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

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 infants1 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 . . .