AMNIOTIC-FLUID INSULIN VALUES IN WOMEN WITH GESTATIONAL DIABETES AS APREDICTOR OF EMERGING DIABETES-MELLITUS

Amniotic fluid insulin levels were estimated in 30 women with insulin- dependent diabetes, 216 with gestational diabetes and 27 with normal g lucose tolerance. Results were correlated with birth-weight, incidence s of fetal macrosomia and neonatal hypoglycaemia, and the risk of the mothers with gestational diabetes developing diabetes mellitus on foll ow-up. The women with prepregnancy diabetes had significantly higher a mniotic fluid insulin values and showed a significant correlation betw een raised liquor insulin values (> 97th percentile) and hypoglycaemia in the infant (p = 0.039). In the gestational diabetic pregnancies th ere were highly significant associations between elevated liquor insul in values and macrosomia (p < 0.0045) and birth-weight (p < 0.00004), and a weak correlation with neonatal blood glucose levels (p = 0.042). Women with gestational diabetes who later developed permanent diabete s mellitus had higher mean amniotic fluid insulin levels than those wh ose glucose tolerance remained normal on follow-up (p less-than-or-equ al-to 0.0072) and more of them had a level greater than the 97th perce ntile than those whose glucose tolerance remained normal (odds ratio 6 .48, 95% confidence interval 1.51-27.8, p = 0.0094). However a high am niotic fluid insulin level was of less clinical value for detection of women destined to develop diabetes (7 of 25, 28%) than was the need f or insulin therapy during pregnancy (18 of 39, 46%).