Preterm delivery in normoalbuminuric, diabetic women without preeclampsia: the role of metabolic control

OBJECTIVE: The aim of this study was to examine the importance of glycemic regulation on the risk of preterm delivery in women with normoalbuminuria and no preeclampsia later in pregnancy. STUDY DESIGN AND METHODS: A prospective study of 71 women with type 1 diabetes mellitus where complete data were collected on HbA1c, insulin dose, and albumin excretion rate from week 12 and every second week hereafter. Fundus photography was performed and diurnal blood pressure measured three times during pregnancy. RESULTS: The preterm rate was 23% and women delivering preterm showed higher HbA1c throughout pregnancy. At regression analysis HbA1c was the strongest predictor for preterm delivery from week 6 to 32, also when including insulin dose, BMI, age, duration of diabetes, and diurnal blood pressure. The risk of delivering preterm was more than 40% when HbA1c was above 7.7% in week 8. Diurnal blood pressure was not found associated with preterm delivery. CONCLUSION: The quality of glycemic regulation in the early and mid-pregnancy is a major, independent risk factor for preterm delivery in normoalbuminuric diabetic women without preeclampsia.     

Serum leptin levels in pregnant women with type 1 diabetes mellitus.

BACKGROUND: Leptin is an important weight regulator and during pregnancy leptin is not only synthesized in adipose tissue but also in the placenta. AIM: To examine changes in serum leptin levels in women with type 1 diabetes mellitus during pregnancy and post delivery in relation to concomitant changes in maternal body weight, birth weight, glycemic control, and blood pressure. METHODS: Non-fasting serum leptin from 45 women with type 1 diabetes mellitus were studied consecutively throughout pregnancy and 3 months post partum. RESULTS: Serum leptin was positively associated with HbA1c in week 18, 22 and 30 (r=0.38, 0.41, and 0.54, respectively, p<0.05, adjusted for body weight). Moreover, serum leptin correlated positively with maternal body weight and BMI (0.4525 kg/m2), the changes during pregnancy and the level of serum leptin were significantly greater compared to lean women (p<0.05). The women with low ambulatory blood pressure (lower tertile, mean arterial blood pressure <83.4 mmHg) showed the lowest level of serum leptin throughout pregnancy and it changed significantly differently from the women with higher blood pressure (p<0.05). CONCLUSION: Changes in serum leptin levels of pregnant women with type 1 diabetes mellitus were associated with parallel changes in maternal body weight and glycemic control. Women with low blood pressure had the lowest serum leptin levels throughout pregnancy.     

Risk factors, pregnancy complications, and prevention of hypertensive disorders in women with pregravid diabetes mellitus

OBJECTIVE: To review the rate, risk factors, and potential prevention of preeclampsia in women with pregravid diabetes mellitus. METHODS: Detailed review of recent English literature describing pregnancy outcome in women with pregravid insulin-dependent diabetes mellitus (Type 1 diabetes). The primary focus of the review is risk factors for preeclampsia and potential methods suggested for prevention of preeclampsia. In addition, pitfalls in diagnosis of preeclampsia will be emphasized. RESULTS: The reported rate of preeclampsia ranged from 9% to 66%. This rate increased with increased severity of diabetes by White's classification, with the highest rate reported in women with pregravid diabetic nephropathy. Risk factors identified for preeclampsia were nulliparity, chronic hypertension, microalbuminuria prior to pregnancy, nephropathy, and poor glycemic control early in pregnancy. There is lack of agreement among reports in the literature concerning criteria used to diagnose preeclampsia. There are two randomized trials that included women with Type 1 diabetes who were randomized to receive either low-dose aspirin or placebo. There was no reduction in the rate of preeclampsia with low-dose aspirin in either trial. CONCLUSIONS: In women with pregravid Type 1 diabetes, the rates of preeclampsia and adverse neonatal outcome increase with increased severity of diabetes. Low-dose aspirin does not reduce rate of preeclampsia in such women. Further studies should address the role of good glycemic control prior to 20 weeks gestation and prevention of microalbuminuria.     

Risk factors,pregnancy complications,and prevention of hypertensive disorders in women with pregravid diabetes mellitus

Objective: To review the rate, risk factors, and potential prevention of preeclampsia in women with pregravid diabetes mellitus.

Methods: Detailed review of recent English literature describing pregnancy outcome in women with pregravid insulin-dependent diabetes mellitus (Type 1 diabetes). The primary focus of the review is risk factors for preeclampsia and potential methods suggested for prevention of preeclampsia. In addition, pitfalls in diagnosis of preeclampsia will be emphasized.

Results: The reported rate of preeclampsia ranged from 9% to 66%. This rate increased with increased severity of diabetes by White's classification, with the highest rate reported in women with pregravid diabetic nephropathy. Risk factors identified for preeclampsia were nulliparity, chronic hypertension, microalbuminuria prior to pregnancy, nephropathy, and poor glycemic control early in pregnancy. There is lack of agreement among reports in the literature concerning criteria used to diagnose preeclampsia. There are two randomized trials that included women with Type 1 diabetes who were randomized to receive either low-dose aspirin or placebo. There was no reduction in the rate of preeclampsia with low-dose aspirin in either trial.

Conclusions: In women with pregravid Type I diabetes, the rates of preeclampsia and adverse neonatal outcome increase with increased severity of diabetes. Low-dose aspirin does not reduce rate of preeclampsia in such women. Further studies should address the role of good glycemic control prior to 20 weeks gestation and prevention of microalbuminuria.     

Night/day ratio as predictor of preeclampsia in normoalbuminuric,diabetic women: early signs of blood pressure disorders

Purpose  Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type 1 diabetes mellitus (T1DM) and in non-diabetic women was evaluated for its association with preeclampsia, retinopathy, HbA1c, and birth weight. Methods  One hundred and sixty-one women were recruited for AMBP performed with a Spacelab 90207 monitor. The pregnant women were 50 non-diabetic women and 111 T1DM women with normoalbuminuria and no hypertension. ANOVA, regression, and ROC curves analysis were applied. Results  Women with simplex retinopathy had higher night/day ratio and lower birth weight than those without retinopathy. Women who developed preeclampsia had night/day ratio similar to those with simplex retinopathy. In first trimester they had higher blood pressure than those who did not develop preeclampsia. Conclusions  Simplex retinopathy and preeclampsia are associated with a reduced night/day ratio even with normal blood pressure but night/day ratio provides no better prediction of preeclampsia than the absolute values.     

Diabetic retinopathy in pregnancy during tight metabolic control

BACKGROUND: The relation between retinopathy and the parameters: 24-h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studied before, during, and after pregnancy in women with insulin-dependent diabetes mellitus on tight metabolic control during pregnancy. METHODS: Prospective study of 112 pregnant women with insulin-dependent diabetes mellitus followed with fundus photography at the Department of Ophthalmology, Arhus University Hospital. Changes in retinopathy were related to 24-h blood pressure, blood glucose, albuminuria, and adverse perinatal outcome. RESULTS: There was an association between grade of retinopathy and HbAlc before (Spearman's rho=0.49, p<0.04) and after pregnancy (Spearman's rho=0.42, p<0.02), but no such correlation was found at any examination during pregnancy where glycemia was kept tight. Those women who had progression of retinopathy during or after pregnancy had significantly earlier onset of diabetes mellitus (14+/-8 years, range 1-27) than those women with improvement or no progression of retinopathy (19+/-8 years, range 1-36, p<0.04). No association was found between progression of retinopathy and HbA1c, blood pressure, adverse perinatal outcome or any of the other variables studied. CONCLUSIONS: Tight glycemic control during pregnancy is recommendable to avoid progression of retinopathy. Attention should be given to the period after delivery where the tight regulation may be difficult to achieve. IDDM women should be encouraged to plan pregnancies early in life.     

Uteroplacental Doppler flow velocity waveform analysis correlates poorly with glycemic control in diabetic pregnant women.

We examined 65 pregnant women with gestational (n = 31) and insulin dependent (n = 34) diabetes mellitus in order to evaluate the clinical usefulness of Doppler flow velocity waveform analysis in these pregnancies. Umbilical and uterine artery flow velocity waveforms were obtained during the third trimester with a continuous wave Doppler device. Quality of maternal glycemic control was evaluated by hemoglobin (Hb) A1 measurements at the time of delivery in 61 patients and by mean capillary blood sugars during the third trimester of pregnancy in four patients. There was no difference in various clinical and Doppler parameters between patients with good glycemic control and those with poor control. In contrast, the same clinical and Doppler parameters were significantly different in patients with preeclampsia than in those without preeclampsia, regardless of glycemic control. There was a poor positive linear correlation (r = 0.30, p less than 0.02) between maternal HbA1 and umbilical artery flow velocity waveforms (systolic/diastolic ratio). Proteinuria correlated better with umbilical artery systolic/diastolic ratio (r = 0.49, p less than 0.001). We conclude that Doppler flow velocity waveform analysis may be clinically useful only in diabetic pregnancies complicated by preeclampsia.     

Effect of treatment of borderline hypertension on microalbuminuria in non-insulin-dependent diabetes mellitus.

The advantage of treatment for borderline hypertension has been a debate. We studied two of the commonly used antihypertensive drugs, i.e., trichlormethiazide (Fluitran 2 mg/tab) and enalapril (Renitec 5 mg/tab) on urinary albumin excretion in seven NIDDM subjects with borderline hypertension, who had never been treated with antihypertensive drugs before entry into this study. The observation period was 2 months, and the treatment period was 6 months. Trichlormethiazide (1 tab qd) or enalapril (1 tab qd) were randomly assigned for the first 3 months and then patients were switched to the other drug for the following 3 months. During the treatment period, blood pressure, body weight, blood chemistry including renal function tests, and urinary albumin excretion rate were regularly followed up every 1 to 3 months. The results showed that both of the regimens significantly lowered blood pressure and the urinary albumin excretion rate [12.72 (2.56-25.95) micrograms/min at baseline, to 5.11 (3.0-13.73) micrograms/min during trichlormethiazide treatment and 4.96 (1.38-11.14) micrograms/min during enalapril treatment, p less than 0.008]. However, no significant difference was noted between the two drugs. The magnitude of change in the urinary albumin excretion rate did not correlate with the changes in blood pressure. Renal function, glycemic control, and lipid profiles did not change significantly during the treatment period. In conclusion, both trichlormethiazide and enalapril are effective in lowering the urinary albumin excretion rate in NIDDM subjects with borderline hypertension.     

Increased soluble VCAM-1 serum levels in preeclampsia are not correlated to urinary excretion or circadian blood pressure rhythm

OBJECTIVE: Soluble vascular cell adhesion molecule-1 (VCAM-1) is known to be elevated in serum of patients with preeclampsia, but there are no data available on the significance of urinary VCAM-1 excretion in preeclampsia. The aim of our study was to uncover possible circadian rhythms of VCAM-1 plasma levels and urinary VCAM-1 excretion in uncomplicated and hypertensive pregnancies and to ascertain their relation to blood pressure. STUDY DESIGN: A total of 10 normotensive and 10 preeclamptic pregnant women were included in this study. Venous blood was collected hourly, and urine samples were taken every 2 h over a period of 24 h. VCAM-1 levels were determined by ELISA. We compared these results with the circadian blood pressure rhythm. RESULTS: The median VCAM-1 plasma levels were significantly (P < 0.01) increased in preeclamptic patients (851.5 ng/mL) in comparison to normotensive pregnant women (659.3 ng/mL) without any circadian rhythm being apparent; however, the urinary excretion of VCAM-1 showed a typical circadian rhythm, with a higher excretion rate during daytime. CONCLUSION: For the first time we have demonstrated that urinary VCAM-1 excretion in pregnancy shows a circadian rhythm without correlation to plasma levels or the circadian blood pressure rhythm. In contrast, VCAM-1 serum levels did not show a diurnal rhythm. We assume that VCAM-1 serum levels do not correlate with systemic blood pressure or urinary excretion.     

Automated blood pressure measurement as a predictor of proteinuric pre-eclampsia

Objectives To investigate the relation between antenatal clinic, obstetric day unit and 24-hour ambulatory blood pressure measurements and 24-hour proteinuria levels in hypertensive pregnancies.
Design An observational study.
Participants Forty-eight women presenting with new hypertension after 20 weeks of gestation.
Results The closest relation was found between ambulatory blood pressure measurements and 24-hour proteinuria levels. No significant relation was found between the conventional diastolic blood pressure threshold of 90 mmHg and 24-hour proteinuria levels.
Conclusions Ambulatory blood pressure measurement gives better information about disease status in pre-eclampsia as assessed by proteinuria than does conventional sphygmomanometry.     

Remote prognosis of primiparous women with preeclampsia

OBJECTIVE: To describe the maternal characteristics of pregnancy and perinatal outcome of primiparous women with preeclampsia, to determine the recurrence rate and to define the maternal risk factors for preeclampsia in subsequent pregnancies. METHODS: A retrospective cohort study. Two groups of patients were defined: the study group consisted of 380 primiparous women with preeclampsia, and in a control group of 385 primiparous women without preeclampsia. The patients were followed during their consecutive deliveries. Multiple logistic regression analysis was used to determine the independent risk factors for the recurrence of preeclampsia in the second pregnancy. RESULTS: In the study and the control group there were a total of 1207 and 1293 deliveries, respectively. Of the 380 primiparous women in study group, 305 (80%) were identified as suffering from mild preeclampsia, 64 (17%) from severe preeclampsia, 10 (2.6%) from super imposed preeclampsia and only one (0.3%) had eclampsia. Primiparous with severe preeclampsia had a significantly higher rate of preterm delivery then those with mild preeclampsia (34 versus 11% respectively, P<0.0001). In addition, the study group had significantly higher rate of perinatal mortality (3.4 versus 0.3%, P=0.013) and perinatal complications. The recurrence rate of preeclampsia was significantly higher in the study group (25% versus 1.9%, P<0.0001). When adjusted for confounding variables, gestational diabetes was strongly associated with the recurrence of preeclampsia in the second pregnancy (OR 3.72 95% CI 1.45-9.53). CONCLUSION: Primiparous women with preeclampsia are at an increased risk for recurrence in subsequent pregnancies. Gestational diabetes in primiparous women with preeclampsia is an independent risk factor for developing preeclampsia in the second pregnancy.     

Incidence of gestational hypertension in gestational diabetes mellitus

The purpose of this study has been to establish the incidence of gestational hypertension (GH) in women with gestational diabetes mellitus (GDM) and to examine the frequency of complications in women with co-existent GDM and GH. Furthermore, we wished to evaluate the significance of urine albumin excretion determined by the urine albumin creatinine ratio (ACR). A total of 215 successive pregnancies with risk factors for gestational diabetes, as defined by the Danish National Board of Health screened for gestational diabetes by the WHO criteria, were reviewed. Women who had a normal OGTT during the screening served as controls. Gestational hypertension was defined as a mean arterial pressure (MAP) >105 mmHg (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg). The two groups were comparable with regard to initial body mass index (BMI) and MAP. GH appeared with a higher frequency in women with GDM (28%) than in women with normal OGTT (10%) P=0.003 χ² test. Serious complications (perinatal mortality, malformations, acute caesarean section) also appeared with a higher frequency in women with GH and GDM (10%) than in women with GH but with normal OGTT (2%) P=0.0083 χ² test. We observed a significant increase in ACR in the group with complications (GDM and GH) during gestation regardless of intensive antihypertensive treatment. We also observed that ACR was significantly higher in women with GDM and GH when compared to women with GDM and a normal blood pressure. The BMI was consistently higher in women with GH, regardless of whether they had GDM or not as compared to the normotensive group. GH appears with a higher frequency in women with GDM and the co-existence seems correlated with a higher frequency of complications. The correlation between urine albumin excretion and complications might suggest that regulating GH should strive to normalise ACR in women with GDM. Received: 25 October 2001 / Accepted: 8 December 2001 Correspondence to J. Kvetny     

Urine albumin/creatinine ratio for the assessment of albuminuria in pregnancy hypertension

BACKGROUND: An accurate method to assess albuminuria in pregnancy is mandatory to diagnose pre-eclampsia. Twenty-four-hour urine collection is still the only universally accepted method. This is, however, a cumbersome and inconvenient method. Therefore, the present study aimed at assessing the accuracy of a spot urine albumin/creatinine ratio in pregnant women with hypertension. MATERIAL AND METHODS: In 54 pregnant women with blood pressure >or=140/90 mmHg, 24-h albumin excretion and subsequent albumin/creatinine ratio on morning spot urine were analyzed in the individual patients. Altogether 75 paired samples were included. Receiver operating characteristic curves, relating different albumin/creatinine ratio cut-off values to 24-h albumin excretion >300 mg were constructed. Correlations were assessed by Spearman rank correlation tests. RESULTS: The area under the receiver operating characteristic curve was 0.985. At the optimal cut-off albumin/creatinine ratio value of 27 mg/mmol the sensitivity, specificity, positive and negative predictive value for detecting albuminuria >300 mg/24 h were: 95, 100, 100 and 86% respectively. There was a close correlation between albumin/creatinine ratio and 24-h albumin excretion values (r=0.95; p<0.001). CONCLUSIONS: It is suggested that in most cases the more cumbersome 24-h urine collection can be replaced by the more convenient albumin/creatinine ratio on spot urine.     

1型糖尿病患儿血浆内皮素和血管性假血友病因子的检测及其与尿白蛋白的关系

目的观察1型糖尿病患儿血管内皮损害标志物—内皮素(ET)和血管性假血友病因子(von Willebrand因子，vWF)的变化,分析其与尿白蛋白排泄率(UAER)的关系，从而筛查出更敏感的早期诊断糖尿病肾病(DN)的指标。 方法收集1998 06—2005 06在山东省立医院就诊的4~18岁1型糖尿病患儿40例，根据UAER分为正常白蛋白尿组(A组)25例和微量白蛋白尿组(B组)15例，同时以年龄、性别、身高1∶1匹配的健康儿童作为对照组，分别检测其血糖(FBG)、糖化血红蛋白(HbA1c)、血浆ET和vWF的变化,并分析其相关性。 结果与正常对照组比较，1型糖尿病患者血浆ET 1和vWF、HbA1c明显增高,尤其是微量白蛋白尿组升高更明显(均P<0.01),血浆ET 1和vWF与UAER、HbA1c均呈正相关。 结论1型糖尿病患儿在出现白蛋白尿前已存在血管内皮功能异常,其白蛋白排泄与血管内皮功能障碍程度有一定相关性。血浆ET 1、vWF检测可作为早期筛查糖尿病肾病的可靠指标。     

The correlation between renal function and systolic or diastolic blood pressure in severe preeclamptic women.

OBJECTIVE: To evaluate the correlation between renal function and systolic or diastolic blood pressure in preeclamptic mothers. METHODS: In this prospective study from August 1998 to September 2002, 28 women >or= 28 weeks gestation with severe preeclampsia were selected. Meanwhile, 56 normotensive pregnant women without proteinuria or edema served as the control group. Urine was collected for 24 hours for all subjects. The concentration of uric acid, blood urea nitrogen, creatinine, sodium, calcium, and albumin in the 24-hour urine and blood of both groups were examined. Neonatal outcome also was evaluated. RESULTS:The serum and 24-hour urine concentration of blood urea nitrogen, creatinine, and albumin were significantly higher in severe preeclamptic women. Serum uric acid and urinary albumin/creatinine ratio was significantly higher in severe preeclamptic women compared with that in normotensive mothers and showed positive correlation with systolic or diastolic blood pressure. On the other hand, serum calcium/creatinine ratio was significantly lower in the severe preeclamptic group and negatively correlated to blood pressure. In multiple regressions, systolic or diastolic blood pressure was dependent on serum uric acid, albumin/creatinine, and calcium/creatinine ratios. Fetal birth weight was significantly lower in women with severe preeclampsia and with a lower Apgar score < 7 at 1 minute and 5 minutes and more preterm delivery compared with that in normotensive women. CONCLUSION: Renal function in women with severe preeclampsia was significantly impaired and highly correlated with systolic or diastolic blood pressure.     

Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia

Aim: To assess whether a single urinary spot urinary albumin:creatinine ratio (ACR) can be used to estimate 24-hour urinary protein excretion in women with preeclampsia. Methods: ACR and 24-hour urinary protein excretion were measured in 50 consecutive patients with preeclampsia. ACR was determined in a spot midstream urine sample and the amount of protein excretion was quantified in a 24-hour urine collection performed the following day. The correlation between the spot ACR and 24-hour urine protein excretion was assessed, and the diagnostic value of ACR was expressed in terms of specificity and sensitivity. Receiver operating characteristic curve analysis was used to determine the best cutoff values of the spot ACR for mild preeclampsia (proteinuria ≥ 0.3 g/24 h) and severe preeclampsia (defined in China as proteinuria ≥ 2 g/24 h). Results: A strong correlation was evident between the spot ACR and 24-hour urinary protein excretion (r = .938; P < .001). The optimal spot ACR cutoff point was 22.8 mg/mmol for 0.3 g/24 h of protein excretion (mild preeclampsia) with a sensitivity and specificity of 82.4% and 99.4%, respectively, and 155.6 mg/mmol for 2 g/24 h of protein excretion (severe preeclampsia) with a sensitivity and specificity of 90.6% and 99.6%, respectively. Conclusions: Compared with 24-hour urinary protein excretion, the spot urinary ACR may be a simple, convenient, and accurate indicator of significant proteinuria in women with preeclampsia.     

The Correlation Between Renal Function and Systolic or Diastolic Blood Pressure in Severe Preeclamptic Women

Objective. To evaluate the correlation between renal function and systolic or diastolic blood pressure in preeclamptic mothers. Methods. In this prospective study from August 1998 to September 2002, 28 women ≥ 28 weeks gestation with severe preeclampsia were selected. Meanwhile, 56 normotensive pregnant women without proteinuria or edema served as the control group. Urine was collected for 24 hours for all subjects. The concentration of uric acid, blood urea nitrogen, creatinine, sodium, calcium, and albumin in the 24-hour urine and blood of both groups were examined. Neonatal outcome also was evaluated. Results. The serum and 24-hour urine concentration of blood urea nitrogen, creatinine, and albumin were significantly higher in severe preeclamptic women. Serum uric acid and urinary albumin/creatinine ratio was significantly higher in severe preeclamptic women compared with that in normotensive mothers and showed positive correlation with systolic or diastolic blood pressure. On the other hand, serum calcium/creatinine ratio was significantly lower in the severe preeclamptic group and negatively correlated to blood pressure. In multiple regressions, systolic or diastolic blood pressure was dependent on serum uric acid, albumin/creatinine, and calcium/creatinine ratios. Fetal birth weight was significantly lower in women with severe preeclampsia and with a lower Apgar score < 7 at 1 minute and 5 minutes and more preterm delivery compared with that in normotensive women. Conclusion. Renal function in women with severe preeclampsia was significantly impaired and highly correlated with systolic or diastolic blood pressure.     

Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes

Aim: To evaluate whether initiation of anti-hypertensive treatment with methyldopa affects fetal hemodynamics in women with pregestational diabetes.

Methods: Prospective study of unselected singleton pregnant women with diabetes (seven type 1 and two type 2 diabetes), normal blood pressure and kidney function at pregnancy booking. Methyldopa treatment was initiated at blood pressure >135/85?mmHg and/or urinary albumin excretion (UAE) >300?mg/g creatinine. Pulsatility indices (PI) of the uterine, umbilical, middle cerebral arteries before and 1 week after initiation of methyldopa treatment (250?mg three times daily) was performed and the cerebro-placental ratio (CPR) was calculated.

Results: Methyldopa treatment was initiated at median 249 (range 192–260) gestational days, mainly due to gestational hypertension (n?=?7). Blood pressure declined from 142 (112–156)/92 (76–103) mmHg before to 129 (108–144)/82 (75–90) mmHg after initiation of methyldopa treatment (p?=?0.11 and 0.04 for systolic and diastolic blood pressure, respectively). There were no significant changes in the umbilical artery PI (0.82 (0.72–1.40) versus 0.87 (0.64–0.95), p?=?0.62) or CPR (1.94 (0.96–2.33) versus 1.78 (1.44–2.76), (p?=?0.73). Gestational age was 265 (240–270) d. Apgar scores were normal.

Conclusions: Stable Doppler flow velocity waveforms were documented after initiation of methyldopa treatment for pregnancy-induced hypertensive disorders in this cohort of pregnant women with pregestational diabetes.     

Glycemic control and spontaneous abortion in insulin-dependent diabetic women

Insulin-dependent diabetic women without adequate glucose control have a higher spontaneous abortion rate when compared with the general population. The present study examined whether the increased rate of spontaneous abortions in insulin-dependent diabetic women was associated with poor glycemic control in the early postconceptional period or close to the abortive event itself. Measurements of glycohemoglobin A1 at eight to nine weeks' gestation provide retrospective indexes of glucose control during the early postconceptional period, whereas measurement of glycosylated serum albumin and serum protein at the same time reflects short-term glycemic control before the abortive event. This study evaluated 84 consecutive pregnancies occurring in 68 insulin-dependent diabetic women; 66 pregnancies progressed beyond 20 weeks with no malformation or death, and 18 pregnancies terminated in spontaneous abortions before 20 weeks' gestation. The mean glycohemoglobin A1 concentrations of women experiencing spontaneous abortions were significantly greater than that of women who did not abort (P less than .05). In contrast, maternal glycosylated proteins and glycosylated albumin concentrations did not differ between groups. The authors suggest that poor control of diabetes in the early conceptional period, rather than that just before abortion, increases the risk of spontaneous abortion.