Stein Roland Gregor, Meinusch Malgorzata, Diessner Joachim, Dietl Johannes, Hönig Arnd, Zollner Ursula
Department of Gynecology and Obstetrics, Würzburg University Hospital, Würzburg, Germany.
Med Sci Monit. 2014 Jan 15;20:54-8. doi: 10.12659/MSM.889503.
Gestational diabetes mellitus (GDM) occurs in 3-5% of all pregnancies. GDM increases both maternal and fetal risks, causes fetal macrosomia, and hence increases the rates of caesarean sections and delivery complications such as shoulder dystocia. An early predictive marker and consequent early treatment could be beneficial, so amniotic fluid insulin and C-peptide have been examined in several studies. Increased amniotic fluid insulin in early amniocentesis between the 14th and 20th gestational week predicted a later GDM. A potential direct association with fetal macrosomia remains to be determined.
This retrospective study investigated amniotic fluid insulin/C-peptide from amniocenteses between 14 and 20 weeks of gestation in correlation with fetal birth weight, type of delivery, and complications. To focus on effects of fetal hyperinsulinism apart from therapeutic confounders, we included patients who did not participate in GDM screening. Insulin and C-peptide were measured in 144 samples of frozen amniotic fluid. Birth weight, type of delivery, complications, and birth injuries were noted.
Birth weights ranged from 760 g to 4410 g with a mean weight of 3424 g at an average of 40 weeks gestation. The mean amniotic fluid insulin was 4.36 U/ml and the mean C-peptide concentration was 0.076 ng/ml. There was no correlation between amniotic fluid insulin or C peptide and birth weight, type of delivery, complications, and birth injuries.
Amniotic fluid insulin and C-peptide are unsuitable as predictive marker for fetal macrosomia, type of delivery, complications, or birth injuries.
妊娠期糖尿病（GDM）在所有妊娠中发生率为3% - 5%。GDM会增加母婴风险，导致胎儿巨大，从而增加剖宫产率以及分娩并发症如肩难产的发生率。一种早期预测标志物及随之而来的早期治疗可能有益，因此在多项研究中对羊水胰岛素和C肽进行了检测。妊娠第14至20周早期羊膜腔穿刺时羊水胰岛素升高预示着后期会发生GDM。与胎儿巨大症的潜在直接关联仍有待确定。
这项回顾性研究调查了妊娠14至20周羊膜腔穿刺获取的羊水胰岛素/C肽，并将其与胎儿出生体重、分娩方式及并发症进行关联分析。为聚焦胎儿高胰岛素血症的影响而排除治疗干扰因素，我们纳入了未参加GDM筛查的患者。对144份冷冻羊水样本进行了胰岛素和C肽检测。记录了出生体重、分娩方式、并发症及出生损伤情况。
出生体重范围为760克至4410克，平均体重为3424克，平均孕周为40周。羊水胰岛素平均为4.36 U/ml，C肽平均浓度为0.076 ng/ml。羊水胰岛素或C肽与出生体重、分娩方式、并发症及出生损伤之间无相关性。
羊水胰岛素和C肽不适宜作为胎儿巨大症、分娩方式、并发症或出生损伤的预测标志物。
