Fetal surveillance and timing of delivery in pregnancy complicated by diabetes mellitus

Abstract

Diabetes concurrent with pregnancy is a high-risk condition associated with risks for adverse pregnancy outcomes. Historically, these risks were unacceptably high and a policy of late preterm delivery induction was the rule. With the advent of improved glycemic management and the introduction of antenatal fetal testing and surveillance, the perinatal risks have dropped significantly such that a healthy pregnancy is expected. Managing stable women with diabetes mellitus to 39 and 40 weeks is now commonplace as fetal surveillance tools such as nonstress testing and biophysical profiles have sufficiently low false-negative rates that providers can feel assured that expectantly managing these pregnancies close to term can be done with minimal risk. However, providers cannot become complacent, and the results of fetal surveillance, clinical characteristics of the pregnancy, and expected neonatal outcomes all need to be accounted when deciding the optimal gestational age to deliver a child.