Effect of Gestational Age at Onset Prenatal Care
on the Risk of Congenital Malformations in the Offspring of Insulin Dependent Diabetic Pregnant Women

1Akhlaghi F, 2Hamedi AB.

1Department of Obstetrics & Gynaecology, 2Department of pediatrics,

Emam Reza Hospital, Mashhad University of Medical Sceinces, Mashhad, Iran

Objective:

Pregnant women with insulin dependent diabetes (IDD) have an increased risk of fetuses with congenital malformations. This is thought to be secondary to hyperglycemia during organogenesis.‏ ‏The purpose of this study is the rate of congenital anomalies in relation gestational age at onset of prenatal care in insulin-dependent diabetic women.

Material and Methods:

From 10/2000–10/2004 we prospectively collected data from 92 pregnancies and offspring of women with IDD who registered for prenatal care in Khorasan Diabetes Resaerches center. Age, parity, duration of diabetes, mean blood glucose in the period of pregnancy, regularity of prenatal care, birth weight and incidence of congenital anomalia in patients were studied. The data of different causes in relation the rate of congenital anomalia in offspring defined and statistical analysis utilized Fisher's exact test and Z test.

Results:

A total of 92 pregnant women with IDD who registered for prenatal care in the Khorasan diabetes researches center. Pregnant women were 18-39 years old (mean 25.3) and the mean gestational age at onset for prenatal care in them was 15.1 weeks. Their mean blood glucose in the pregnancy period was 133mg/dl. Mean birth weight of offsprings were 3400 gram. 40 pregnant women had regular prenatal care and 52 had irregular prenatal care. 69 women initiated prenatal care early and before 20 weeks of pregnancy and 23 women late and after 20 weeks of pregnancy. A toatl 11 congenital anomalia (12%) were seen in neonates, 1 in early prenatal care group and 10 in late prenatal care group that the different was significant. Congenital anomalies include 2 heart malformation, 3 CNS malformation and 6 extermities anomalia., Maternal age, parity, duration of diabetes , regularity in care and gestational age at onset the prenatal care were significant in association with the occurrence of malformations. Mean value of blood glucose and neonatal birth weight was not significant in association with the occurrence of malformations.

Conclusion:

Poor glucose control before and during the early weeks of gestation has emerged as the major cause of congenital malformations and perinatal mortality. Therefore Insulin dependent diabetic women should be initiate early prenatal care and normoglycaemia should be strived during pregnancy