USE OF THE TDX-FLM ASSAY IN EVALUATING FETAL LUNG MATURITY IN AN INSULIN-DEPENDENT DIABETIC POPULATION

Objective: To assess the usefulness of the recently introduced TDx-FLM assay in managing pregnant women with diabetes. Methods: Participatin g institutions were recruited from the 1993 and 1994 Society of Perina tal Obstetricians Diabetes Special Interest Group meetings. Study pati ents consisted of insulin-dependent diabetic women who had undergone t ransabdominal amniocentesis with assay of the fluid by the TDx-FLM met hod. Pertinent data were requested concerning pregnancy and respirator y outcomes of the corresponding neonates. Results: Data from 261 pregn ancies at 13 institutions were collected. Eight of the 182 infants bor n within 4 days of amniocentesis developed respiratory distress syndro me (RDS); five of the eight infants with RDS required intubation, and all five had TDx-FLM values less than 70 mg of surfactant per gram of albumin. Three of the eight infants with RDS required hood oxygen only ; two of these infants had TDx-FLM values at least 70 mg/g. Thirteen o f 144 (9%) subjects who delivered within 4 days of amniocentesis and f or whom a TDx-FLM assay and phosphatidylglycerol level were both repor ted had a TDx-FLM level of at least 70 mg/g and a negative phosphatidy lglycerol result. No infant with this combination of results developed RDS. Fifteen of the 40 patients who delivered more than 4 days after amniocentesis, with both tests available, had TDx-FLM values at least 70 mg/g and were phosphatidylglycerol negative. Conclusion: In infants of diabetic mothers, TDx-FLM values at least 70 mg/g were not associa ted with RDS requiring intubation. The TDx-FLM assay may be useful in determining the best time of delivery for pregnant patients with diabe tes.