Palmitic acid concentration of amniotic fluid in diabetic pregnancy

The fatty acid composition of total lipid and phospholipid contents was determined in the amniotic fluid of normal and diabetic pregnant patients. Disturbance of lipid metabolism which is not related to the severity of diabetes, causes difficulties in the determination of L/S ratio. The palmitic acid content of total lipid and lecithin is increased in diabetic pregnancy. The lecithin synthesis is significantly decreased as result of a transitory or prolonged acidosis.     

Decreased amniotic fluid index in low-risk pregnancy

OBJECTIVE: To evaluate the perinatal outcomes of pregnancies complicated by isolated decreased amniotic fluid volume (AFI) after 30 weeks' gestation (AFI < or = 5 or > 5 cm but < 2.5th percentile). STUDY DESIGN: We retrospectively studied 150 low-risk singleton pregnancies > 30 weeks' gestation with decreased AFI. We also compared the outcomes of 57 pregnancies with AFI < or = 5 cm to those of 93 pregnancies with AFI > 5 cm but < 2.5th percentile (borderline AFI). Pregnancy outcome was assessed with respect to antepartum, intrapartum and neonatal measures. Statistical significance (P < .05) between groups was determined by means of the Student t test and chi 2 analysis. RESULTS: There were no statistically significant differences between pregnancies with AFI < or = 5 cm and those with AFI > 5 cm but < 2.5th percentile with respect to labor induction for an abnormal nonstress test (7.0% vs. 7.5%, overall 7.3%), cesarean sections for fetal heart rate abnormalities (7.0% vs. 7.5%, overall 7.3%), presence of meconium (16.1% vs. 15.7%, overall 16%) and Apgar score < 7 at five minutes (0 vs. 1.1%, overall 0.66%). There were no perinatal deaths in either group. Antepartum variable decelerations were more common in pregnancies with AFI < or = 5 cm as compared to those with AFI > 5 cm but < 2.5th percentile (63.1% vs. 45.1%, P = .007; overall 53.3%). CONCLUSION: With antepartum monitoring, perinatal outcome in low-risk pregnancies with an isolated decreased AFI after 30 weeks' gestation (< or = 5 or > 5 cm but < 2.5th percentile) appears to be good.     

Decreased amniotic fluid index in term pregnancy. Clinical significance.

In a study of 331 term pregnancies a four-quadrant technique was used to obtain amniotic fluid index measurements, and the results were compared with the current widely used single-pocket measurement. In contrast to the "2-cm rule," the amniotic fluid index measurements consistently demonstrated higher sensitivity in predicting poor fetal outcome with no decrease in specificity. It was noted that pregnancies with an index of < or = 8 cm showed higher incidences of meconium staining, cesarean delivery for fetal distress, abnormal fetal heart rate monitoring and Apgar scores of < or = 7 or less at one minute.     

Correlation between amniotic fluid glucose concentration and amniotic fluid volume in pregnancy complicated by diabetes

OBJECTIVE: Pregnancies complicated by diabetes are frequently characterized by an increased volume of amniotic fluid, and the pathophysiologic mechanism of this increase is not known. Our goal was to evaluate the relationship between amniotic fluid glucose concentration and the amniotic fluid index in pregnancies complicated by insulin-treated diabetes and to compare it with that seen in normal pregnancies. STUDY DESIGN: Amniotic fluid index and amniotic fluid glucose levels were measured before elective repeated cesarean delivery in 41 women with insulin-treated diabetes and in 35 women without diabetes. Only singleton gestations without anomalous fetuses were included. Women with diabetes were hospitalized for approximately 4 weeks before delivery, during which time glycemic control was optimized. Amniotic fluid index and amniotic fluid glucose concentration were correlated with each other and were compared between the groups with and without diabetes. RESULTS: The mean amniotic fluid index was significantly increased in the diabetes group (16.6 +/- 5.0 cm in the diabetes group vs 13.4 +/- 3.5 cm in the control group; P =.002). The amniotic fluid glucose concentration was also significantly greater in the diabetes group than in the control group (39 +/- 17 mg/dL in the diabetes group vs 24 +/- 11 mg/dL in the control group; P <.001). Among women with diabetes the amniotic fluid glucose concentration was significantly correlated with the amniotic fluid index (r = 0.32; P =.04), a correlation not found among the control women. The mean fasting blood glucose concentration among the women with diabetes for the week before amniocentesis was 82 +/- 11 mg/dL. CONCLUSION: The amniotic fluid index parallels the amniotic fluid glucose level among women with diabetes. This finding raises the possibility that the hydramnios associated with diabetes is a result of increased amniotic fluid glucose concentration.     

Changes in amniotic fluid glucose, beta-hydroxy-butyrate, glycerol, and lactate concentration in diabetic pregnancy

Amniotic fluid glucose, beta OH butyrate, glycerol, and lactate concentrations were measured in 75 samples collected in the third trimester of pregnancy from 50 diabetic patients, all but four of whom required insulin. Increases in maternal fasting plasma sugar were accompanied by corresponding increases in amniotic fluid glucose and on occasion increases in amniotic fluid beta OH butyrate. These data correspond to previous reports of placental glucose transfer and in addition, provide statistically significant evidence of placental betaOH butyrate transfer since the hyperglycemic, hyperinsulinemic fetus of a diabetic mother would be a poor primary source for ketogenesis. Relatively poor correlation of elevated fluid levels of these solutes to fetal outcome probably reflects a low incidence of maternal hyperglycemia, ketogenesis. Relatively poor correlation of elevated fluid levels of these solutes to fetal outcome probably reflects a low incidence of maternal hyperglycemia, ketoacidosis, and over-all reduced neonatal morbidity-mortality rates in this group of metabolically well-controlled, predominantly insulin-requiring diabetic patients managed in a regional high-risk perinatal center.     

Decreased maternal serum magnesium concentration and adverse fetal outcome in insulin-dependent diabetic women

Insulin-dependent diabetic pregnant women are at risk for magnesium deficiency, predominantly because of increased urinary magnesium losses. They also have a high incidence of spontaneous abortion, possibly related to major lethal malformations. We tested the hypothesis that adverse fetal outcome (fetal loss before 20 weeks' gestation and/or congenital major malformations) is related to magnesium status (as assessed by determining serum magnesium levels) in insulin-dependent diabetic pregnant women, even after sonographic documentation of fetal viability. Eighty-four insulin-dependent diabetic women (class B to RT) with 96 pregnancies were recruited prospectively in a program project. Serum magnesium and blood glycohemoglobin were measured at about nine weeks' gestation. Blood glycohemoglobin was higher (P = .039) and serum magnesium concentration lower (P = .05) in the 21 pregnancies that ended in adverse fetal outcome, compared with the other (75) successful pregnancies. When compared with the "successful pregnancy" group, blood glycohemoglobin was higher (P = .012) and serum magnesium lower (P = .037) in the subgroup of nine pregnancies with fetal cardiac activity present by ten weeks and ending in adverse fetal outcome, compared with the 64 equivalent pregnancies in the "successful" group. We speculate that decreased magnesium status may contribute to the high spontaneous abortion and malformation rate in insulin-dependent diabetic pregnant women.     

A comparison of amniotic fluid fetal pulmonary phospholipids in normal and diabetic pregnancy

OBJECTIVE: Our purpose was to determine whether there are differences in the timing of the appearance of various amniotic fluid fetal pulmonary phospholipids in normal and diabetic pregnancy. STUDY DESIGN: A case-control study of 295 subjects with diabetes and 590 control subjects was performed by use of gestational age-matched amniocentesis specimens analyzed for lecithin/sphingomyelin (L/S) ratio, phosphatidylinositol (PI), and phosphatidylglycerol (PG) composition. Diabetic subjects were stratified according to type of diabetes, degree of blood glucose control, and birth percentile of the neonate. RESULTS: There was no difference in L/S ratios over gestational age by type of diabetes or quality of glycemic control. Women with preexisting diabetes had significantly higher PI levels at 33 to 35 weeks' gestation, which became similar to levels of control subjects after 36 weeks, whereas patients with gestational diabetes mellitus and control subjects had similar PI levels throughout. In diabetic subjects, the onset of production of PG was delayed from 35.9 +/- 1.1 weeks (controls) to 38.7 +/- 0.9 weeks (overt diabetics) and 37.3 +/- 1.0 weeks for gestational diabetes mellitus (P <.001). The delay in PG synthesis was not related to infant sex, level of maternal glucose control, or fetal macrosomia. CONCLUSIONS: Fetal pulmonary maturation, as evidenced by the onset of PG production in the amniotic fluid, is delayed in diabetic pregnancy by 1 to 1.5 weeks. This delay appears to be associated with an early and sustained elevation in amniotic fluid PI levels at 32 to 34 weeks.     

妊娠期糖尿病患者羊水葡萄糖水平与羊水量及新生儿出生体重的关系

目的探讨妊娠期糖尿病(GDM)孕妇羊水葡萄糖水平变化与羊水量及新生儿出生体重的关系。方法对255例足月、单胎孕妇,于孕24~28周行50g葡萄糖筛查试验(50gGCT),口服葡萄糖后1h血糖≥7·8mmol/L,且<10·6mmol/L者为葡萄糖筛查阳性,阳性者进一步行75g葡萄糖耐量试验(75gOGTT)。根据两项试验结果分为GDM组、妊娠期糖耐量低减(GIGT)组和正常妊娠组,每组85例。分别测定3组孕妇的羊水葡萄糖水平、羊水指数、新生儿出生体重、孕妇空腹血糖、脐静脉血糖,并进行各指标间相关与回归的统计学分析。结果(1)GDM组羊水葡萄糖水平为(1·30±0·71)mmol/L,明显高于GIGT组的(1·02±0·57)mmol/L和正常妊娠组的(0·90±0·58)mmol/L,分别比较,差异均有统计学意义(P均<0·01)。(2)GDM组羊水指数为(16·1±4·6)cm,稍高于GIGT组的(14·8±4·3)cm,差异无统计学意义(P>0·05);明显高于正常妊娠组的(12·7±3·2)cm,差异有统计学意义(P<0·01)。(3)GDM组新生儿出生体重为(3612±510)g,低于GIGT组的(3694±490)g,高于正常妊娠组的(3487±458)g,但分别比较,差异均无统计学意义(P>0·05)。(4)GDM组羊水葡萄糖水平分别与羊水指数(r=0·330,P=0·002)、新生儿出生体重(r=0·347,P=0·001)、孕妇空腹血糖(r=0·589,P<0·01)、脐静脉血糖(r=0·218,P=0·045)呈正相关关系。GIGT组和正常妊娠组羊水葡萄糖水平仅与羊水指数呈正相关关系。(5)GDM组中血糖控制理想孕妇的羊水葡萄糖水平、羊水指数及新生儿出生体重分别为(1·02±0·50)mmol/L、(13·9±4·2)cm及(3497±475)g,血糖控制不理想孕妇分别为(1·92±0·76)mmol/L、(16·4±4·4)cm及(3869±481)g,两者分别比较,差异均有统计学意义(P<0·01、P<0·05、P<0·01)。GDM组中血糖控制理想孕妇的以上3项指标接近正常妊娠组(P>0·05)。结论GDM患者的羊水葡萄糖水平与羊水量、新生儿出生体重有密切关系。血糖控制理想与否对GDM合并羊水过多、巨大儿等并发症起决定因素,而积极管理可极大地改善GDM患者的母儿预后。     

Interrelationship between amniotic fluid C-peptide and catecholamines in the last trimester of diabetic pregnancy

Amniotic fluid concentration and content (amniotic fluid volume X concentration) of C-peptide and catecholamines (epinephrine, norepinephrine) and their interrelationship was studied in nine women with gestational diabetes, in 14 women with type I diabetes, and in 20 healthy control women between the thirty-sixth and thirty-ninth week of gestation. Mean amniotic fluid volume was significantly larger (p less than 0.05) in the type I diabetic group than in the control group. Mean concentration and content of amniotic fluid C-peptide were elevated in women with gestational diabetes, significantly so in women with type I diabetes (p less than 0.05) as compared with nondiabetic control women. Mean amniotic fluid catecholamine concentrations were lower, although not statistically so, in both insulin-dependent and gestational diabetic women than in control women. Mean amniotic fluid catecholamine content was higher, although not statistically so, in women with gestational diabetes than in control women. In the type I diabetic group, epinephrine content was significantly lower (p less than 0.05) and norepinephrine content significantly higher (p less than 0.05) than in the control group. A significant positive correlation between the content of norepinephrine and C-peptide was found in control women (r = 0.57; p less than 0.05) and in women with gestational diabetes (r = 0.75; p less than 0.05). The close interrelationship could indicate a parallel maturation of these two hormonal systems.     

Falling amniotic fluid palmitates in diabetic pregnancies

Palmitic acid levels were measured in samples of amniotic fluid obtained from 15 patients with diabetes. Seven patients had palmitate values which decreased at some time in pregnancy but only one of the infants developed respiratory distress. Eight of the 15 patients had final amniotic fluid palmitate values which were greater than 0.07 mmol/l and one infant developed respiratory distress. The other seven patients had final amniotic fluid palmitate values of 0.07 mmol/l or less and one of the infants developed respiratory distress. The significance of falling amniotic fluid palmitate values is discussed.     

Content of amniotic fluid prostaglandins in normal, diabetic, and drug-abuse human pregnancy

This study attempts quantification of prostaglandins (PGs) in amniotic fluid antepartum at 24, 26-33, 34-36 weeks of gestation and in labor in 6 normal patients, 6 diabetic patients, 3 patients taking methadone, and 1 patient taking heroin. Results of measurements of PGs showed that in the different weeks of gestation, the contents of PGs were essentially unchanged. PG values increased considerably at the time of labor, with no differences in the content of PGs in labor of normal, diabetic, and drug-abuse patients. The dominant fraction was PGF2alpha either during pregnancy or during labor, and the smallest fraction was PGE2 during gestation and PGE1 during labor. Significant differences of PGF2alpha concentrations were found in the serum of women at various stages of gestation. The high PG content in the amniotic fluid in labor indicates that PGs are needed for initiation of labor, and their origin is probably of fetal and decidual origin.     

The prediction of fetal lung maturity by amniotic fluid fluorescence polarization in diabetic pregnancy

Amniotic fluid fluorescence polarization was determined in 105 pregnant diabetic women who delivered between 31 and 41 weeks gestation within 48 hours of an amniocentesis. Seventy-seven of these 105 women had lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol (PG) determinations. Seven (6.6%) of the 105 neonates suffered from hyaline membrane disease (HMD). Fluorescence polarization at any cutoff value between 0.310 and 0.330 excluded reasonably well the possibility of HMD (false mature prediction rate, 2.7-3.4%). At these cutoff values, there was no difference in sensitivity and false mature prediction rate between fluorescence polarization and L/S ratio. However, PG determination was the most sensitive method and carried no false mature predictions.     

Significance of amniotic fluid glucose in pregnancy

Amniotic fluid glucose values were measured in 285 women with normal and abnormal pregnancies. A progressive decrease in glucose values was observed with advancing gestation. Complications in pregnancy did not influence the amniotic fluid glucose value for the given gestational age. In patients with diabetes, very high levels were found, but these progressively decreased with advancing gestation. Since abnormal conditions in pregnancy, other than diabetes, do not affect the amniotic fluid glucose level, it seems to be a reliable tool in assessing fetal maturity. Values above 15 mg/100 ml rule out term pregnancies and those below 5 mg/100 ml, prematurity.