Antenatal testing: diabetes mellitus

Diabetes complicating pregnancy is a problem for which fetal surveillance testing is considered to be the standard of care. In response to the unacceptable frequency of stillbirth in such pregnancies, fetal testing historically was first introduced to manage women whose pregnancies were complicated by diabetes. Essentially all forms of antepartum testing have been used to assess fetal well-being during the third trimester of pregnant diabetics. The contraction stress test became established as the "gold standard," yet other testing protocols have been used successfully. It is clear that control of diabetes throughout gestation, not just in the later stages, is more important for optimal outcome than is a specific form of fetal testing. Biweekly testing has become the standard and with well-controlled diabetics, allowing the gestation to continue until the onset of spontaneous labor, even when the gestation exceeds 40 weeks, is appropriate management with normal testing.