Effects of identifying a high risk population.

Gestational diabetic women who are at greater risk for perinatal loss include those patients with the history of a previous intrauterine death, an elevated fasting glucose level, pregnancy-induced hypertension, or prolonged gestation. These patients do require a program of antepartum fetal surveillance to prevent intrauterine deaths. Within the broad category of gestational diabetes, however, another group of patients may be defined who can be followed safely to term with no higher perinatal mortality than that observed in the general population. Such women have been designated Class A diabetic by White, indicating that they have normal fasting glucose levels, an abnormal oral glucose tolerance test, and require only minimal dietary regulation. Fasting glucose levels must be followed closely in Class A patients to detect those who develop overt diabetes.