With excellent control of blood glucose a priority, the historically high rate of fetal demise in the third trimester has been markedly reduced.

Nonetheless, due largely to factors not yet clarified, the fetus is at risk in the late third trimester in the insulin-dependent gravida.

Fetal lung maturity is delayed in these patients, so confirmation of lung maturity by L/S ratio and phosphatidylglycerol is advised prior to elective delivery.

If fetal lung maturity is confirmed, delivery method depends on obstetrical factors. Cesarean section should also be considered if the estimated fetal weight is greater than 4500 grams to prevent shoulder dystocia at delivery from fetal macrosomia.

Management of labor in the insulin-requiring diabetic patient