Intensive glycemic control in diabetic pregnancy with intrauterine growth restriction is detrimental to fetus.
Hyperglycemia during early pregnancy can lead to congenital malformations and/or spontaneous abortion while in the last few days of pregnancy it causes neonatal metabolic complications. Macrosomia is the most common complication and is due to maternal hyperglycemia in second and third trimester of pregnancy. In view of all these, intensive glycemic control of the mother is recommended throughout pregnancy. Intrauterine growth restriction (IUGR) is a well known complication of pre-gestational diabetic patients due to vasculopathy and is also seen in gestational diabetes mellitus (GDM) due to overinsulinisation. Hitherto there are no separate recommendations for glycemic targets in pregnant diabetic patients with IUGR. In presence of IUGR due placental vascular insufficiency, intensive glycemic control may deprive fetus of nutrition. Secondly frequent hypoglycemias which are inevitable complication of insulin treatment may further worsen the IUGR. In presence of IUGR, macrosomia is a rare possibility, and in such situation intensive glycemic control throughout pregnancy may not be justifiable and may actually be detrimental. Neonatal metabolic complications can be avoided by strict glycemic control during last two weeks of pregnancy.
Parikh
Rakesh M
RM
Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400 012, India. drrakeshparikh@gmail.com
Joshi
Shashank R
SR
Menon
Padmavathy S
PS
Shah
Nalini S
NS
D005260:Female; D005317:Fetal Growth Retardation / Q000139:chemically induced*; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011254:Pregnancy in Diabetics / Q000188:drug therapy*