A 32-year-old multiparous woman with GDM diagnosed at 26 weeks is counselled on maternal and fetal complications. Regarding the complications and long-term sequelae of GDM, all of the following are associated with GDM EXCEPT:

Explanation

## Maternal and Fetal Complications of GDM ### Correct Answer: Intrauterine Growth Restriction (IUGR) **Key Point:** IUGR is NOT a typical complication of GDM. In fact, GDM is associated with **fetal macrosomia** (excessive fetal growth), not growth restriction. IUGR is seen in pre-eclampsia, placental insufficiency, and maternal vascular disease — not hyperglycaemia. ### Why Other Options Are True Complications | Complication | Mechanism | Clinical Significance | |--------------|-----------|----------------------| | **Neonatal hypocalcaemia & hypomagnesaemia** | Maternal hyperglycaemia → fetal hyperinsulinaemia → suppression of parathyroid hormone (PTH) and magnesium reabsorption | Presents as jitteriness, seizures, tetany in first 24–72 hours of life | | **Maternal type 2 DM** | GDM indicates underlying insulin resistance; 50–60% develop type 2 DM within 5–10 years | Requires postpartum glucose tolerance testing and lifestyle counselling | | **Neonatal RDS** | Fetal hyperinsulinaemia inhibits surfactant synthesis and delays lung maturity; also associated with preterm delivery | Risk increases with poor glycaemic control; antenatal corticosteroids recommended if preterm delivery anticipated | ### Fetal Complications of GDM **High-Yield Mnemonic — "FETAL MACROSOMIA" complications:** - **F**etal macrosomia (birth weight >4000–4500 g) - **E**xcessive amniotic fluid (polyhydramnios) - **T**ransposition of great arteries (cardiac anomalies, increased 2–3×) - **A**cute complications: shoulder dystocia, brachial plexus injury, birth trauma - **L**ate complications: neonatal hypoglycaemia, hypocalcaemia, hypomagnesaemia, RDS - **M**aternal: pre-eclampsia, polyhydramnios, preterm labour - **A**nemia (polycythaemia in neonate) - **C**ardiomyopathy (transient hypertrophic cardiomyopathy) - **R**espiratory distress (delayed lung maturity) - **O**besity and metabolic syndrome in childhood - **S**udden intrauterine fetal death (rare, with very poor control) - **O**besity and type 2 DM in offspring (long-term) - **M**acrosomia-related injuries (shoulder dystocia, clavicular fracture) - **I**ntrauterine infections (no direct link) - **A**nomalies (cardiac, renal, skeletal — 2–3× increased risk) **Clinical Pearl:** The hallmark of GDM is fetal **macrosomia with hyperinsulinaemia**, not growth restriction. Poorly controlled GDM leads to large-for-gestational-age (LGA) infants at risk of birth trauma and metabolic derangements. **Warning:** Do not confuse GDM (hyperglycaemia → macrosomia) with pre-eclampsia or placental insufficiency (which cause IUGR). This is a classic exam trap.