Antenatal fetal testing in well-controlled GDMA2 patients – does it correlate with glycemic control? Is it necessary?

Abstract

Background: Because GDMA2 pregnancies are believed to be at increased risk of perinatal morbidity and mortality, fetal surveillance is initiated in the third trimester. Objectives: To correlate the results of antepartum fetal surveillance with glycemic control and fetal outcomes. Materials and Methods: A retrospective chart study of 421 pregnant women with diabetes was performed over a 7-year period. Patients with GDMA1, preexisting hypertension, diabetes, severe preeclampsia, fetal growth restriction, noncompliance, and substance abuse were excluded. For study purposes good glycemic control was fasting (F) and 2-hour postprandial (PP) glucose values of <105 and <120 mg/dL, respectively; fair was F and 2-hour PP values of <150 mg/dL; and poor control was F and 2-hour PP values of >150 mg/dL. The mean of the F and 2-hour PP values was noted on the day of and the day preceding the nonstress test (NST). The number of NSTs and biophysical profile(s) (BPPs) each patient underwent, the frequency of abnormal test results dictating further testing/delivery, and the fetal outcomes were recorded and correlated with glycemic control. Results: One hundred fifty-two patients in the study underwent 1,555 NSTs. Of the NSTs, 7.4 % were nonreactive, and glycemic control was good in 4.2% and fair or poor in 3.0%. There was no statistically significant difference. Further data, including glycemic control in reactive NSTs and fetal outcomes, will be presented. Conclusions: The role of antepartum fetal surveillance in GDMA2 patients, especially well-controlled patients, remains to be determined.