[Amniotic fluid insulin levels versus mean maternal blood glucose levels in gestational diabetes mellitus: an analysis of the neonatal outcome].
OBJECTIVE
To compare the obstetric and neonatal outcome in pregnancies complicated by gestational diabetes mellitus after amniocentesis for amniotic fluid insulin measurement or maternal blood glucose monitoring or both as selection criterion for therapy.


METHODS
In a retrospective study, 408 diabetic pregnancies were analyzed; 307 were treated with diet alone (group 1) and 101 with diet and insulin (group 2). Pearson's chi2 or Fisher's exact test was used to assess obstetric and anthropometric data within these groups, and p values <0.05 were considered statistically significant.


RESULTS
Group 1 - According to the method used, no significant differences were found for gestational age at birth (p = 0.396), mode of delivery (p = 0.79) and neonatal outcome parameters determined as mean birth weight (p = 0.348), birth weight above the 75th percentile (p = 0.473), mean ponderal index (PI; p = 0.434), pH of umbilical artery (p = 0.065) and of umbilical-vein blood (p = 0.052), mean Apgar scores at 1 (p = 0.56) and 5 min (p = 0.072), insulin (p = 0.25) and glucose (p = 0.535) in cord blood. Significant differences were found for birth weight above the 90th percentile (p = 0.005) and Apgar score <7 at 1 min (p = 0.019). Group 2 - Again, no significant differences were observed in terms of gestational age at birth (p = 0.219), mode of delivery (p = 0.386), mean birth weight (p = 0.59), birth weight above the 75th (p = 0.701) and 90th percentiles (p = 0.487), mean PI (p = 0.156), pH of umbilical-artery (p = 0.197) and umbilical vein blood (p = 0.056), Apgar scores at 1 (p = 0.58) and 5 min (p = 0.52), insulin (p = 0.67) and glucose (p = 0.11) in cord blood.


CONCLUSIONS
In retrospective analysis there was no significant difference in outcome parameters in pregnancies complicated by gestational diabetes dependent on the method used as selection criterion for therapy.
Klinische Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Auenbruggerplatz 14, Graz, Austria. margit.holzapfel-bauer@medunigraz.at
Margit
M
Holzapfel-Bauer
Eva
E
Magnet
Martina
M
Eder
Josef
J
Haas
Gernot
G
Desoye
Uwe
U
Lang
D000328:Adult; D000367:Age Factors; D000653:Amniotic Fluid / Q000378:metabolism*; D000886:Anthropometry; D001034:Apgar Score; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D003927:Diet, Diabetic; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood* / Q000627:therapeutic use; D008423:Maternal Age; D008431:Maternal-Fetal Exchange / Q000187:drug effects / Q000502:physiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D055815:Young Adult
D001786:Blood Glucose; D007328:Insulin