Diabetes, HBA1C & correlation with Foetal malformations

How important is to achieves near normal hba1c to avert or minimize  the prevalence of congenital malformations ( CEMACH study)  ?? The study revealed that  that there is increased risk of CM  in untreated diabetes and  degree if or severity of malformation are related to HBA1C level::-There is an increased risk of congenital abnormalities. In the of pre-existing diabetes the overall rate was 4% with a threefold increase in the rates of both neural tube defects and congenital heart disease time of conception and directly correlated with the Hba1c. Women with HbA1c <8% have a risk of approximately 5 % but in those with levels >10 % the risk is as high as 25%. The risk is eliminating if normal HbA1c levels are achieved. The recommendation is that the HbA1c should be <7% and <6.1% in the United Kingdom if safely achievable at the time of conception.

Any specific CM which is observed mainly in DM cases?? The specific congenital abnormality associated with diabetes is sacral agenesis, but this is very rare. Much more common are congenital heart defects skeletal abnormalities and neural tube defects.

The perinatal and neonatal mortality rates can be increased 5 to 10 fold in babies of mothers with diabetes and these too relate to HbA1c at conception and in early pregnancy. In the CEMACH study of diabetes in pregnancy in the United Kingdom the perinatal mortality rate for both type 1 and type 2 diabetes was about 3 %.