Bibliographic information
GuidelineWHO recommendations on care for women with diabetes during pregnancy
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
For pregnant women with type 1, type 2 or gestational diabetes requiring blood glucose-lowering medication, consider additional monitoring of fetal wellbeing, as indicated.
Recommended
Notes and Remarks
- Monitoring to assess growth and wellbeing of the developing baby is a routine part of antenatal care, particularly in high-income countries. WHO recommends ultrasound before 24 weeks to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience (10). It also recommends that healthy pregnant women be made aware of the importance of fetal movements in the third trimester and of reporting reduced fetal movements, and that clinical enquiry about maternal perception of fetal movements occur at each antenatal care visit as part of good clinical practice (10).
- Given the potential for congenital anomalies and other adverse perinatal outcomes among women with diabetes of any type during pregnancy, the GDG considered that earlier and additional fetal monitoring is optimal. There is little empirical evidence on fetal monitoring for pregnant women with type 1, type 2, or GDM. The GDG considered an approach that is woman-centred, based on the ethical principle of autonomy including the importance of informed decision making, and physiological evidence on how diabetes might impact pregnancy outcomes. In pregnant women with diabetes, the GDG acknowledged that antenatal fetal monitoring may help to inform the timing of childbirth. Indications for additional ultrasound scans after 24 weeks
- Additional ultrasound scans after 24 weeks aim to identify growth restriction and accelerated growth and help in planning for the birth. Their use may be indicated when restricted or accelerated growth is suggested by fundal height measurement or in the context of complicated diabetes (i.e. insulin treated or when glycaemic control is poor) and will likely be based on availability of resources.
- Modelling to estimate the effect of the interval between examinations on fetal growth in the general pregnant population suggests that taking measurements at least three weeks apart may minimize false positive rates (55). False positive rates were higher when the first scan was performed at 36 weeks (compared to first scan at 32 weeks)