CORD-BLOOD INSULIN TO ASSESS THE QUALITY OF TREATMENT IN DIABETIC PREGNANCIES

According to the Pedersen hypothesis, fetal hyperinsulinism is the maj or cause for adverse neonatal outcome. We investigated associations be tween insulin levels in cord blood and fetal complications. Three grou ps of 21 insulin-dependent diabetic patients with different insulin le vels in cord blood were matched according to White Classes. Insulin le vels in cord blood of < 20 mu U/ml were considered normal (controls), 20-50 mu U/ml intermediate group, and > 50 mu U/ml high (cases). The m ean(+/-S.D.) insulin level in cord blood in the three groups was 10.7/-5.6, 28.6+/-8.1, and 103.0+/-61.0 mu U/ml, respectively. Controls an d cases showed significant differences in birth weight >90th percentil e (9.5% vs. 76.2%), premature birth < 37 weeks (4.8% vs. 71.4%), caesa rean delivery (28.6% vs. 66.4%), hypoglycaemia of the neonate (14.3% v s. 61.9%), cushingoid appearance (4.8% vs. 42.9%) and respiratory dist ress syndrome (0% vs. 33.3%). The results of the intermediate group we re between the controls and the cases. Insulin levels in cord blood >2 0 mu U/ml represent a continuum of increasing diabetogenic fetopathy. We consider neonates with insulin levels in cord blood < 20 mu U/ml as metabolically healthy, those with 20-50 mu U/ml as having mild fetopa thy, and those with > 50 mu U/ml as having marked fetopathy, respectiv ely. (C) 1998 Elsevier Science Inland Ltd. All rights reserved.