1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-2-17-a 10.15844/pedneurbriefs-2-3-1 Congenital Malformations Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Diabetes and Fetal Malformations http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 03 1988 01 08 2016 2 3 17 17 Copyright: © 1988 The Author(s) 1988 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis

Diabetic and healthy control pregnant women were followed in a multicenter collaborative study coordinated by the Epidemiological Branch, National Institute of Child Health and Human Development, Bethesda, MD.

 Hypoglycemia Hyperglycemia Periconceptional Glycemic Control

Diabetic and healthy control pregnant women were followed in a multicenter collaborative study coordinated by the Epidemiological Branch, National Institute of Child Health and Human Development, Bethesda, MD. Major malformations, including ananencephaly, arhinencephaly and holoprosencephaly, microcephaly, meningomyelocele and hydrocephalus, were detected in 4.9% of diabetic women who entered the study early compared to 9% in late-entry diabetic subjects (P=.032) and 2.1% in controls (P=.027). Mean blood glucose and glycosylated hemoglobin levels during organogenesis were not significantly higher in women whose infants were malformed, and hypoglycemia was not more common in the same group. Hyperglycemia during organogenesis was not correlated with malformation. The authors conclude that not all malformation can be prevented by good glycemic control but the lower incidence among women studied within 21 days of conception (early-entry group) as compared with the late-entry group justifies good metabolic control around time of conception. [1]

COMMENT. Previous studies have shown low malformation rates in diabetic women who achieved excellent periconceptional glycemic control. The present study suggests that poor glycemic control explains some but not all diabetes associated malformations. Metabolic factors other than glycemic control may be relevant according to animal studies. Genetic factors may also be involved and female offspring are more susceptible. Congenital optic nerve hypoplasia, not encountered in this study, has been reported in women whose mothers had diabetes mellitus. [2]

 Mills JL Knopp RH Simpson JL Jovanovic-Peterson L Metzger BE Holmes LB Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis N Engl J Med 1988 Mar 318 11 671 6 10.1056/NEJM198803173181104 3344018 Nelson M Lessell S Sadun AA Optic nerve hypoplasia and maternal diabetes mellitus Arch Neurol 1986 Jan 43 1 20 5 10.1001/archneur.1986.00520010016013 3942508