ANTEPARTUM FETAL SURVEILLANCE IN PATIENTS WITH DIABETES - WHEN TO START

OBJECTIVE: Although antepartum fetal well-being testing is an accepted practice in the management of diabetic patients, there are few data s uggesting when to start. Our goal was to examine when testing should b e started in the pregnant diabetic woman. STUDY DESIGN: Antepartum tes t results and patient histories were prospectively collected on all di abetic pregnancies from January 1981 through December 1991. The data w ere retrospectively analyzed for when fetal compromise became evident. Fetal compromise was defined as stillbirth, first positive contractio n stress test, or intervention because of an abnormal antepartum fetal test result. RESULTS: Six hundred fourteen patients were enrolled in the study. There were three stillbirths, 45 (7.4% patients had at leas t one positive contraction stress test, and 71 (11.6%) patients were d elivered because of an abnormal fetal test result. Those with early co mpromise (less-than-or-equal-to 34 weeks' gestation) could not be iden tified solely by diabetic class. The majority of patients (73%) requir ing early intervention because of an abnormal test were class R or F d iabetic patients with a growth-retarded fetus or were patients who had a concomitant diagnosis of hypertension. CONCLUSIONS: Class R or F di abetic patients or diabetic patients with a growth-retarded fetus or a concomitant diagnosis of hypertension may require testing to be start ed as early as 26 weeks' gestation. Otherwise, testing may be safely d elayed until 32 weeks' gestation.