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Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance

  • Diabetes and Pregnancy (M-F Hivert and CE Powe, Section Editors)
  • Published:
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Abstract

Purpose of Review

To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes.

Recent Findings

Women with pregestational diabetes have a 3- to 5-fold increased odds of stillbirth compared to women without diabetes. The stillbirth risk in women with gestational diabetes (GDM) is more controversial; while recent data suggest the odds for stillbirth are approximately 50% higher in women with GDM at term (37 weeks and beyond) than in those without GDM, it is unclear if this risk is seen in women with optimal glycemic control. Current professional society guidelines are broad with respect to fetal testing strategies and delivery timing in women with diabetes.

Summary

The data supporting strategies to reduce the risk of stillbirth in women with diabetes are limited. Antepartum fetal surveillance should be performed to reduce stillbirth rates; however, the optimal test, frequency of testing, and delivery timing are not yet clear. Future studies of obstetric management for women with diabetes should consider not just individual but also system level costs and benefits associated with antenatal surveillance.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis Street, ASB 1-3, Boston, MA, 02115, USA

    Ukachi N. Emeruwa

  2. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Chloe Zera

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Emeruwa, U.N., Zera, C. Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance. Curr Diab Rep 18, 96 (2018). https://doi.org/10.1007/s11892-018-1058-5

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