INDICATION AND RESULTS OF INSULIN THERAPY FOR GESTATIONAL DIABETES-MELLITUS

The aim of this study was to determine whether amniotic fluid insulin concentration (AFI) is a better parameter than mean maternal blood glu cose values (MBG) for deciding about insulin therapy in patients with gestational diabetes. MBG's were calculated on the base of 9 blood glu cose levels during a 24 hour period after one week of diet therapy. In a prospective trial between 1987 and 1989 in Karlsburg, 123 gestation al diabetic patients were randomized into two groups. Treatment was ei ther based on the concentration of AFI or MBG levels. In a second seri es in Berlin, 103 patients were offered amniocentesis. 81 patients agr eed and 22 refused. Treatment was then analogous to that in Karlsburg. In both groups of the randomized population, strict metabolic control was achieved. There was no difference regarding pregnancy complicatio ns. Earlier labor induction and higher cesarean section rates were see n in the non-invasive group (p < 0.05). The incidence of dia betic fet opathy and neonatal hypoglycemia was significantly lower in the invasi ve group (p < 0.01), even though the metabolic control parameters did not differ between the two groups. The results in Berlin correspond to these findings. In conclusion, AFI enables the recognition of any hyp erinsulinism reaction to the maternal metabolic situation. We recommen d the additional measurement of the AFI concentration between 28 and 3 6 weeks as the direct fetal parameter for deciding about insulin treat ment.