Spontaneous abortions and major malformations in women with diabetes mellitus

Women with insulin dependent diabetes mellitus are at increased risk for bo th first trimester spontaneous abortions and major congenital malformations when they become pregnant. The magnitudes of both of these risks depend up on the degree of metabolic control of their diabetes in the first trimester . The risks differ in the degree of control necessary to minimize them and the degree to which they can ultimately be reduced. A stricter degree of me tabolic control is necessary to avoid spontaneous abortions than major malf ormations. Although the risks for both complications can be reduced by impr oved metabolic control, the risk for major malformations remains elevated, when compared to the risk for non-diabetic women, despite good to excellent control. In contrast, good to excellent control does reduce the risk for s pontaneous abortions to a rate comparable to that seen in non-diabetic wome n. Women with insulin dependent diabetes mellitus who are planning pregnanc ies should be encouraged to achieve the best possible degree of metabolic c ontrol prior to and throughout pregnancy. They should be re-assured, howeve r, that perfect control is not necessary to avoid dramatically increased ri sks for spontaneous abortions and major malformations.