Antepartum fetal monitoring in insulin-dependent diabetic pregnancies

In order to minimize unexplained stillbirths in insulin-dependent diabetic pregnancies, fetal well-being was assessed by antepartum monitoring while development of pulmonary maturity was awaited. Antepartum monitoring consisted of outpatient nonstress tests beginning at 32 weeks' gestation. Fetuses with nonreactive nonstress tests were further evaluated by contraction stress tests and were delivered if tests were positive. With use of this system there were no unexplained stillbirths during management of 119 insulin-dependent diabetic pregnancies. Of 14 infants delivered because of positive contraction stress tests, six were found to have major disorders; the other eight had no major residual neonatal morbidity. Thus this system of antepartum fetal surveillance: (1) eliminated unexplained stillbirths, (2) identified a subgroup of insulin-dependent diabetic pregnancies with a high rate of major fetal abnormalities, and (3) allowed for identification and subsequent timely delivery of the other distressed fetuses that were at a high risk of neonatal morbidity and/or mortality, such that potential long-term adverse outcomes were avoided.