Amniotic fluid phosphatidylglycerol in diabetic pregnancies

Despite L/S ratios indicating fetal lung maturity, respiratory distress continues to occur more frequently in infants of diabetic mothers. Amniotic fluid pulmonary phospholipids were studied in an attempt to understand the occurrence of false-positive L/S ratios in preterm diabetic pregnancies. Qualitative chromatographic assays of surfactant phosphatides revealed reduced or absent phosphatidylglycerol in diabetic amniotic fluid specimens between 34 and 37 weeks' gestation. Mean phosphatidylglycerol in 15 nondiabetic and 29 diabetic specimens was 16 and 4 per cent of total extracted pulmonary phospholipids (P < 0.001). Non-insulin-dependent diabetic pregnancies had lowest mean per cent phosphatidylglycerol. Respiratory distress occurred in six infants of diabetic mothers delivered preterm with L/S ratios of 2:1 or greater; phosphatidylglycerol was absent in five. The inclusion of phosphatidylglycerol in amniotic fluid phospholipid assessment may be an adjunctive index for fetal lung maturation in diabetic pregnancies.