Carpenter M W, Canick J A, Star J, Carr S R, Burke M E, Shahinian K
Department of Obstetrics and Gynecology, Brown University School of Medicine, Women & Infants Hospital of Rhode Island, Providence, USA.
Obstet Gynecol. 1996 Jan;87(1):89-93. doi: 10.1016/0029-7844(95)00361-4.
To examine the predictive value of amniotic fluid (AF) insulin at 14-20 weeks' gestation for subsequent gestational diabetes and macrosomia in unselected gravidas 35 years or older at time of genetic amniocentesis.
We identified 296 pregnancies through stored AF samples from genetic amniocenteses (collected March 1987 through August 1992) in women meeting the following criteria: age 35 years or older, amniocentesis at 14-20 weeks, performance of a 50-g glucose challenge test, and adequate delivery data.
A modified double-antibody radioimmunoassay reliably measured AF insulin with a detection limit of 0.35 microU/mL. Pregnant women in whom gestational diabetes was later diagnosed had higher median AF insulin levels than women who did not (0.60 versus 0.42 microU/mL, respectively; P = .026). A stepwise logistic regression analysis of gestational age at amniocentesis, maternal second-trimester weight, maternal age, and log AF insulin value on gestational diabetes showed only AF insulin to have a significant association with gestational diabetes (P = .004). Seven of 21 cases of gestational diabetes had AF insulin values exceeding the 95th percentile (1.33 microU/mL) compared with only 14 of 275 women with normal glucose tolerance (P < .001). Amniotic fluid insulin did not predict macrosomia in either nondiabetic or gestational diabetic pregnancies.
Gestational diabetes is associated with increased AF insulin at 14-20 weeks, suggesting augmentation of fetal insulin production in the early fetal period in at least some cases of gestational diabetes.
探讨孕14 - 20周时羊水胰岛素对接受遗传羊膜腔穿刺术时年龄在35岁及以上未选择孕妇后续发生妊娠期糖尿病和巨大儿的预测价值。
我们通过储存的1987年3月至1992年8月期间遗传羊膜腔穿刺术的羊水样本，确定了296例妊娠，这些孕妇符合以下标准：年龄35岁及以上、孕14 - 20周进行羊膜腔穿刺术、进行50克葡萄糖耐量试验以及有足够的分娩数据。
改良双抗体放射免疫分析法能可靠地检测羊水胰岛素，检测限为0.35微单位/毫升。后来被诊断为妊娠期糖尿病的孕妇羊水胰岛素中位数水平高于未患该病的孕妇（分别为0.60与0.42微单位/毫升；P = 0.026）。对羊膜腔穿刺术时的孕周、孕中期孕妇体重、孕妇年龄以及羊水胰岛素对数与妊娠期糖尿病进行逐步逻辑回归分析，结果显示只有羊水胰岛素与妊娠期糖尿病有显著关联（P = 0.004）。21例妊娠期糖尿病患者中有7例羊水胰岛素值超过第95百分位数（1.33微单位/毫升），而275例糖耐量正常的女性中只有14例超过该值（P < 0.001）。羊水胰岛素在非糖尿病或妊娠期糖尿病妊娠中均不能预测巨大儿。
妊娠期糖尿病与孕14 - 20周时羊水胰岛素增加有关，提示至少在某些妊娠期糖尿病病例中，胎儿早期胰岛素分泌增加。
