Amniotic fluid osmolality in pregnancies complicated by diabetes PENRHYN MARY
BAILEY BLAKE
BENJAMIN
YOUNGER
CLARK
HINKLEY
GEORGE
CASSADY
Birmingham, Alabama Amnioticjuid osmolality (AF Osm) was studied in 247 patients whose pregnancies were romplicated by maternal diabetes. Significant increases in mean AF Osm accompanied pre-existing fetal as well as subsequent perinatal death. Abnormal increases in AF Osm were associated with a sign$cant increase in risk of perinatal compromise with cumulative morbidity and mortality rates of 54 per cent. These data suggest that seriul evaluation oj’ AF Osm enables detection of a “higher risk” group of diabetic pregnancies in which perinatal death is more than doubled.
RELATION BETWEEN amniotic fluid osmolality (AF Osm) and fetal compromise has been a recent topic of clinical concern in perinatal medicine.‘+ Definitive data concerning this relation, particularly in the pregnancy complicated by diabetes, are sparse.’ The present report attempts to provide preliminary data in this regard.
available, while in 128 serial samples were obtained. Duration of gestation was estimated from menstrual history and confirmed in many cases with fetal sonar measurements as well as by Dubowitz8 examination of the newborn infant. Criteria for diagnosis of gestational diabetes were similar to those of O’Sullivan and associates,g the diagnosis of Class A diabetes being made if whole blood glucose exceeded 110 mg. per cent (fasting), 170 mg. per cent (one hour), 120 mg. per cent (two hours), or 110 mg. per cent (three hours) following a 100 Cm. oral glucose load (GTT). Class AD diabetes (gestational diabetes with carbohydrate decompensation) was diagnosed if whole blood glucose exceeded 120 mg. per cent (fasting) or 180 mg. per cent (two hours) after GTT or if whole blood glucose exceeded 300 mg. per cent at any time. Severity of insulin-requiring diabetes (Classes B to D) was estimated with the criteria of White and co-workers.‘O Electronic fetal monitoring was performed in many patients and both one- and five-minute Apgar scores were determined at delivery for all patients. Those with electronic evidence of type II fetal bradycardia,” predelivery passage of meconium, and/or one- or five-minute Apgar scores of 56 were considered to have perinatal asphyxia. Following delivery, most of these infants were cared for in the University HighRisk Nursery where they were screened for biochemical evidence of hypoglycemia (serum “true sugar” ~30 mg. per cent if three times those of our population as a whole during the same years (perinatal mortality rate 85.0 in stud) groupi30.6 in total population 1970 to 1972). In nearl) one third of the perinatal patients, asphyxia and/or hypoglycemia was documented (77/247) and one in five was large for gestational age (491247). Fetal growth retardation was no more common in these patients (26/247 = 10.5 per cent) than that in the general population (ten per cent by definition13). Table II summarizes the effect that severity of maternal diabetes had on the frequency of certain clinical problems. Excess perinatal death was confined
Amniotic fluid osmolality and diabetes
Table
IV.
Relation
of amniotic
fluid osmolality
to certain
clinical
findings
259
in the study pregnancies
Number Patient
group
Osmolality* (mOsm. /Kg.)
of
fluids
Perinatal morbidity Yes NO Fetal death Yes NO
Neonatal death Yes No Altered fetal growth Macrosomia IGR Normal fetal growth Severity of disease Class A Class AD Class B-D Vascular disease Yes No Gestational ages at time of sampling *Mean + one standard deviation.
167 277
258.4 255.8
k 11.2 k 11.0
BAILEY BLAKE
BENJAMIN
YOUNGER
CLARK
HINKLEY
GEORGE
CASSADY
Birmingham, Alabama Amnioticjuid osmolality (AF Osm) was studied in 247 patients whose pregnancies were romplicated by maternal diabetes. Significant increases in mean AF Osm accompanied pre-existing fetal as well as subsequent perinatal death. Abnormal increases in AF Osm were associated with a sign$cant increase in risk of perinatal compromise with cumulative morbidity and mortality rates of 54 per cent. These data suggest that seriul evaluation oj’ AF Osm enables detection of a “higher risk” group of diabetic pregnancies in which perinatal death is more than doubled.
RELATION BETWEEN amniotic fluid osmolality (AF Osm) and fetal compromise has been a recent topic of clinical concern in perinatal medicine.‘+ Definitive data concerning this relation, particularly in the pregnancy complicated by diabetes, are sparse.’ The present report attempts to provide preliminary data in this regard.
available, while in 128 serial samples were obtained. Duration of gestation was estimated from menstrual history and confirmed in many cases with fetal sonar measurements as well as by Dubowitz8 examination of the newborn infant. Criteria for diagnosis of gestational diabetes were similar to those of O’Sullivan and associates,g the diagnosis of Class A diabetes being made if whole blood glucose exceeded 110 mg. per cent (fasting), 170 mg. per cent (one hour), 120 mg. per cent (two hours), or 110 mg. per cent (three hours) following a 100 Cm. oral glucose load (GTT). Class AD diabetes (gestational diabetes with carbohydrate decompensation) was diagnosed if whole blood glucose exceeded 120 mg. per cent (fasting) or 180 mg. per cent (two hours) after GTT or if whole blood glucose exceeded 300 mg. per cent at any time. Severity of insulin-requiring diabetes (Classes B to D) was estimated with the criteria of White and co-workers.‘O Electronic fetal monitoring was performed in many patients and both one- and five-minute Apgar scores were determined at delivery for all patients. Those with electronic evidence of type II fetal bradycardia,” predelivery passage of meconium, and/or one- or five-minute Apgar scores of 56 were considered to have perinatal asphyxia. Following delivery, most of these infants were cared for in the University HighRisk Nursery where they were screened for biochemical evidence of hypoglycemia (serum “true sugar” ~30 mg. per cent if three times those of our population as a whole during the same years (perinatal mortality rate 85.0 in stud) groupi30.6 in total population 1970 to 1972). In nearl) one third of the perinatal patients, asphyxia and/or hypoglycemia was documented (77/247) and one in five was large for gestational age (491247). Fetal growth retardation was no more common in these patients (26/247 = 10.5 per cent) than that in the general population (ten per cent by definition13). Table II summarizes the effect that severity of maternal diabetes had on the frequency of certain clinical problems. Excess perinatal death was confined
Amniotic fluid osmolality and diabetes
Table
IV.
Relation
of amniotic
fluid osmolality
to certain
clinical
findings
259
in the study pregnancies
Number Patient
group
Osmolality* (mOsm. /Kg.)
of
fluids
Perinatal morbidity Yes NO Fetal death Yes NO
Neonatal death Yes No Altered fetal growth Macrosomia IGR Normal fetal growth Severity of disease Class A Class AD Class B-D Vascular disease Yes No Gestational ages at time of sampling *Mean + one standard deviation.
167 277
258.4 255.8
k 11.2 k 11.0
