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We thank Drs Ross and Kjos for their comments on our work regarding the linear relationship between birthweight and amniotic fluid index (AFI) percentiles in poorly controlled diabetic patients.1Vink J.Y. Poggi S.H. Ghidini A. Spong C.Y. Amniotic fluid index and birth weight: is there a relationship in diabetics with poor glycemic control?.Am J Obstet Gynecol. 2006; 195: 848-850Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar We also appreciate their reference to the elegant study conducted by Dr Kjos and team who found that only the presence of nonreactivity and decelerations, not AFI, were predictive of cesarean delivery for fetal distress. However, in contrast to our study, this cohort consisted of primarily term, well-controlled diabetic pregnancies with poor glycemic control only present in 1.6% (n = 24) of the patients. Of these, none had polyhydramnios or oligohydramnios.2Kjos S.L. Leung A. Henry O.A. Victor M.R. Paul R.H. Medearis A.L. Antepartum surveillance in diabetic pregnancies: predictors of fetal distress in labor.Am J Obstet Gynecol. 1995; 173: 1532-1539Abstract Full Text PDF PubMed Scopus (67) Google Scholar There are many factors of maternal and neonatal well-being that should be taken into consideration when caring for diabetic patients. For instance, poorly controlled diabetics are at risk for preterm labor, preeclampsia, stillbirth, and shoulder dystocia, which may all adversely affect the mother and fetus. The infant is also at increased risk for profound hypoglycemia, respiratory distress syndrome, polycythemia, organomegaly, electrolyte disturbances, and hyperbilirubinemia, all of which can lead to significant neonatal morbidity and mortality. At the current time, there are no studies that look at the relationship between polyhydramnios in poorly controlled diabetics and these particular adverse outcomes (Pubmed search with keywords polyhydramnios, diabetes, and outcome, 1960-November 12, 2006, English language journals). Although cesarean delivery for fetal distress is an important outcome to consider, everyone would agree that neonatal and long-term infant outcome would be more relevant. Further studies should be conducted to evaluate for potential relationships between other significant adverse maternal and neonatal outcomes in poorly controlled diabetics with polyhydramnios. In line with our mutual concerns about optimal antepartum testing in diabetic patients is the recent article by Kontopoulos and Vintzileos3Kontopoulos E.V. Vintzileos A.M. Condition-specific antepartum fetal testing.Am J Obstet Gynecol. 2004; 191: 1546-1551Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar in which polyhydramnios, not oligohydramnios, is cited as a reason to maintain intense surveillance in diabetic patients. Use of amniotic fluid index in diabetic patientsAmerican Journal of Obstetrics & GynecologyVol. 196Issue 6PreviewWe read with interest the article of Vink et al1 in which the authors demonstrate a linear relationship between birthweight and amniotic fluid index (AFI) in poorly controlled diabetic patients. As noted by the authors, this study is consistent with previous reports indicating the association of polyhydramnios with poorly controlled diabetes. The authors conclude that “future studies may determine whether incorporating AFI into management algorithms of diabetic patients may optimize fetal size at birth and reduce the risk of adverse perinatal outcomes in this population.” The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin Pregestational Diabetes Mellitus2 indicates that fetal assessment for women with pregestational diabetes mellitus may include antepartum fetal monitoring, including the nonstress test and the biophysical profile. Full-Text PDF