Diabetic embryopathy and growth retardation are approximately 2-3 times more common in infants of diabetic women than in offspring of non-diabetic pregnancy [1]. The mechanisms causing these developmental disturbances are unknown [2,3]. Experimental studies in vivo and in vitro have suggested that glucose and b -hydroxybutyrate cause growth retardation and malformations in rodent embryos [4][5][6]. In an earlier study we showed that serum from insulin-treated diabetic rats is teratogenic despite normalisation of glucose and b -hydroxybutyrate concentrations [7], in line with similar results by Buchanan et al. [8]. These studies support the notion of a multifactorial aetiology of embryonic dysmorphogenesis in diabetic pregnancy [9,10].In the present work we have extended these studies by assessing the components in excess of high glucose and high ketone bodies that may exert significant teratogenic activity in vitro. This was done by culturing day 9 rat embryos for 48 h in serum from normal rats and rats made diabetic either with 50 mg/kg streptozotocin (STZ) or with 75 mg/kg STZ (denoted 50 MD and 75 MD). The glucose concentration of the culture media was set at 30 mmol/l, Diabetologia (1997) 40: 7-14 Teratogenic effect of diabetic serum is prevented by supplementation of superoxide dismutase and N-acetylcysteine in rat embryo culture Summary Congenital malformations are more common in offspring of diabetic mothers than offspring of non-diabetic mothers. The precise cell biological mechanism leading to the increased incidence of congenital malformations in diabetic pregnancy is not known. In previous studies increased glucose and b -hydroxybutyrate concentrations were found to cause embryonic dysmorphogenesis. We have previously shown that rat embryos, cultured in serum from insulin-treated diabetic rats, develop malformations, despite normalisation of glucose and b -hydroxybutyrate concentration, thereby suggesting a multifactorial teratological nature of the diabetic environment. In the present study, therefore, we aimed to characterise the teratogenic activity of various components of diabetic serum and in addition to study the possible antiteratogenic effects of supplementation of superoxide dismutase and N-acetylcysteine in rat embryo culture. We found that diabetic serum has a teratogenic effect on embryo development, a capacity residing in the alteration of several serum components in addition to glucose. Improving the embryonic capability to scavenge oxygen radicals, either by increasing superoxide dismutase activity or by supplying a ratelimiting precursor (N-acetylcysteine) for the enhanced synthesis of reduced glutathione, blocks the embryonic dysmorphogenesis. [Diabetologia (1997) 40: 7-14] Keywords Diabetic pregnancy, embryo development, congenital malformation, glucose, b -hydroxybutyrate, branched chain amino acids, embryo culture, superoxide dismutase, N-acetylcysteine.Received: 16 July 1996 and in revised form: 30 September 1996Corresponding author: P. Wentzel, Department of Medical Cell ...