Influence of glycemic control on fetal lung maturity in gestations affected by diabetes or mild hyperglycemia.
OBJECTIVE
To evaluate the influence of glycemic control on fetal lung maturity in pregnancies affected by diabetes or mild hyperglycemia.


METHODS
Cross-sectional study.


METHODS
Level III maternity center.


METHODS
A total of 187 pregnant women were submitted to routine amniocentesis for the assessment of fetal lung maturity up to 72 hours before delivery.


METHODS
Fetal lung maturity thresholds were: Clements-positive at a dilution of 0.5; OD(650) (nm)> or =0.15; and lamellar body count (LBC) > or = 32,000/microl. The relation of test results with adequate (< or =6.7 mmol/l) or poor (>6.7 mmol/l) glycemic mean (GM) at term and at preterm was evaluated.


METHODS
Delay in fetal lung maturity when glycemic control was poor.


RESULTS
Glycemic control was adequate in 146 (78.1%) women. Clements maturity rates were higher at term (91.9%) than at preterm (64.7%) when GM < or = 6.7 mmol/l (p<0.001), but not when control was inadequate. LBC median was higher at term (99.0; 62.0-154.0) than at preterm (66.5; 40.5-108.25) (p=0.009) when GM < or = 6.7 mmol/l, while GM > 6.7 mmol/l did not lead to any difference between these rates at term or preterm. When glycemic control was adequate, OD(650) (nm) medians at term and at preterm were similar. However, when GM >6.7 mmol/l, OD(650) (nm) median at term (0.29; 0.22-0.40) was higher than that observed at preterm (0.15; 0.12-0.18) (p<0.001).


CONCLUSIONS
Our results suggest that in term pregnancies routine amniocentesis for the assessment of fetal lung maturity should be abandoned. In preterm pregnancies, or when glycemic control is inadequate it is recommended.
De Luca
Ana Karina Cristiuma
AK
Department of Pediatrics, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil. anakarina@fmb.unesp.br
Nakazawa
Cristiane Yoshie
CY
Azevedo
Beatriz Camargo
BC
Rudge
Marilza Vieira Cunha
MV
De Araújo Costa
Roberto Antonio
RA
Calderon
Iracema Mattos Paranhos
IM
D000328:Adult; D000649:Amniocentesis; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000196:embryology*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology*
D001786:Blood Glucose