Fetal and placental measurements as indicators of control in diabetic pregnacy

ABSTRACT

Abnormal fetal growth in diabetic pregnancy is associated with increased peri-natal morbidity and mortality. Infant's birth weight reflects the degree of diabetic control. i.e. poor control is associated with large for gestational age [LGA] fetus. The antenatal detection of LGA fetuses is a challenge to the obstetrician managing diabetic pregnancy. Ninety pregnant women were included in this study and classified according to the blood glucose level into 3 groups; 30 normal, 30 with controlled diabetes and 30 with uncontrolled diabetes. They had ultrasonographic measurements of the biparietal diameter [B.P.D.], chest circumference, femur length [FL.], abdominal circumference [A.C.], estimated fetal weight [E.F.W.] and placental thickness together with estimation of the glycosylated haemoglobin [G-HB or Hb-A[ic]] at 38 weeks' gestation. A high degree of correlation was found between the infant's birth weight and the blood glucose level [i.e. the degree of maternal glycemic control] 10% of patients with controlled diabetes [F.B.S.<100 mg/dl.] and 57% of patients with uncontrolled diabetes [F.B.S. > 130 mg/dl.] gave birth to macrosomic babies [>4000 gm]. Similar degree of correlation was also found between the infant. s birth weight and A.C. and E.F.W. measurements but not with B.P.D. and F.L. measurements. Abdominal circumference measurment by ultrasongraphy is the most reliable sonographic parameter for the detection of macrosomia in utero and predicting the degree of maternal glycemic control