Elevated Maternal Hemoglobin A1Cin Early Pregnancy and Major Congenital Anomalies in Infants of Diabetic Mothers

Abstract

PERINATAL mortality has decreased in pregnancies complicated by diabetes mellitus.¹ As losses from stillbirths, intrapartum asphyxia, and hyaline-membrane disease diminish, major congenital anomalies emerge as the most important causes of mortality in infants of diabetic mothers.^{1 , 2} The overall incidence of major anomalies was 6 to 9 per cent in several large studies of such infants^{1 2 3} — three to four times that found in a general neonatal population.⁴ Fetal malformations occur before eight weeks of gestation (postmenstrual dates), when most diabetic pregnant women have not yet come to medical attention.⁵ Until recently, there has been no objective method to assess control . . .