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Fetal hyperinsulinism at 14-20 weeks and subsequent gestational diabetes
M W Carpenter1, J A Canick, J Star
1Department of Obstetrics and Gynecology, Brown University School of Medicine, Women & Infants Hospital of Rhode Island, Providence, USA.
Obstetrics and Gynecology
|January 1, 1996
Summary
Amniotic fluid insulin levels measured during early pregnancy can help predict gestational diabetes in women over 35. However, it does not predict macrosomia.
Area of Science:
- Reproductive Endocrinology
- Maternal-Fetal Medicine
- Metabolic Disorders
Background:
- Gestational diabetes (GDM) poses risks to both mother and fetus.
- Early detection of GDM is crucial for timely intervention.
- Maternal age over 35 is a known risk factor for GDM.
Purpose of the Study:
- To evaluate the predictive capability of mid-trimester amniotic fluid (AF) insulin levels for GDM and macrosomia.
- To assess these predictions in women aged 35 years or older undergoing genetic amniocentesis.
Main Methods:
- Retrospective analysis of 296 pregnancies with stored AF samples from genetic amniocenteses.
- Inclusion criteria: maternal age ≥35, amniocentesis at 14-20 weeks, glucose challenge test, and delivery data.
- AF insulin measured using radioimmunoassay; statistical analysis included logistic regression.
Main Results:
- Higher median AF insulin levels were observed in women who later developed GDM (0.60 µU/mL) compared to those without (0.42 µU/mL).
- AF insulin was the only significant predictor of GDM (P = .004) in logistic regression analysis.
- Elevated AF insulin (>95th percentile) was strongly associated with GDM (P < .001), but did not predict macrosomia.
Conclusions:
- Increased mid-trimester AF insulin levels are associated with subsequent GDM.
- This suggests potential early fetal hyperinsulinemia in some GDM cases.
- AF insulin measurement is not a reliable predictor for fetal macrosomia.