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Influence of maternal glycaemia on embryonal growth in insulin dependent diabetes mellitus

Objective: The aim of the study was to determine association between delayed early embryonic development and gycaemia control, occurrence of miscarriages and occurrence of congenital malformations. Study design: 102 IDDM pregnant women and 192 healthy pregnant women enrolled to the study. Pregnancy was confirmed by presence of b-human chorionic gonadotrophin (b-HCG) in maternal serum within 14 days of missed period. The b-HCG level was determined in 48 hours intervals. Vaginal sonography was performed to differentiate normal from abnormal pregnancies using 5 MHz vaginal probe attached to Aloka SSD 680 sonograph. Foetal pregnancies were subgrouped according to normal and delayed growth pattern. Frequency of congenital value of oGT test were compared to HbA1c values. Gestational age was calculated by last menstrual period, and additionally estimated by sonograpy measurements and clinical examinations. Results: The findings were - significant association between glycaemic regulation and early embryonic growth, and significantly higher levels of HbA1c in study groups compared to control group. HbA1c levels suggest hyperglycaemic condition in IDDM women at the time of conception and during early embryonic development period. Growth delayed subgroup of pregnancies revealed statistically more frequent miscarriages in IDDM group then controls (p < 0.005). The sample size was too small for through evaluation of congenital malformation occurrence and early embryonic growth delay. Conclusions: Achieving good glycaemic regulation preconceptionally and during first trimester in women with IDDM reduces incidence of miscarriages, early embryonic growth delay and possibly occurrence of congenital malformations.

insulin dependent diabetes mellitus; embryonal growth; congenital malformations; abortion

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