The use of lamellar body counts to predict fetal lung maturity in pregnancies complicated by diabetes mellitus.
OBJECTIVE
The purpose of this study was (1) to correlate amniotic fluid lamellar body counts with the lecithin/sphingomyelin ratio and the presence of phosphatidylglycerol in pregnancies that were complicated by maternal diabetes mellitus and (2) to determine a lamellar body count value that maximizes sensitivity and specificity in the prediction of fetal lung maturity.


METHODS
We reviewed our prospectively collected perinatal database from November 1992 through October 1999 to identify pregnancies that were complicated by diabetes mellitus for which fetal lung maturity studies had been performed within 72 hours of delivery. Lamellar body counts were correlated with lecithin-sphingomyelin ratio and phosphatidylglycerol values. The sensitivities and specificities of various lamellar body count cutoff values were calculated with the lecithin/sphingomyelin ratio and phosphatidylglycerol values as indicators of fetal lung maturity. Receiver operating curves were used to determine the lamellar body count that indicated fetal lung maturity. Our neonatal database was reviewed for this same time period to obtain all cases of respiratory distress syndrome. The maternal data were compared with the neonatal data to determine whether distress syndrome had developed in an infant who had undergone fetal lung maturity testing respiratory.


RESULTS
Lamellar body counts were correlated with lecithin/sphingomyelin ratio (r = 0.51, P <.001) and phosphatidylglycerol values (r = 0.57, P <.001) in 90 diabetic pregnant patients. A lamellar body count of 37,000/microL was found to have a sensitivity of 80% and a specificity of 100% in the prediction of fetal lung maturity by standardized methods of phospholipid analysis. There were no cases of neonatal respiratory distress syndrome in this study population.


CONCLUSIONS
The lamellar body count is a valid, rapid screening test for the determination of biochemical fetal lung maturity in pregnancies that are complicated by diabetes mellitus. A lamellar body count of > or =37,000/microL correlated with the lecithin/sphingomyelin ratio and phosphatidylglycerol values in the pregnancies of diabetic patients. Use of lamellar body counts in pregnancies that are complicated by diabetes mellitus could decrease the need for time-consuming and more costly phospholipid profiles. A full phospholipid profile is recommended for amniotic fluid specimens with lamellar body count values of <37,000/microL.
DeRoche
Michael E
ME
Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT, USA.
Ingardia
Charles J
CJ
Guerette
Paula J
PJ
Wu
Alan H
AH
LaSala
Christine A
CA
Mandavilli
Srinivas R
SR
D000653:Amniotic Fluid / Q000378:metabolism*; D005260:Female; D005325:Fetal Organ Maturity; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008168:Lung / Q000196:embryology*; D010713:Phosphatidylcholines / Q000378:metabolism; D010715:Phosphatidylglycerols / Q000378:metabolism; D010743:Phospholipids / Q000378:metabolism*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000378:metabolism / Q000503:physiopathology*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000378:metabolism*; D012372:ROC Curve; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012680:Sensitivity and Specificity; D013109:Sphingomyelins / Q000378:metabolism
D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; D010743:Phospholipids; D011663:Pulmonary Surfactants; D013109:Sphingomyelins