A pregnant woman at 36 weeks has HbA1c 7.8% and is on insulin. Her fetal biometry shows EFW at the 90th percentile with normal amniotic fluid index. According to ACOG, at what gestation should delivery be planned in a woman with pregestational diabetes and LGA fetus, assuming no other complications?

• A 39 weeks 0 days ✓
• B 37 weeks 0 days
• C 38 weeks 0 days
• D 40 weeks 0 days

Explanation

For women with well-controlled pregestational diabetes (Type 1 or Type 2) on insulin without end-organ damage, ACOG recommends delivery at 39 weeks 0 days to balance the risks of stillbirth (increased in diabetic pregnancies beyond 39 weeks) with neonatal complications of prematurity. If macrosomia (EFW >4500 g in diabetics) is present, delivery at 38–39 weeks is recommended. Poorly controlled diabetes or vascular complications may warrant earlier delivery at 36–37 weeks.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.