Fetal surveillance in diabetic pregnancy

The focus of monitoring in diabetic pregnancy is no longer the prevention of fetal mortality, owing to the impressive benefits of strict maternal glucose control. Against this background, fetal monitoring must account for congenital anomalies, fetal mortality and severe morbidity as a result of metabolic consequences of hyperinsulinism, the exponential effect of diabetes when other maternal complications are present, and peripartum problems of the macrosomic infant, of delayed lung maturation, birth trauma and neonatal hypoglycemia. Thus, a broad range of potential fetal problems with varying maternal complications requires individualized, serial observation with multiple-format, properly validated tests. There has been recent progress: definition of the population at risk, clarification of pathophysiology, application of multiple-format tests, and evaluation of neonatal impacts; further precision may be developed with specific fetal tests. This review deals with the continued fine tuning of this critical area of perinatal medicine.