Third trimester

1. Diabetic gravida should be seen every one to two weeks until 32 weeks of gestation and then weekly until delivery.

a. Antepartum fetal testing is recommended for pregnancies complicated by pregestational diabetes starting with weekly NSTs at 32 weeks when there is suboptimal glycemic control (hemoglobin A1c values >7 percent) and by 35 weeks with good control (hemoglobin A1c <7 percent), increasing the frequency of testing to two times per week as indicated. In complicated patients with intrauterine growth restriction, oligohydramnios, preeclampsia, or poorly controlled blood sugars, testing may start at 26 weeks.

b. Assessment of fetal growth. The ultrasound examination is repeated at 28 to 30 weeks. If there is evidence of intrauterine growth restriction, tests of fetal well-being are initiated. The last sonographic examination is performed at 38 weeks to estimate fetal weight.

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