Pregnancy in women with pregestational diabetes is associated
with high perinatal morbidity and mortality. Stillbirth accounts for
the majority of cases with perinatal death. Intrauterine growth
restriction, pre-eclampsia, foetal hypoxia and congenital malformations
may be contributing factors, but more than 50% of stillbirths
are unexplained. Majority of stillbirths are characterised by
suboptimal glycaemic control during pregnancy. Foetal hypoxia and
cardiac dysfunction secondary to poor glycaemic control are probably
the most important pathogenic factors in stillbirths among
pregnant diabetic women. There is thus a need for newstrategies for
improving glycaemic control to near-normal levels throughout
pregnancy and for preventing and treating hypertensive disorders
in pregnancy. Antenatal surveillance tests including ultrasound
examinations of the foetal growth rate, kick counting and nonstress
testing of foetal cardiac function are widely used. However,
future research should establish better antenatal surveillance tests
to identify the infants susceptible to stillbirth before it happens.