Amniotic Fluid Insulin at 14–20 Weeks’ Gestation

Abstract

OBJECTIVE—To examine the hypothesis that early second trimester amniotic fluid (AF) insulin concentration is elevated and later fetal growth is augmented in gravidas demonstrating later oral glucose intolerance. RESEARCH DESIGN AND METHODS—In this prospective observational cohort study, AF was sampled at 14–20 weeks’ gestation in 247 subjects, and 1-h 50-g oral glucose challenge tests (GCTs) were performed at ≥24 weeks. AF insulin was assayed by an automated immuno-chemiluminometric assay (8). Macrosomia was defined as birth weight above the 90th centile. RESULTS—AF insulin concentration (range 1.4–44.5 pmol/l) correlated positively with gestational age and maternal weight. A logistic regression analysis, adjusted for maternal age and midpregnancy weight, showed increased AF insulin multiples of gestational age-specific medians to be associated with subsequently diagnosed gestational diabetes mellitus (GDM) (OR 1.9, CI 1.3–2.4, P = 0.029). Among 60 subjects with GCT values >7.2 mmol/l, each unit increase in AF insulin multiple of median (MOM) was associated with a threefold increase in fetal macrosomia incidence (3.1, 1.3–4.9, P = 0.048). CONCLUSIONS—An elevated AF insulin concentration at 14–20 weeks’ gestation is associated with subsequently documented maternal glucose intolerance. Among gravidas with GCT values >7.2 mmol/l, elevated early AF insulin concentration is associated with fetal macrosomia. Maternal glucose intolerance may affect fetal insulin production before 20 weeks’ gestation.

Modified Therapy for Gestational Diabetes Using High-Risk and Low-Risk Fetal Abdominal Circumference Growth to Select Strict Versus Relaxed Maternal Glycemic Targets

“…In nonrandomized patient treatment assignment, instituting insulin therapy when elevated amniotic fluid insulin levels were detected reduced the risk of both complications compared with those not treated. Other researchers have confirmed that only markedly elevated amniotic fluid insulin levels (Ͼ18 U/ml) were associated with somatic overgrowth at birth (13), whereas others found that elevated levels can be found early in pregnancy before 20 weeks and were associated with later glucose intolerance and macrosomia (14). Metzger and Freinkel (9) found long-term effects into childhood, namely obesity and impaired glucose tolerance, were associated with third trimester elevated amniotic fluid insulin levels of Ͼ150 pmol/l (ϳ20 U/ ml) and Ͼ100 pmol/l (ϳ14 U/ml), respectively.…”

Midtrimester amniyotik sıvı leptin ve insülin düzeyleri ile gestasyonel diabetes mellitus ilişkisi

“…[10]'nın araştırmasında maternal yaş ortalaması 37, 8 Carpenter ve ark. [8]'nın çalışmasında 38 idi. AS'de leptin ve insülin düzeylerini araştıran D' Anna ve ark.…”

“…[10]'nın çalışmasında 15,3, Carpenter ve ark. [8]'nın araştırmasında16, D' Anna ve ark. [12]'nın çalışmasında 15,9 olarak saptanmıştır, bu bulgular bizimki ile benzerlik göstermektedir.…”

Hypoglycemics: Pharmacokinetic Considerations During Pregnancy

“…33,34 The risk for neonatal macrosomia has been associated with high levels of insulin in cord blood and amniotic fluid. 35,36 The production of anti-insulin antibodies is believed to be minimized by the use of human insulin over porcine or bovine insulin. However, anti-insulin antibody production has been observed in response to human insulin treatment in women with GDM.…”