The primary goal of metabolic therapy for women with GDM during pregnancy is directed at the prevention of fetal morbidity, especially morbidity related to excessive fetal growth. It has been shown that measurement of the fetal abdominal circumference (AC) between 29-33 wks gestation identifies infants at high risk for macrosomia at birth and that maternal insulin therapy during the last 6-8 wks of pregnancy markedly reduces the rate of large for gestational age infants in those pregnancies (Diabetes Care, 1994;17:275-80). We did anthropometric measurements within 12 h of birth in 20 infants born to GDM with fasting hyperglycemia (≥105 <130 mg/dl) treated with diet + insulin as standard treatment (control) and 18 infants born to gestational diabetic mothers treated with diet with home monitoring, and insulin added if fetal AC was ≥70 the percentile for gestational age at 29-33 wks or FSG>120(study). Four mothers remained on diet as fetal AC was <70 the percentile. All patients were under good control. GA at delivery, birthweight, crown heel length (L), head circumference (HC) and measurement of triceps (TRC), biceps(BCP), iliac crest (ILC) and subscapular (SBS) skin fold thickness were similar in two groups. Table

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We conclude that incorporating the ultrasound assessment of fetal growth to guide the use of insulin therapy in mothers with moderate GDM reduces excessive fetal growth and adiposity. Excessive fetal growth does not occur if fetal AC remains <70 in GDM mothers with controlled diet.