| Autor: |
U M, Schaefer-Graf, S L, Kjos, K J, Bühling, W, Henrich, M, Brauer, T, Heinze, J W, Dudenhausen, K, Vetter |
| Rok vydání: |
2003 |
| Předmět: |
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| Zdroj: |
Diabetic medicine : a journal of the British Diabetic Association. 20(5) |
| ISSN: |
0742-3071 |
| Popis: |
Fetal hyperinsulinism is a strong predictor for excessive growth and fetopathy in pregnancies complicated by diabetes. We examined (i). the relationship between measurements of amniotic fluid insulin (AF insulin) and fetal abdominal circumference (AC) at the time of amniocentesis, and (ii). whether there is a threshold for fetal AC percentiles which can identify low vs. high-risk levels of AF insulin without performing an amniocentesis.In a retrospective study, AF insulin from 121 pregnant diabetic women (32 pregestational; 89 gestational) was measured during the 3rd trimester as part of a diabetes management protocol. AC measurements were transformed into a continuous variable of percentile growth for gestational age (Hadlock). Division of the cohort according to deciles or quartiles of AC percentiles was performed to identify a threshold AC with a significant increase in elevated AF insulin, previously defined as AF insulinor= 7 microU/ml. A receiver operator characteristic (ROC) curve was created and the negative predictive value (NPV) of the determined threshold was calculated.AF insulin levels were significantly correlated with the AC percentiles (r = 0.3, P = 0.0005) by linear regression. No AC threshold could reliably identify a moderate elevated AF insulinor= 7 microU/ml (NPV 77.2%), but an AC thresholdor= 75th percentile could identify with fetal hyperinsulinism with an AF insulinor= 16 microU/ml. All 10 cases of AF insulinor= 16 microU/ml were identified with a NPV of 100% (74/74).Our data indicate that an ACor= 75th percentile determined by a 3rd trimester ultrasound examination may discriminate between pregnancies at low vs. high risk for AF insulinor= 16 microU/ml. This AF insulin concentration corresponds to a level of hyperinsulinism reported to be associated with considerable neonatal and long term morbidity. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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