During the last 15 years, protocols for antepartum fetal assessment in pregnancies complicated by diabetes mellitus have shifted the focus of care during the third trimester to an outpatient setting, reducing health care costs and emotional stress on patients and their families. Maternal assessment of fetal activity is the primary screening test in most surveillance programs, which use the nonstress test, contraction stress test, or biophysical profile. The success of these protocols continues to be predicted on careful regulation of maternal glycemia through aggressive therapy with insulin and diet.