Early Sonographic Evaluation for Fetal Growth Delay and Congenital Malformations in Pregnancies Complicated by Insulin-Requiring Diabetes

  1. National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study
  1. The University of Washington Seattle, Washington; the Epidemiology Branch, National Insutitute of Child Health and Human Development Bethesda, Maryland; Northwestern University, Evansity Illinois; University of Pittsburgh Pittsburgh, Pennsylvania; Cornell University Ithaca, New York; and Harvard University Boston, Massachustts
  1. Address correspondence and reprint requests to Zane A. Brown, MD, RH-20, University of Wasington, Seattle, WA 98195.

Abstract

Objective It has been reported that early fetal growth retardation may be a useful marker for congenital malformations in diabetic pregnancies. To test this hypothesis, diabetic and nondiabetic women were sonographically evaluated during the first trimester.

Research Desihn and Methods Fetal crown-rump lengths were measured sonographically at least once during the first 15 wk of pregnancy in 329 nondiabetic and 312 diabetic women. Of these, 289 nondiabetic and 269 diabetic women had sonograms before 10 wk of gestation and 283 nondiabetic and 269 diabetic women had sonograms between 10 and 15 wk of gestation. Early fetal growth delay was defined as a sonographic gestational age of ≥6 days less than menstrual gestational age.

Results The mean crown-rump lengths at 8 wk were 17.9 ± 4.6 mm in the diabetic and 18.7 ± 4.9 mm in the nondiabetic groups (P = 0.13). At 12 wk, the mean fetal crown-rump length was 58.5 ± 8.8 mm for diabetic subjects and 60.6 ± 8.7 mm for nondiabetic subjects (P = 0.04). Between 5 and 9 wk, 28 of 289 (9.7%) fetuses of nondiabetic subjects, 34 of 259 (13.1%) normal fetuses of diabetic subjects, and 2 of 10 (20%) malformed fetuses of diabetic subjects demonstrated growth delay (P = 0.31, normal vs. malformed diabetic). Between 10 and 15 wk of gestation, 28 of 283 (9.9%) fetuses of nondiabetic subjects, 32 of 256 (12.5%) normal fetuses of diabetic subjects, and 4 of 13 (30.8%) malformed fetuses of diabetic subjects demonstrated growth delay (P = 0.06, normal vs. malformed diabetic). Early fetal growth delay did not predict a reduced birth weight at term.

Conclusions Among insulin-dependent diabetic subjects who were moderately well controlled at conception, statistically significant but mild early fetal growth delay was present but did not appear to be useful clinically in predicting congenital malformations. Recommendations that growth delay demonstrated on early ultrasound be used as a predictor of congenital malformation require careful reexamination.

  • Received July 19, 1990.
  • Revision received August 28, 1991.
  • Accepted August 28, 1991.
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