The management of the macrosomic fetus and the assessment of wellbeing in gestational diabetes mellitus

Abstract

IntroductionDiabetes mellitus(DM) in pregnancy is associated with an increased risk of fetal, neonatal, and offspring complications, as well as with long term complications in adulthood. DM may be pregestational (ie, type 1 or 2 diabetes diagnosed before pregnancy with a prevalence 1.8%) or gestational (ie, diabetes diagnosed during pregnancy with a prevalence 7.5%). The outcome mainly is related to the onset and duration of glucose intolerance during pregnancy and the severity of DM. The burden in public health of maternal DM has dramatically increased worldwide. Not only its prevalence rate at present, but the increase of its incidence in the near future will rise a global health problem. Diabetic population will increase from 415 million today to 642 million by the year 2040. In 2015, 199.5 million women counted with DM and 60 million of them were in reproductive age (18-44 years old). 1 It is estimated that the percentage of gestational diabetes mellitus (GDM) globally is about 5-20% depending on racial and socioeconomic factors. The majority of women remains undiagnosed until usual screening pregnancy tests. According to 7th Diabetes Atlas, hyperglycaemia in pregnancy is classified into three main types: diabetes detected prior to pregnancy or preexisting diabetes (type 1 and type 2), diabetes first detected in pregnancy and GDM which is defined as any degree of glucose intolerance with onset or first recognized during pregnancy.The 15-45% of diabetic mother babies present macrosomia, which is a 3-fold higher risk compared to normoglycemic ones. Macrosomia is defined as a birth weight above the 90th percentile for gestational age or alternatively over 4,000 g.Other maternal factors that cause fetal macrosomia ,except maternal hyperglycemia, are maternal