Antenatal fetal testing in pregnancies complicated by gestational diabetes mellitus

Most obstetricians adapt some form of strategy for antenatal fetal testing in pregnancies complicated by gestational diabetes mellitus (GDM). There are, however, wide differences of opinion among providers as to the preferred protocol for such testing. The optimal method of fetal surveillance, the gestational age at which to start testing, the frequency of testing, and even whether all patients with GDM require antenatal testing are all controversial, unresolved issues. Indeed, in the absence of prospective, randomized clinical trials, it is impossible to determine whether antenatal fetal testing is beneficial in uncomplicated GDM. Moreover, it appears that even with the use of well-defined antenatal testing protocols, it is unavoidable that some women with GDM will experience an unexplained third trimester stillbirth. Pending the availability of solid data based on prospective trials, it is prudent to incorporate antenatal fetal testing in the management scheme of women with gestational diabetes.