Abstract
Background: Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers, however there is no sufficient evidence to support this. Objective: The purpose of the present systematic review was to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes. Materials and Methods: The databases were searched to find English and Persian articles published from 1975-2018 about antenatal fetal assessment in pregnancies complicated with diabetes. Relevant sources cited in the selected publications were also searched manually. Keywords were GDM, pregnancy, fetal testing, fetal surveillance, NST, BPP, CTG. A total of 1954 studies were identified. Of these, 1913 were excluded on the basis of title and abstract review. Results: Among the 41 studies retrieved for detailed full-text analysis, a total of 10 fulfilled the inclusion criteria for the analysis. Still birth rate was 5.6/1000, cesarean rate was 418/1000. In diabetic pregnant women (gestational and overt diabetes) with well controlled blood sugar who did fetal surveillance tests the intrauterine fetal death rate isn’t different with general population. Conclusion: As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control. No randomized clinical trial has been conducted to investigate this claim.
Highlights
Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers; there is no sufficient evidence to support this
As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control
The purpose of the present systematic review is to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes, through reviewing the observational studies
Summary
Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers; there is no sufficient evidence to support this. The increasing prevalence of diabetes in the general population and getting pregnant in older ages has caused an increased number of diabetic pregnancies.[1,2,3] Gestational diabetes mellitus (GDM) affects 3%-6% of all pregnancies.[4,5,6] There is an increased risk of maternal and fetal complications associated with both overt and gestational diabetes.[7,8] With overt diabetes, the risk of stillbirth and neonatal death will be increased 5 and 3 times respectively.[9,10] In women with elevated fasting glucose levels in GDM, the rate of intrauterine fetal death (IUFD) is elevated.[11] Perinatal complications may be reduced in women who maintain their euglycemia during pregnancy.[12] The risk of late pregnancy fetal death in pregnancies complicated with diabetes promoted recommendations for fetal surveillance programs.[13] American College of Obstetrics and Gynecology (ACOG) recommends initiating tests between 32 and 34 weeks of gestational age None of these tests has been evaluated in a randomized clinical trial. The research question was whether there is sufficient evidence in the studies to support antenatal fetal assessment in diabetic women with well-controlled blood sugar to reduce fetal death
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