In diabetic pregnancies with vasculopathy, which pattern of fetal growth is most commonly observed?

• A. Asymmetric IUGR
• B. Symmetric IUGR
• C. Macrosomia
• D. Normal growth

Answer: (A)

Placental vasculopathy in diabetes reduces uteroplacental perfusion, especially later in pregnancy, so the fetus experiences nutrient limitation and prioritizes brain growth. This brain-sparing response produces asymmetric IUGR, with a relatively small abdominal circumference while head size remains relatively preserved. Macrosomia would be more typical if glycemic control were the main driver without placental insufficiency, whereas symmetric IUGR suggests an earlier, non–placental insult. Normal growth is unlikely when placental vasculopathy is present.