Fetal lung maturity in pregnancies complicated by insulin-dependent and gestational diabetes: a matched cohort study

Objective. To study fetal lung maturity (FLM) as determined by amniotic flu id (AF) tests in diabetic pregnancies (DP) under euglycemic metabolic contr ol, in comparison with matched controls (C). Patients and methods. From 514 consecutive pregnancies where amniocentesis was performed for FLM assessment, we selected 45 glycemic controlled DP. Ni neteen DP were Type I (IDDM) and 26 pregnancies were diagnosed Type III (GD M). Cases were matched to C by therapy with corticosteroids, gestational ag e at amniocentesis, pregnancy complications other than diabetes and gender. FLM was determined by the shake test and lamellar bodies (LB) count, lecit hin/sphingomyelin (L/S) ratio (planimetric and stechiometric) and phosphati dylglycerol presence (PG). DP were further sub-divided according to gestati onal age period at amniocentesis, type of diabetes, associated therapy and fetal malformations. Results. RDS (n = 2) and neonatal wet lung (n = 5) were diagnosed in neonat es from diabetic mothers. We found no statistical difference when comparing FLM indices between DP and C groups: shake test 3.1:1 +/- 1.2 vs. 2.7:1 +/ - 1.2, P < 0.40; planimetric L/S 3.4 +/- 1.4 vs. 3.1 +/- 2.0, P < 0.27; ste chiometric L/S 8.2 +/- 7.4 vs. 7.1 +/- 6.1, P < 0.54; percentage of PG posi tivity 57% vs. 46%, P < 0.13; lamellar bodies count (x10(3)/mu l) 42.8 +/- 36.9 vs. 41.5 +/- 30.4, P < 0.72. NO differences were found between DP and controls for subgroups according to gestational age, type of Diabetes (IDDM or GDM), congenital lesions and associated therapy. Conclusions. In euglycemic, metabolically controlled diabetic patients FLM is not delayed, however an increased risk for neonatal wet lung should be c onsidered. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.