GROWTH AND MOTOR DEVELOPMENT IN FETUSES OF WOMEN WITH TYPE-1 DIABETES .1. EARLY GROWTH-PATTERNS

Early embryonic and fetal growth were followed longitudinally in 23 women with type-1 diabetes to investigate whether there was any evidence of early growth delay and, if so, when it originated and when catch-up growth occurred. Weekly crown-rump length (CRL) measurements were taken between 7 and 14 weeks of gestation; the biparietal diameter (BPD) of the fetal head was measured once every 2-4 weeks from 13 to 30 weeks of gestation. Data were compared to those of a control group and to control data published in the literature. The CRL of the fetuses in the diabetic group was generally shorter than that observed normally. Six out of the 23 (26%) fetuses showed true early growth delay (a size smaller than normal by 6 days or more). Growth delay was present from the first recording onwards and must therefore have occurred before the seventh gestational week. Fetal growth (BPD) was found to be normal at around 20 weeks and there was evidence of accelerated growth of the BPD during the second trimester in fetuses that became macrosomic. Early embryonic growth delay was most profound in the women whose periconceptional quality of glucose control was poor, although the relationship with the HbA1c values was not statistically significant. It is concluded that fetuses of women with type-1 diabetes, as a group, have a significantly different growth pattern than control fetuses throughout the first 30 weeks of pregnancy.