Vol 92, No 2 (2021)
Research paper
Published online: 2021-02-26

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Fetal growth trajectory in type 1 pregestational diabetes (PGDM) — an ultrasound study

Lukasz Adamczak1, Daniel Boron1, Pawel Gutaj1, Grzegorz H. Breborowicz2, Jerzy Moczko3, Ewa Wender-Ozegowska1
Ginekol Pol 2021;92(2):110-117.


Objectives: Growth disorders are frequent in diabetic pregnancies. However, they are difficult to predict and capture early
during pregnancy. These newborns are at risk of obesity, diabetes, and cardiovascular disease. While developing, fetal
growth abnormalities are typically progressive. Therefore, capturing the earliest moment when they emerge is essential
to guide subsequent obstetric management.
Material and methods: We aimed to analyze fetal ultrasound growth trajectories in type 1 diabetics. Moreover, we aimed
to establish time points when first ultrasound manifestations of fetal growth abnormalities appear and to identify factors
that affect fetal growth in women with diabetes.
We collected clinical and ultrasound data from 200 patients with PGDM managed in the third-referential centre for diabetes
in pregnancy. During every visit, patients underwent an ultrasound examination according to a standard protocol giving
1072 ultrasound scan’s records. Every ultrasound consisted of fetal weight estimation, according to the Hadlock 3 formula.
Retrospectively patients were divided into three groups depending on neonatal weight. In the group of 200 patients,
60 (30%) delivered LGA and 9 (4.5%) SGA newborns.
Results: Fetal growth trajectories show different patterns among fetuses with growth abnormalities in women with
type 1 diabetes. The moment, when fetal growth curves diverge, seems to take place in the second trimester, just after
the 23rd week of gestation.
Conclusions: It suggests that fetal growth abnormalities in type 1 diabetes may have its roots much earlier than expected.
In the first trimester, there were differences in LDL-cholesterol, total cholesterol, triglyceride levels and in insulin requirements
between AGA, SGA and LGA subgroups.

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