title: Adequate timing of fetal ultrasound to guide metabolic therapy in mild gestational diabetes mellitus. Results from a randomized study.
abstract: BACKGROUND
  Ultrasound assessment of abdominal circumference early in the third trimester had been proposed to introduce insulin therapy in order to prevent fetal overgrowth in women with mild gestational diabetes mellitus. The purpose of this study was to investigate adequate weeks gestation timing for testing this parameter.
  
  
  METHODS
  One hundred and forty-one women were included in a randomized trial. Seventy-three women were evaluated at both 28 and 32 weeks gestation whereas 68 women were investigated only at 32 weeks gestation. In both groups, insulin therapy was promptly started when abdominal circumference exceeded the 75th percentile. Macrosomic rates were compared using the Fisher's exact test.
  
  
  RESULTS
  Twenty-nine women whose fetal abdominal circumference exceeded the 75th percentile were considered eligible for insulin therapy. In this group, we observed a statistically significant increase in the percentage of macrosomic infants born from women whose ultrasound abdominal circumference assessment was performed only at 32 weeks gestation when compared to women evaluated at both 28 and 32 weeks gestation (71.43% vs 33.33%, p<0.05).
  
  
  CONCLUSIONS
  Our results support the need for fetal ultrasound at 28 weeks gestation to direct metabolic therapy since insulin administration introduced after 32 weeks gestation has a poor effect on fetal growth.
authors.affiliation: The II Department of Obstetrics and Gynecology, Clinica L. Mangiagalli, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: E
authors.initials: E
authors.lastname: Somigliana
authors.forename: M
authors.initials: M
authors.lastname: Moschetta
authors.forename: B
authors.initials: B
authors.lastname: Bottani
authors.forename: M
authors.initials: M
authors.lastname: Barbieri
authors.forename: M
authors.initials: M
authors.lastname: Vignali
mesh_terms: D000005:Abdomen / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000188:drug therapy; D005314:Embryonic and Fetal Development; D005260:Female; D005320:Fetal Macrosomia / Q000000981:diagnostic imaging*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013997:Time Factors; D016216:Ultrasonography, Prenatal
chemical_list: D007328:Insulin