Abstract
This review discusses available literature on the diagnosis and management of intrauterine growth restriction (IUGR) in women with type 1 diabetes. IUGR is diagnosed when ultrasound-estimated fetal weight is below the 10th percentile for gestational age. IUGR diagnosis implies a pathologic process behind low fetal weight. IUGR in pregnancy complicated by type 1 diabetes is usually caused by placental dysfunction related to maternal vasculopathy. Prevention of IUGR should ideally start before pregnancy. Strict glycemic control and intensive treatment of nephropathy and hypertension are essential. Low-dose aspirin initiated before 16 gestational weeks can also reduce IUGR risk in women with vasculopathy. Umbilical and uterine artery Doppler studies can guide diagnosis and surveillance of fetuses with IUGR. Decisions regarding the timing of delivery should be based on assessment of umbilical artery Doppler. The risk of prematurity and impaired fetal lung maturation should always be considered, especially in fetuses younger than 32 weeks.
Highlights
Fetal growth is a result of complex interactions between the genetic growth potential of the fetus and the impact of the maternal intrauterine environment
Impairment of placental function in diabetic vasculopathy has been directly confirmed in a study by Salvesen et al It was conducted in a cohort of 41 women with type 1 diabetes undergoing cordocentesis up to 24 h before delivery
intrauterine growth restriction (IUGR) in pregnancy complicated by type 1 diabetes is usually the result of placental dysfunction related to maternal vasculopathy
Summary
Fetal growth is a result of complex interactions between the genetic growth potential of the fetus and the impact of the maternal intrauterine environment. The incidence of type 1 diabetes peaks in 10–14 year olds and is rising at an alarming rate worldwide, in younger age groups (0–4 years) [17] Many of these girls are reaching childbearing age as women with long-standing diabetes, frequently complicated by vasculopathy. It has been previously shown that almost a quarter of type 1 diabetic placentas harbored decidual vasculopathy [20] These pathological changes are associated with IUGR, in preeclamptic women [19, 21]. Distal villus maldevelopment is a term representing a group of histopathological findings including distal villous hypoplasia, distal villous immaturity, chorangiosis, and dysmorphic villi These changes are associated with the reduction of functional villus surface area and can be observed in a significant proportion of IUGR placentas [23, 24]. The authors of this study demonstrated significantly increased first trimester serum levels of VCAM-1 and intercellular adhesion molecule-1 (ICAM-1) in the preeclamptic group [28]
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