Fetal Lung Maturity Testing in Diabetic Mothers

Abstract

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...

Maduración Pulmonar Fetal Con Corticoides, Una Situación Compleja en La Madre Con Diabetes

“…Luego de la publicación de datos controversiales respecto de la utilidad de marcadores bioquímicos en embarazadas con diabetes mellitus (DM), principalmente en relación al del índice L/E, el consenso actual es que el valor umbral en las pruebas de madurez pulmonar puede utilizarse tanto en embarazadas sin o con diabetes, tanto pregestacional (DPG) como gestacional (DG) 3,4,5 .…”