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Glycemic Control Prevents Congenital Anomalies

John L. Kitzmiller, MD; Laurence A. Gavin, MD; Gary D. Gin, MD, MPH; Lois Jovanovic-Peterson, MD; Elliott K. Main, MD; William D. Zigrang, MD

JAMA. 1991;265(6):731-736.

Abstract
To test the value of intensive management of diabetes before and during early pregnancy, 84 women recruited prior to conception were compared with 110 women who were already pregnant referred at 6 to 30 weeks' gestation. All underwent daily measurement of fasting and postprandial capillary blood glucose levels. Mean blood gluose levels during embryogenesis and organogenesis were within 3.3 to 7.8 mmol/L in 50% of preconception subjects and exceeded 10 mmol/L in 6.5%. One major congenital anomaly occurred in 84 infants (1.2%) of women treated before conception compared with 12 anomalies in 110 infants (10.9%) of mothers in the postconception group. Transient symptomatic hypoglycemia occurred during embryogenesis in 60% of women in the preconception group, with a median frequency of 2.7 episodes per week, but was not associated with excess malformations. We conclude that education and intensive management for glycemic control of diabetic women before and during early pregnancy will prevent excess rates of congenital anomalies in their infants.

(JAMA. 1991;265:731-736)

Author Affiliations
From the Departments of Obstetrics, Gynecology, and Reproductive Sciences (Dr Kitzmiller), Medicine (Dr Gavin), and Pediatrics, University of California, San Francisco; and Children's Hospital of San Francisco, (Drs Gin, Jovanovic-Peterson, Main, and Zigrang).

Footnotes
Reprint requests to Department of Obstetrics, Gynecology, and Reproductive Services, University of California School of Medicine, Room M-1489, San Francisco, CA 94143 (Dr Kitzmiller).

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