269-271.
44.
Diamond MP, Vaughn WK, Salyer SL, et al: Antepartum fetal monitoring in insulin-dependent diabetic pregnancies . Am J Obstet Gynecol1985; 153:528-535.
