There are no data from randomized trials on which to base recommendations regarding initiation of fetal monitoring in women whose pregnancies are complicated by GDM. For pregestational diabetic pregnancies, ACOG recommends antepartum monitoring beginning at 32 to 34 weeks of gestation. ACOG states that fetal monitoring is warranted in patients who do not have well-controlled GDM, who require insulin, or who have other complications of pregnancy.2 The most commonly used test is the nonstress test. It is typically performed once or twice per week. (Twice per week is thought to be more efficacious because it offers confidence that the fetus is doing well for a 72-hour period and provides a sensitivity that is equivalent to a weekly contraction stress test or a weekly biophysical profile.) A reactive nonstress test is required if the fetal heart rate increases 15 beats or more per minute for at least 15 seconds twice within a 20-minute period. The fetal biophysical profile should include assessment of tone, amniotic fluid level, gross and fine motor movement, heart rate, and breathing. Fetal movement counting can be used in conjunction with the nonstress test and/or biophysical profile. The contraction stress test is another option, although it is used infrequently.