Fadel H E, Saad S A, Davis H, Nelson G H
Department of Obstetrics and Gynecology, Medical College of Georgia Hospital and Clinics, Augusta.
Am J Obstet Gynecol. 1988 Aug;159(2):457-63. doi: 10.1016/s0002-9378(88)80108-x.
Insulin, prolactin, and lecithin phosphorus levels were measured in 97, 62, and 44 amniotic fluid samples from third trimester normal, gestational diabetic, and insulin-dependent diabetic patients, respectively. There was no difference in lecithin phosphorus concentration (index of fetal lung maturity) among the three groups. The amniotic fluid insulin level was significantly higher in insulin-dependent diabetic patients, whereas there was no difference in amniotic fluid prolactin levels among the groups. Correlations of amniotic fluid prolactin levels with both lecithin phosphorus and insulin levels were not statistically significant in any of the groups. This is probably because amniotic fluid prolactin is decidual, rather than fetal, in origin. Even though amniotic fluid insulin levels, which reflect fetal levels, were significantly higher in insulin-dependent diabetic patients, there was no difference in the amniotic fluid lecithin phosphorus concentration in diabetic pregnancies compared with that in normal pregnancies. Moreover, there was a positive, and not a negative, correlation between amniotic fluid insulin and amniotic fluid lecithin phosphorus levels in diabetic pregnancies. These results do not support the theory that fetal hyperinsulinemia results in delayed pulmonic maturation in diabetic pregnancies.
分别对97例、62例和44例来自妊娠晚期正常孕妇、妊娠期糖尿病孕妇和胰岛素依赖型糖尿病孕妇的羊水样本进行了胰岛素、催乳素和卵磷脂磷水平的测定。三组之间的卵磷脂磷浓度（胎儿肺成熟度指标）没有差异。胰岛素依赖型糖尿病患者的羊水胰岛素水平显著更高，而各组之间的羊水催乳素水平没有差异。在任何一组中，羊水催乳素水平与卵磷脂磷和胰岛素水平之间的相关性均无统计学意义。这可能是因为羊水催乳素起源于蜕膜，而非胎儿。尽管反映胎儿水平的羊水胰岛素水平在胰岛素依赖型糖尿病患者中显著更高，但与正常妊娠相比，糖尿病妊娠的羊水卵磷脂磷浓度没有差异。此外，糖尿病妊娠中羊水胰岛素与羊水卵磷脂磷水平之间呈正相关，而非负相关。这些结果不支持胎儿高胰岛素血症导致糖尿病妊娠肺成熟延迟这一理论。
