Abnormal growth patterns in diabetes in pregnancy: a longitudinal study.

In this longitudinal study we sought to investigate the presence of different abnormal fetal growth patterns in the pregnant diabetic. At least three serial ultrasound examinations were performed during the third trimester on 522 diabetic and 93 control subjects. Growth curves were established for femur length, abdominal circumference and head circumference. In addition, daily growth rate was calculated for fetal weight and all morphometric measurements. The study revealed: a) in the gestational diabetes group large-for-gestational age infants, two accelerated growth patterns (early mean blood glucose 107 +/- 16 and late mean blood glucose 116 +/- 18) were identified; b) there was a significantly larger abdominal circumference (expressed as an age-related percentile) in the early than in the late pattern (88 +/- 10 vs. 60 +/- 18, P less than 0.05); c) femur length, head circumference and growth rate were similar for large-for-gestational age and appropriate-for-gestational age fetuses; d) in the control macrosomic infants (n = 57), the percentile of femur length, head circumference and abdominal circumference within 4 days of delivery were 91 +/- 11, 89 +/- 10, 60 +/- 26, respectively; e) analysis for small-for-gestational age infants showed a similarity in the morphometric measurements and growth rate of insulin-dependent diabetes mellitus and hypertensive control subjects; and f) in contrast, a significantly larger abdominal circumference was found in the gestational diabetes small-for-gestational age infants than in the previous small-for-gestational age groups. Recognition of the specific dynamics and characteristics of these patterns will allow for early detection of the fetus at risk, which in turn will improve clinical decision-making.