Fetal surveillance in pregnancies complicated by insulin-dependent diabetes mellitus Mark B. Landon, MD: Oded Langer, MD,b Steven G. Gahbe, MD,. Carol Schick, RN,' and Lois Brustman, MDb Columbus, Ohio, and Bronx, New York OBJECTIVE: Our objective was to determine whether maternal vascular disease and/or glycemic control can be related to tests of fetal condition in diabetic pregnancies. STUDY DESIGN: A total of 114 women with insulin-dependent diabetes who used a memory-based glucose reflectance meter were prospectively evaluated. Nonstress testing was begun weekly at 28 to 30 weeks and twice weekly at 32 weeks. A nonreactive nonstress test was followed by a biophysical profile in all cases. RESULTS: A total of 1676 nonstress tests was performed (14.7 ± 3.2 tests per patient). Eight percent (n = 134) were nonreactive, necessitating a biophysical profile. A comparison of ambulatory glucose profile data, including mean blood glucose level, variation, and excursions from the median, revealed no significant differences in patients with reactive versus nonreactive nonstress tests. Ten patients, including eight with vascular disease, were delivered because of abnormal test results of fetal condition. Nephropathy or hypertension was associated with intervention for fetal well-being in 8 of 20 women (40%) with these risk factors. Only 2 of 94 patients (2%) without nephropathy or hypertension required delivery because of abnormal results of fetal testing (p < 0.001). One fetal death occurred. No significant differences in the various glycemic parameters were found in women delivered for suspected fetal jeopardy versus the nonintervention group. CONCLUSION: Pregnancies complicated by vascular disease are at greatest risk for abnormal results of fetal testing that necessitate early delivery. Women without vascular complications and with maintenance of good glycemic control rarely have fetal compromise. (AM J OSSTET GVNECOL 1992;167:617-21.)
Key words: Diabetic pregnancy, glycemic control, fetal testing Although intrauterine fetal death has become an uncommon event in pregnancies complicated by insulindependent diabetes, intensive antepartum fetal surveillance during the third trimester remains the standard practice of obstetricians.' Goals of antepartum fetal surveillance include the avoidance of intrauterine death, early detection of fetal compromise, and prevention of unnecessary preterm delivery. None of these techniques has been subjected to prospective randomized clinical trials, but the methods have been incorporated into complex patient-care programs consisting of a specialized team approach with an emphasis on normalization of maternal blood glucose levels! Intervention because of abnormal results of fetal testing is performed in
Key words: Diabetic pregnancy, glycemic control, fetal testing Although intrauterine fetal death has become an uncommon event in pregnancies complicated by insulindependent diabetes, intensive antepartum fetal surveillance during the third trimester remains the standard practice of obstetricians.' Goals of antepartum fetal surveillance include the avoidance of intrauterine death, early detection of fetal compromise, and prevention of unnecessary preterm delivery. None of these techniques has been subjected to prospective randomized clinical trials, but the methods have been incorporated into complex patient-care programs consisting of a specialized team approach with an emphasis on normalization of maternal blood glucose levels! Intervention because of abnormal results of fetal testing is performed in
