FETAL SURVEILLANCE IN DIABETIC PREGNANCY

The focus of monitoring in diabetic pregnancy is no longer the prevent ion of fetal mortality, owing to the impressive benefits of strict mat ernal 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 exponen tial effect of diabetes when other maternal complications are present, and peripartum problems of the macrosomic infant, of delayed lung mat uration, birth trauma and neonatal hypoglycemia. Thus, a broad range o f potential fetal problems with varying maternal complications require s individualized, serial observation with multiple-format, properly va lidated tests. There has been recent progress: definition of the popul ation at risk, clarification of pathophysiology, application of multip le-format tests, and evaluation of neonatal impacts; further precision may be developed with specific fetal tests. This review deals with th e continued fine tuning of this critical area of perinatal medicine.