Combing Diabetes' Teratogenic 'Suspect List'

Abstract

ABSTRACT INFANTS of insulin-dependent diabetic mothers have a twofold to threefold higher rate of congenital malformations than infants of mothers without the disorder. In recent years, blood glucose has topped the list of teratogenic suspects, so much so that a recent controversial study suggested that slightly elevated levels even in nondiabetic mothers were associated with an increased incidence of congenital abnormalities in their offspring (N Engl J Med 1986;315:989-992). However, the inclusion of anomalies not typically associated with diabetic pregnancies raised questions about the study's conclusions (N Engl J Med 1987;316:1343-1346).Now, data from the Diabetes in Early Pregnancy Study, one of the largest ever to follow diabetic women throughout their pregnancies, suggest that while glucose control plays a role in malformations, investigators must redouble their search for other factors if they hope to prevent problems such as caudal regression (sacral dysgenesis and hypoplasia of the femora) and congenital heart defects