Response to García-Patterson et al.

We read with interest the letter by García-Patterson et al. (1) that appears in this issue of Diabetes Care. We thank them for their correction and close reading of our article (2). We also thank them for highlighting their findings that small-for-gestational-age (SGA) infants born to women with gestational diabetes had increased neonatal morbidity compared with those with appropriate and large-for-gestational-age growth. We do agree that intensive glycemic control has been shown by their study (3) and several others to normalize the birth weight pattern of infants born to women with gestational diabetes. Langer et al. (4) have shown that the proportion of SGA growth increases as the mean glucose levels were decreased by intensive insulin therapy. Thus, in our collective efforts to “normalize” birth weights of these infants through strict euglycemia, we suggest that whereas this strategy may benefit those infants who are at risk for excessive fetal growth, it may adversely effect those infants who are at risk for SGA growth. We believe that ultrasound assessment of fetal growth should be used in conjunction with maternal glycemia to identify which pregnancies would benefit from intensive therapy.