MATERNAL DIABETES AND IUGR

Link to Maternal Diabetes

GESTATIONAL DIABETES

IUGR, unrelated to fetal anomaly is exceedingly rare in gestational diabetics. The relationship is influenced by the type and duration of the diabetes.

Manning (1) suggests two mechanisms for this protective effect:

1. Circulating maternal levels, and therefore fetal levels, of glucose are higher. The fetus thus resides in an environment of ample substrate and tropic hormone resulting in axial growth and increased fat deposition. This suggests that some aspects of IUGR may be overcome by increasing fetal substrate.
2. The percentile curves used for the evaluation of the fetus of a diabetic mother do not take into account that growth of the diabetic fetus is accelerated. There are no charts available that reflect this phenomenon.

PRECONCEPTUAL DIABETES

Preconceptual diabetics have a markedly higher incidence of IUGR. This risk increases with both duration and severity of the maternal disease.
This risk is further increased in diabetics with vascular disease, nephropathy or the presence of superimposed preeclampsia.

REFERENCES

1. Manning FA. Fetal Medicine. Principles and Practice. Chapter 7. Intrauterine Growth Retardation. Appletin and Lange, Connecticut 1995:320.