Diabetes in Pregnancy Supp -- Sept 2016--New Final.qxd

Diabetes in pregnancy starts affecting the foetus even in the pre-conception period. The complications encountered in third trimester are foetal macrosomia and intrauterine foetal demise; birth of a macrosomic baby further leads to shoulder dystocia, birth trauma, brachial plexus injury. Additionally, pregnancies with overt/pregestational diabetes may be complicated with foetal growth restriction, congenital abnormalities diagnosed in third trimester and foetal hypertrophic obstructive cardiomyopathy. Even minor degrees of hyperglycaemia is associated with adverse pregnancy outcome. Optimizing maternal glycaemic control and foetal surveillance is crucial for optimizing the perinatal outcome and minimizing aforesaid complications. The management of macrosomia is controversial regarding timing and mode of delivery, but most authorities agree for primary caesarean if estimated foetal weight at the end of pregnancy is 4500 gram or more.