Glycemic control in gestational diabetes mellitus-How tight is tight enough: Small for gestational age versus large for gestational age?

Diabetes mellitus in pregnancy

“…30 In contrast, some fetuses may be at risk of growth restriction due to excessively tight maternal glucose control . 31 A correlation has been reported between ultrasound (USS) fetal abdominal circumference (AC) (AC>75th percentile) and high amniotic fluid insulin levels in a recent study 30 . There have been four randomized controlled studies looking at the use of USS fetal AC as a guide to adjust the blood sugar levels.…”

Early onset fetal growth restriction

“…The second and much more common group includes medical conditions that can affect placental function: pre-eclampsia, chronic hypertension and gestational hypertension are complicated by FGR in 30 to 40% of cases [23]; diabetes is complicated by FGR in 10 to 20% of cases irrespective of glycemic control [25]; maternal vascular disease, renal disease, thrombophilia, autoimmune disease, can lead to uteroplacental hypoperfusion thereby impairing fetal growth [26]; hypoxemia secondary to cardiac, respiratory and hematological disorders may also cause FGR.…”

Gestational Diabetes Mellitus: a review of the diagnosis, clinical implications and management

“…Macrosomia is generally defined as birth-weight in excess of 4,000-4,500 g [6]. Mean blood glucose level (BGL) strongly correlated with neonatal birth-weight in women with GDM, and the degree of macrosomia was also found to be associated with fetal plasma insulin immune-reactivity and blood pH [8,9]. Fetal pancreatic beta-cell hyperplasia is implicated in the pathogenesis of fetal acidemia and macrosomia [9].…”