Amniotic fluid insulin, C peptide concentrations, and fetal morbidity in infants of diabetic mothers

Amniotic fluid insulin levels and fetal abdominal circumference at time of amniocentesis in pregnancies with diabetes

“…This supports the pathophysiology of accelerated growth in diabetic pregnancies. An association between macrosomia at birth and elevated AF insulin at third trimester as well as at time of birth has been well documented [22–24]. Second, our findings suggest that using AC measurements with a threshold ≥ 75th percentile for gestational age may be useful in identifying severe hyperinsulinism.…”

Relationship between mid‐trimester ultrasound fetal liver length measurements and gestational diabetes mellitus 妊娠中期三个月超声测量的胎儿肝脏长度与妊娠期糖尿病之间的关系

“…Consequently, increased abdominal circumference measurements suggest excessive glycogen deposition in the liver secondary to raised fetal insulin levels. Such an association between fetal macrosomia and amniotic fluid insulin has already been documented in the third trimester and at birth, 15,16 The aim of the present study was to test correlations between blood glucose levels during an oral glucose tol-erance test (OGTT) with FLL evaluated the during midtrimester ultrasound examination, as well to assess the value of these measurements in the screening of GDM in a high-risk population of pregnant women.…”

Can glucose tolerance test predict fetal hyperinsulinism?

“…In 1954 Pedersen 23 proposed that maternal hyperglycaemia induces fetal hyperglycaemia and hyperinsuli‐naemia and that this premature activation of fetal islets is responsible for adverse neonatal outcomes. Subsequent studies found increased levels of insulin and related compounds in the amniotic fluid in the 3rd trimester and significant correlations between amniotic fluid insulin concentration and maternal metabolic control 7,9 , maternal diabetes later in life 15 , fetal death in utero 8 , premature birth 6 , macrosomia 6,7,9–11 and neonatal conditions, such as hypoglycaemia, hypocalcaemia, polycythaemia, hyper‐bilirubinaemia, respiratory disorders and feeding problems 6–9,11,12 . Fetal hyperinsulinaemia also seems to cause problems for the offspring later in life.…”

“…The clinical value of a diagnostic test resides in its ability to predict defined endpoints 5 , and the risk of diabetes in future is of little relevance for the obstetrician. Amniotic fluid hyperinsulinism is the important end‐point for the obstetrician because it is the diabetes‐specific fetal complication associated with complications of the pregnancy, of the newborn, and later of the adolescent and adult 6–15 . In the present series the fetus serves as the sensor for the quality of maternal glucose metabolism.…”