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Birth defects in diabetic pregnancies: where do we go from here?

Major congenital malformations affecting predominantly the central nervous system, heart and great vessels, kidneys and skeleton occur in 8–12% of pregnancies complicated by type I or type II diabetes in the absence of special preconceptional diabetes care. As morbidity and mortality from other complications of diabetic pregnancies have been reduced by careful maternal blood glucose regulation during the second and third trimesters, malformations have become the major cause of perinatal mortality and an important cause of perinatal morbidity associated with maternal diabetes. A review of human embryology indicates that the developmental disturbances that cause the malformations occur very early in pregnancy, probably during the first six weeks of development. Because ethical considerations preclude the study of human embryos during this period, animal models have been developed to study the biochemical mechanisms by which maternal diabetes causes embryonic malformations. One of the most useful techniques was developed by New and colleagues