In diabetic women with vasculopathy, which fetal condition occurs most frequently?

• A. Symmetric IUGR
• B. Asymmetric IUGR
• C. Macrosomia
• D. Fetal demise

Answer: (B)

When placental blood flow is compromised by maternal vascular disease in diabetes, the fetus often experiences reduced nutrient and oxygen delivery later in gestation. This uteroplacental insufficiency tends to slow body growth more than head growth, producing a brain-sparing pattern where the abdomen is preferentially small while the head remains relatively preserved. That pattern is known as asymmetric IUGR, and it is the most common fetal finding in diabetic pregnancies with vasculopathy. Macrosomia occurs when placental function is relatively adequate and maternal hyperglycemia drives fetal overgrowth, which is less likely in the setting of significant vasculopathy. Symmetric IUGR points to an early, global insult (earlier in pregnancy) rather than late-onset placental insufficiency, and fetal demise, while possible, is not the most frequent outcome here.