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THE RELATIONSHIP BETWEEN SECOND‐TRIMESTER AMNIOTIC FLUID INSULIN AND GLUCOSE LEVELS AND SUBSEQUENT GESTATIONAL DIABETES
Author(s) -
STAR JAMI,
CANICK JACOB A.,
PALOMAKI GLENN E.,
SALLER DEVEREUX N.,
SUNG C. JAMES,
TUMBER MAREA B.,
COUSTAN DONALD R.
Publication year - 1997
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/(sici)1097-0223(199702)17:2<149::aid-pd48>3.0.co;2-s
Subject(s) - amniotic fluid , amniocentesis , medicine , gestational diabetes , insulin , gestational age , diabetes mellitus , gestation , obstetrics , endocrinology , pregnancy , fetus , prenatal diagnosis , biology , genetics
Associations between elevated amniotic fluid glucose and insulin levels in the second trimester and the subsequent development of gestational diabetes have been reported. We conducted a case–control study to determine which analyte best predicts future maternal glucose intolerance. Thirty‐nine women diagnosed with gestational diabetes (criteria of Carpenter and Coustan, Am. J. Obstet. Gynecol. , 144, 768, 1982) who had undergone genetic amniocentesis for advanced maternal age were matched with euglycaemic controls. Glucose and insulin concentrations were determined by analysis of stored amniotic fluid samples. No significant difference was detected between cases and controls for amniotic fluid glucose concentrations. Amniotic fluid insulin concentrations were significantly higher in cases (mean rank 4·44, P <0·01, using matched rank analysis of variance, where 1 is the lowest and 6 is the highest rank). After conversion to multiples of the median, 20 per cent of women with subsequent gestational diabetes were found to have amniotic fluid glucose levels at or above the 90th centile, while 35 per cent of cases had similarly elevated amniotic fluid insulin levels. We conclude that second‐trimester amniotic fluid insulin is a more sensitive predictor of impending glucose intolerance than amniotic fluid glucose, although neither is sufficiently powerful to use alone as a screening test. © 1997 by John Wiley & Sons, Ltd.