Does early growth delay occur in diabetic pregnancy?

Abstract

Objective To identify the date of ovulation in pregnant women with Type 1 diabetes in order to assess the validity of the concept of early growth delay. Design Identification of ovulation by measurement of urinary luteinising hormone and assessment of fetal growth using ultrasound scan. Setting Diabetic pre‐pregnancy and antenatal clinic in a teaching hospital. Subjects Twenty women with Type 1 diabetes who had attended a pre‐pregnancy clinic. Measures Urinary LH, by laboratory and kit methods, during conception cycles. Human chorionic gonadotrophin measured in early pregnancy. Early ultrasound scans by a single observer blind to menstrual and ovulation dates. Outcome Gestation calculated from ovulation date and gestation estimated from menstrual dates, compared with gestation at age indicated by early ultrasound scan. Results When the date of ovulation was identified in 20 women with Type 1 diabetes there was no evidence of growth delay in any pregnancy. When gestation was estimated from menstrual dates there was apparent early growth delay in six pregnancies. Conclusion This study, together with others discussed, indicates that early growth delay is probably an artefact of incorrectly estimated ovulation date.

Discrepancy in term calculation from second trimester ultrasound scan versus last menstrual period in women with type 1 diabetes

“…These findings were based on examinations of crown–rump length 7–14 weeks after the LMP, compared with the expected length calculated from the LMP. Other small studies found no such growth delay, or explained an apparent delay with menstrual or ovulatory disturbances . Focus in these studies was partly on a possible prediction of excess malformation risk in fetuses with growth delay in early pregnancy.…”

The Effect of Maternal Glycemic Control on Fetal Growth in Diabetic Pregnancies

“…They also found that the fetal growth (BPD) was within the normal range at around 20 weeks and there was evidence of accelerated growth of the BPD during the second trimester. However, recently Steel et al 18 suggested that early growth delay is probably an artifact of incorrectly estimated ovulation date. We found that fetuses in the less well-controlled group have comparable BPD values at 13-14 weeks to the well-controlled group.…”

Serum levels of insulin‐like growth factor41 in first trimester of diabetic pregnancy: relation to early growth delay

“…In the first trimester of pregnancy in diabetic women we found that some fetuses were smaller by sonography than expected from the mothers' menstrual histories (Pedersen & Merlsted‐Pedersen 1981). Some groups have been unable to reproduce our finding, for which we use the term early growth delay, and suggest that it might be an artefact resulting from inaccurate estimation of ovulation (Steel et al 1995).…”