Antepartum fetal monitoring in pregnant women with diabetes: A systematic review.

Diabetes in pregnancy affects approximately 15.5% of pregnant women worldwide, the majority of these women are in low- and middle-income countries. Current guidelines recommend additional fetal monitoring for pregnant women with diabetes, particularly during the third trimester, though there is limited evidence supporting these recommendations. Our objective was to identify the optimal methods and regimens for antepartum fetal monitoring for pregnant women with diabetes to inform recommendations for future clinical practice. CENTRAL, Embase, MEDLINE, and LILACs databases were searched through 23 July 2024. There were no restrictions on language or publication type. We included randomized controlled trials (RCTs) or nonrandomized studies of interventions (NRSIs) involving pregnant women with diabetes (whether gestational, type 1, or type 2). Eligible studies were those investigating fetal monitoring in these women, such as fetal growth monitoring, fetal well-being monitoring, or Doppler ultrasonography. Our comparisons of interest were (1) monitoring versus no monitoring/usual care, (2) monitoring versus a different type of monitoring, and (3) different regimens of the same type of monitoring. Meta-analysis was not possible due to heterogeneity of the included studies; narrative synthesis was conducted and the Synthesis Without Meta-analysis (SWiM) guidelines were followed. The GRADE approach (Grading of Recommendations, Assessment, Development, and Evaluations) was used to assess the certainty of evidence for each outcome. Five studies with 4440 pregnant women with diabetes were included; two were RCTs (239 women) and three were NRSIs (4201 women). A single ultrasound growth scan over no ultrasound growth scan probably increases the risk of caesarean section (risk ratio [RR] 1.71, 95% confidence interval [CI] 1.46-2.01, 1 study, n = 2357, moderate certainty). There is a paucity of data regarding optimal antepartum fetal monitoring for pregnant women with diabetes. Robust, high-quality studies are urgently needed to inform clinical guidelines.