Antepartum Fetal Surveillance and Timing of Delivery in the Pregnancy Complicated by Diabetes Mellitus

Abstract

Pregnancies complicated by diabetes mellitus are associated with an increased risk of fetal and neonatal risks compared with pregnancies in the healthy gravida. Data suggest that stillbirth and perinatal mortality may be increased as much as 5 times for patients with insulin-dependent diabetes than in the general population. Pregnancies complicated by preexisting diabetes should undergo twice weekly surveillance with nonstress test or biophysical profile or a combination of both. Doppler studies should be reserved for those patients with vascular disease, intrauterine growth restriction, or hypertensive disorders.

Fetal and umbilical Doppler ultrasound in high-risk pregnancies

“…When it comes to the provision of antenatal care or research, pregnant women tend to be divided into low- and high-risk populations; however, the boundaries between the groups are often blurred. For most researchers, ‘high-risk status’ includes maternal conditions associated with increased perinatal mortality and morbidity such as diabetes, hypertensive disorders (chronic hypertension and pre-eclampsia), cardiac, renal and autoimmune disorders (Fisk 2001; Graves 2007; Westergaard 2001). More recently, thrombophilias (congenital and acquired) have been added to this list (Alfirevic 2002; Greer 1999).…”

Comparison of umbilical artery Doppler and non-stress test in assessment of fetal well-being in gestational diabetes mellitus: A prospective cohort study

“…In London’s study conducted on 35 insulin-dependent diabetic women, 50% of fetuses of women with vascular disease had an abnormal UA Doppler in the third-trimester, compared with 12% in women with uncomplicated diabetes ( 23 ). They recommended Doppler methods for diabetes women with vasculopathy, intrauterine growth restriction, and hypertensive disorders ( 23 , 24 ). Our results were not consistent with previous studies which found that UA S/D index was superior to NST in predicting adverse outcomes ( 16 , 17 , 25 ).…”

Sonographic Evaluation and the Pregnancy Complicated by Diabetes

“…Antenatal assessment of fetal well-being is recommended in patients with diabetes because of the increased risk. Forms of testing include the non-stress test (NST) (fetal heart rate tracing), biophysical profile (ultrasound evaluation of fetal tone, movement, breathing, and amniotic fluid), and fetal vascular Doppler velocimetry [46]. A review of the NST by Devoe and Jones [47] determined a negative predictive value of twice-weekly NST of more than 90% for stillbirth.…”