Two weeks ago, Alice Chuang, MD, FACOG, of the N.C. Women's Hospital, fielded a question from a pregnant mom with gestational diabetes on TriangleMom2Mom.

The mom had a couple of follow-up questions for Dr. Chuang, who is an assistant professor of obstetrics and gynecology. Here are her questions and Dr. Chuang's answers.

The first question: How often should a patient come in for a fetal non-stress test, especially when the baby looks healthy each time?

The answer: A non-stress test is a test of fetal well-being that allows us to have an idea of how the fetus is doing in utero.  They can be performed with or without the addition of amniotic fluid testing or amniotic fluid index measurement.  The non-stress test can be performed once in the event of an acute situation or regularly in a mother who has a chronic issue.  So for example, if a patient trips in the parking lot and scrapes up her knee in the third trimester and specifically does not injure her abdomen, we might recommend a one-time stress test to evaluate the fetus just to be sure the mild trauma did not stress the fetus.  In a gestational diabetic who has blood sugars that are well-controlled with diet alone, some would argue a stress test is not even necessary.  In a poorly controlled pre-gestational diabetic (i.e. someone who had diabetes prior to being pregnant), a stress test is probably necessary twice a week.  It all depends on how well the blood sugars are controlled.  In general, it depends on how worried you are about the fetus.  Other signs that the fetus is in trouble is if there is growth lag, i.e. the fetus is small or if the amniotic fluid decreases. Thus, patients with serious chronic disease, including diabetes and hypertension, are usually on some type of fetal testing schedule which includes non-stress test, growth ultrasounds and fluid index measurements.  The intervals between these tests depends on the results of all the other tests and the previous results.  The idea of doing them regularly is to pick up early signs that the fetus is in trouble. Even if you had several that were normal in a row, it is not unreasonable to continue them until delivery.  Most would recommend this type of fetal testing until delivery.  

The second question: What is happening when a woman has gestational diabetes and her sugar drops to below normal at the end of pregnancy (around 37 weeks)? My sugar has been fine until now.

The answer:  I do not know of any phenomenon which causes blood sugars to improve in a diabetic at the end of pregnancy.  Usually insulin needs increase at the end of pregnancy requiring an increase in medication dose.  The blood sugar is a product of carbohydrates consumed and activity level. The blood sugar might fall if the patient was not eating as well or was increasing her activity towards the end of pregnancy.

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