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Reply to “Diabetes and the risk of miscarriage”

Nature Medicine volume 5, pages 126–127 (1999)Cite this article

Moley et al. reply—We thank Dr. Kalter for his interest in our paper. In his 1987 review, he concluded "it is most probable that there is no excess of spontaneous abortions in the diabetic pregnancy." Fortunately, in the intervening twelve years, several well–designed clinical studies investigating diabetes in pregnancy have refuted Kalter's conclusion. The most definitive evidence is the Diabetes in Early Pregnancy study5 conducted by the National Institute of Child Health and Human Development. In this prospective, multicenter, collaborative study—the largest of its kind so far—the authors definitively establish a direct correlation between spontaneous abortion in women with insulin–dependent diabetes mellitus and glycosylated hemoglobin levels, a marker for glucose control. Women with diabetes in poor metabolic control show an increase risk of pregnancy loss. Several other clinical studies, as well as animal studies, concur with these findings6,7.

We note that Kalter does not question our experimental results. In our article, we provided clear evidence to support a deleterious effect of maternal diabetes and elevated glucose levels per se on the preimplantation murine blastocyst. Our findings describe a biochemical effect and suggest a precise molecular mechanism to explain a cause–and–effect relationship between maternal diabetes and spontaneous abortion and fetal malformations. Contrary to Kalter's assertion, similar phenomena, arrived at by different mechanisms in the blastocyst model, have been shown to result in miscarriage and fetal malformations8.

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References

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Washington University School of Medicine, 499 S. Euclid Ave., St. Louis, 63110, MO

    Kelle Moley

  2. Department of Cell Biology and Physiology, Diabetes Research and Training Center, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, 63110, MO

    Mike Mueckler

Authors
  1. Kelle Moley
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Moley, K., Mueckler, M. Reply to “Diabetes and the risk of miscarriage”. Nat Med 5, 126–127 (1999). https://doi.org/10.1038/5475

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