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The effect of glycemia on early embryonic development in diabetic pregnancies

Objectives This study assessed the correlation between early embryonic growth and maternal glycemia, as well as between early embryonic growth restriction and incidence of spontaneous abortions and of congenital malformations. Methods The prospective study included 102 pregnant women with insulin-dependent diabetes mellitus and 192 matched healthy controls. All women had regular periods. The level of serum chorionic gonadotropin was determined at least twice: at 6-8 weeks of pregnancy and before 12 weeks of pregnancy. A single measurement of maternal glycosylated hemoglobin, two ultrasound examinations and multiple measurements of blood glucose levels were performed between 6 and 12 weeks of pregnancy. Pregnancies were classified into groups with normal and restricted embryonic growth according to ultrasound fetal biometry. Differences in glycemia between groups, incidence of spontaneous abortions and congenital malfomations were calculated. Results Early embryonic growth restriction was significantly more frequent in diabetic pregnancies. Poor maternal metabolic control in diabetic pregnancies, measured as raised glycosylated hemoglobin level, was correlated with early embryonic growth restriction. The group of pregnancies with restricted embryonic growth also showed a significantly higher incidence of spontaneous abortions, and the correlation with congenital malformations was marginally significant. Conclusions Our results support the hypothesis that the level of maternal blood glucose immediately prior to conception and during early embryonic development may directly affect human embryonic and consequently fetal development. The number of embryopathies in diabetic pregnancies could be reduced if normoglycemia were maintained in these periods.

DIABETIC PREGNANCY; HYPERGLYCEMIA; EMBRYONIC DEVELOPMENT; EARLY EMBRYONIC GROWTH RESTRICTION; DIABETIC EMBRYOPATHY

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