Fetal lung maturity in pregnancies complicated by insulin-dependent and gestational diabetes: a matched cohort study

Piazze, Juan; Anceschi, Maurizio M.; Maranghi, Luca; Brancato, V; Marchiani, Emanuela; Cosmi, Ermelando V.

doi:10.1016/s0301-2115(98)90333-5

Cited by 23 publications

(17 citation statements)

References 19 publications

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“…Furthermore, the risk of harm for the fetal lung seems to be increased with the duration and extent of hyperglycemia exposure. Piazze et al [23] found that well-controlled diabetes in pregnancy (pregestational diabetes or GDM) does not delay fetal lung maturity, emphasizing the importance of maternal glycemic control for maintaining normal fetal lung development. We studied the relationship of fetal lung maturity with metabolic control, and our results were consistent with this hypothesis: a significant percentage of pregnant women with GDM treated with insulin (and therefore, with worse metabolic control) had fetal lung immaturity compared to patients from both the control and diet-only groups.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus

Sánchez

Mateo

et al. 2018

Fetal Diagn Ther

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Objectives: The aim of the present study was to evaluate fetal lung maturity using the noninvasive method of quantitative ultrasound analysis of fetal lung texture (quantusFLM) in women with gestational diabetes mellitus (GDM). Methods: A total of 96 women at 36–38 weeks of gestation were enrolled. They were classified as follows: 33 GDM cases treated with diet, 30 GDM cases treated with diet plus insulin, and 33 normoglycemic women (control group). A quantitative analysis of lung texture was performed. Results: There were significant differences in the lung maturity results among groups (p = 0.004). These differences were established between the insulin-treated group of patients and both the control (p = 0.006) and diet-only (p = 0.003) groups. While none of the women in the control group or in the diet group had a high risk of immaturity, 16.7% of those treated with insulin (5/30) did (p = 0.003). There was no statistically significant correlation between HbA1c and the result of the test. Conclusions: Quantitative ultrasound study of fetal lung texture suggests that a significant percentage of pregnant women with GDM treated with insulin had fetal lung immaturity in the late preterm to early term.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus

Sánchez

Mateo

et al. 2018

Fetal Diagn Ther

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“…Nevertheless, there is evidence in the literature that fetal lung maturation in pre-existing diabetes is altered 1,3,[22][23][24][25]42 .…”

Section: Discussionmentioning

confidence: 99%

“…Since the L/S ratio may be influenced by the presence of pre-existing diabetes 1,[22][23][24][25]42 , the construction of normal Table 1 Comparison of lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC) (× 1000/µl) in women who had received glucocorticoids for < 10 days prior to amniocentesis, and women who had not received glucocorticoids. Ranges are shown in parentheses curves for the L/S ratio was performed after exclusion of women with pre-existing diabetes.…”

Section: Construction Of Normal Curvesmentioning

confidence: 99%

“…Some authors have reported a lower L/S ratio 1,22 or a lower predictive value of the L/S ratio [23][24][25] , while others have found that L/S ratios in diabetic and non-diabetic women were comparable [25][26][27][28] , thereby questioning the accuracy of the test 29,30 . Few data are available on the relation between the diabetic status of the woman and the LBC 3,4,25 . Recent studies indicate that small-for-dates infants, born preterm, may have a similar chance of developing RDS compared to appropriately grown infants [31][32][33] .…”

Section: Introductionmentioning

confidence: 99%

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The effect of clinical characteristics on the lecithin/sphingomyelin ratio and lamellar body count: a cross-sectional study

Wijnberger

Kleine

Voorbij

et al. 2003

The Journal of Maternal-Fetal & Neonatal Medicine

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“…[1][2][3][4][5][6][7][8][9] Other studies illustrate normal fetal lung development in pregnancies with well-controlled diabetes. 1,3,4,6,[10][11][12][13] The TDx-FLM II surfactant-to-albumin assay (Abbott Laboratories, Abbott Park, IL) is one of the most widely used screens for fetal lung maturity. 10,11 Most of the studies referenced above were performed using older or less common assays, such as the previous generation surfactant-to-albumin assay (TDx-FLM), lecithin-sphingomyelin (L/S) ratio, or phosphatidylglycerol (PG).…”

mentioning

confidence: 99%

Fetal Lung Maturity Testing in Diabetic Mothers

Melanson

Jarolím

McElrath

et al. 2007

Laboratory Medicine

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ScienceDiabetes, either pregestational or gestational, can affect up to 4% of pregnancies. 1 These pregnancies are subject to increased risks of prematurity and perinatal morbidity, including respiratory distress syndrome (RDS). 2 Accurate timing of delivery can improve outcomes but requires metabolic control, antepartum fetal monitoring, and documentation of fetal lung maturity. Assessment of the effect of maternal diabetes on fetal lung maturity has yielded controversial findings. Some studies suggest that fetal lung maturation is delayed in diabetic pregnancies, resulting in a greater risk of RDS, when compared with non-diabetic pregnancies of similar gestational age (GA). [1][2][3][4][5][6][7][8][9] Other studies illustrate normal fetal lung development in pregnancies with well-controlled diabetes. 1,3,4,6,[10][11][12][13] The TDx-FLM II surfactant-to-albumin assay (Abbott Laboratories, Abbott Park, IL) is one of the most widely used screens for fetal lung maturity. 10,11 Most of the studies referenced above were performed using older or less common assays, such as the previous generation surfactant-to-albumin assay (TDx-FLM), lecithin-sphingomyelin (L/S) ratio, or phosphatidylglycerol (PG). 14 Consequently, it is unclear what types of fetal lung maturity testing are most informative in diabetic pregnancies, what GA ranges are most relevant, and how to interpret the results. 10,14 Prior studies have shown that the disaturated phosphatidylcholine (DSPC) levels have value beyond that of TDx-FLM II at predicting lung maturity in diabetic pregnancies. 10,15 In addition, the author's institution has developed and validated a probabilistic model that incorporates both TDx-FLM II results and GA to more accurately predict the risk of RDS. 16,17 The current study explores the utility of the testing algorithm, evaluates the performance of the second generation TDx-FLM II assay, and examines the role of DSPC testing in diabetic pregnancies. Materials and MethodsApproval for this study was received from the institutional Human Research Committee at Brigham and Women's Hospital. Diabetic women were selected from a data set of women who had TDx-FLM II testing performed at Brigham and Women's Hospital between January 1, 2003 and December 31, 2005. 16 During the study period, clinical care consisted of performing DSPC in addition to TDx-FLM II in diabetic pregnancies, so both results were available to analyze. Women were excluded if they delivered more than 72 hours after the TDx-FLM II estimation. Only live, singleton, non-anomalous births were included.The maternal medical records were reviewed to classify the type of diabetes (ie, pregestational or gestational diabetes mellitus [GDM]), the date of delivery, the results of TDx-FLM II, the GA, and DSPC results. Gestational age was assigned on the basis of the following criteria, listed in order of priority: in vitro fertilization or intrauterine insemination dating, last menstrual period (LMP) confirmed by first trimester ultrasound (US), LMP confirmed by second trimester...

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Fetal lung maturity in pregnancies complicated by insulin-dependent and gestational diabetes: a matched cohort study

Cited by 23 publications

References 19 publications

Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus

Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus

The effect of clinical characteristics on the lecithin/sphingomyelin ratio and lamellar body count: a cross-sectional study

Fetal Lung Maturity Testing in Diabetic Mothers

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