Fetal CPR at Term for Prediction of Adverse Neonatal Outcome in Pregnancies Complicated by GDM

pregnant females in the reproductive age, pregnant ≥37 weeks, who were diagnosed with gestational diabetes by routine screening at 24-28 weeks, and are on metformin or insulin treatment. Informed consent, to share in the study, will be taken from all participants after describing the aim of the study and the potential hazards. The patients enrolled in our study will be divided into two equal groups according to their treatment regimens: (Group A): 130 patients who are on insulin treatment (Group B): 130 patients who are on metformin \*All participants will be subjected to the following: A) Full history taking: Including personal, menstrual, obstetric, present, past \& family history. B) Complete Physical Examination (general \& local). C) Investigations: * Routine baseline investigations: 1. Complete blood picture, Rh typing, liver \& kidney functions. 2. HbA1C estimation. 3. Surveillance of maternal diabetes: daily fasting and 2- hour postprandial capillary glucose measurement. 4. Routine obstetric ultrasound will be done at term (at 37 weeks gestation): to confirm gestational age, assess fetal weight (EFW) and amniotic fluid index (AFI) and to exclude fetal anomalies. * Doppler ultrasonography assessment: Doppler study and Cerebroplacental ratio assessment will be done at 37 weeks gestation and repeated every two weeks.To reduce inter-operator variability, a single experienced sonographer will perform all sonograms. The mode of delivery and the gestational age at delivery will be noted Early neonatal assessment: 1. 1\&5 minutes APGAR score 2. Neonatal blood glucose 3. Neonatal cord blood PH 4. The need for NICU admission