Fetal Anterior Wall Thickness and Amniotic Fluid Insulin Levels: an Interdependence?

Zusammenfassung

Ziel: Die exzessive fetale Fettansammlung als Folge des fetalen Hyperinsulinismus ist eine der Komplikationen beim Gestationsdiabetes (GDM). Eine nicht invasive Methode für die fetale Überwachung beim GDM ist notwendig. Das Ziel dieser Studie war es, zu evaluieren, ob die fetale anteriore Bauchwanddicke (AAWT) eine frühe Prädiktion des Hyperinsulinismus mit Ultraschall ermöglicht. Material und Methoden: Bei 220 Frauen mit Gestationsdiabetes (diagnostiziert mit einem 75 g oGTT in der 24.–28. SSW) wurde zwischen der 28. und 32. Schwangerschaftswoche eine Amniozentese durchgeführt. Die Fruchtwasserinsulinwerte (AFIL) wurden mittels eines kommerziell erhältlichen Radioimmunoassays bestimmt. Die biometrischen Daten einschließlich des AAWT wurden mittels transabdominalen Ultraschalls ermittelt. Die maternalen Parameter (Gewicht, BMI, oGTT-Blutzuckerwerte sowie mittlere Blutglukosewerte) wurden mit den fetalen biometrischen Daten einschließlich AAWT und mit den AFIL-Werten korreliert. Ergebnisse: Die AAWT-Werte korrelierten nicht mit den AFIL-Werten. Es konnte auch keine Korrelation zwischen den AFIL-Werten und allen anderen fetalen Parametern wie auch mit den oGTT-Resultaten gezeigt werden. Die AFIL-Werte zeigten nur mit dem maternalen Gewicht (p = 0,02) und BMI (p = 0,01), sowohl vor der Schwangerschaft als auch zum Zeitpunkt der Amniozentese, eine signifikante Korrelation. Schlussfolgerung: AAWT-Messungen im frühen dritten Trimenon korrelieren nicht mit fetalen Insulinwerten.

Abstract

Purpose: Excessive fetal fat as the hallmark of GDM pregnancy complications is one consequence of fetal hyperinsulinism. Noninvasive methods for fetal surveillance and measurement of fetal fat are needed. The purpose of this study was to test the hypothesis that measurements of the fetal anterior abdominal wall thickness (AAWT) in women with GDM will allow early detection of fetal hyperinsulinism. Materials and Methods: Amniocentesis was performed between 28 and 32 weeks of gestation (wks) in 220 women with GDM (diagnosed by 75 g oGTT at 24 to 28 wks). Amniotic fluid insulin levels (AFIL) were determined by a commercially available radioimmunoassay. Transabdominal ultrasound provided fetal biometric measurements following standard procedures and the AAWT including fetal skin and subcutaneous tissue at the time of amniocentesis. Maternal parameters (weight, BMI, oGTT blood glucose levels and mean daily blood glucose levels) were correlated with fetal biometric data and with AFIL. Results: There was no difference in AAWT in women with GDM and no correlation with mean AFIL. AFIL also did not correlate with any other fetal measurement or with mean oGTT blood glucose levels. AFIL only showed a correlation with maternal weight (p = 0.02) and maternal BMI (p = 0.01). The correlation was present for values both before pregnancy and at the time of amniocentesis. Conclusion: In the early third trimester, AAWT measurements do not correlate with fetal insulin levels.

Key words

abdominal wall - ultrasound 2D - metabolic disorders - anterior abdominal wall thickness - amniotic fluid insulin levels

References

• 1 Metzger B E, Lowe L P. HAPO Study Cooperative Research Group et al . Hyperglycemia and adverse pregnancy outcomes.  N Engl J Med. 2008;  358 1991-2002
• 2 Fraser R. Gestational diabetes mellitus: developments in diagnosis and treatment.  Women’s Health. 2009;  5 263-268
• 3 Bánhidy F, Acs N, Puhó E H et al. Congenital abnormalities in the offspring of pregnant women with type 1, type 2 and gestational diabetes mellitus: a population-based case-control study.  Congenit Anom. 2010;  50 115-121
• 4 Wroblewska-Seniuk K, Wender-Ozegowska E, Szczapa J. Long-term effects of diabetes during pregnancy on the offspring.  Pediatr Diabetes. 2009;  10 432-440
• 5 Persson B, Heding L G, Lunell N O et al. Fetal beta cell function in diabetic pregnancy. Amniotic fluid concentrations of proinsulin, insulin, and C-peptide during the last trimester of pregnancy.  Am J Obstet Gynecol. 1982;  144 455-459
• 6 Esakoff T F, Cheng Y W, Sparks T N et al. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus.  Am J Obstet Gynecol. 2009;  200 672.e1-674
• 7 Vohr B R, Boney C M. Gestational diabetes: the forerunner for the development of maternal and childhood obesity and metabolic syndrome?.  J Matern Fetal Neonatal Med. 2008;  21 149-157
• 8 Pedersen J. Diabetes and pregnancy; blood sugar of newborn infants during fasting and glucose administration.  Nord Med. 1952;  47 1049
• 9 Freinkel N. Banting Lecture 1980. Of pregnancy and progeny.  Diabetes. 1980;  29 1023-1035
• 10 Nolan C J, Proietto J. The feto-placental glucose steal phenomenon is a major cause of maternal metabolic adaptation during late pregnancy in the rat.  Diabetologia. 1994;  37 976-984
• 11 Weiss P A, Kainer F, Haeusler M et al. Amniotic fluid insulin levels in nondiabetic pregnant women: an update.  Arch Gynecol Obstet. 1998;  262 81-86
• 12 Higgins M F, Russell N M, Mulcahy C H et al. Fetal anterior abdominal wall thickness in diabetic pregnancy.  Eur J Obstet Gynecol Reprod Biol. 2008;  140 43-47
• 13 Weiss P A, Haeusler M, Tamussino K et al. Can glucose tolerance test predict fetal hyperinsulinism.  BJOG. 2000;  107 1480-1485
• 14 Kautzky-Willer A, Bancher-Todesca D, Repa A et al. Gestationsdiabetes (GDM).  Wien Klin Wochenschr. 2007;  119 49-53
• 15 White P. Classification of obstetric diabetes.  Am J Obstet Gynecol. 1978;  130 228-230
• 16 Chitty L S, Altman D G, Henderson A et al. Charts of fetal size. 3. Abdominal measurements.  BJOG. 1994;  101 125-131
• 17 Hadlock F. Ultrasound assessment of fetal growth. In Callen P, editor Ultrasonography in obstetrics and gynaecology.. 3rd ed. WB Saunders; 1994. 3rd ed.
• 18 Hadlock F P, Harrist R B, Sharman R S et al. Estimation of fetal weight with the use of head, body, and femur measurements -a prospective study.  Am J Obstet Gynecol. 1985;  151 333-337
• 19 Voigt M. Methodische Aspekte der Berechnung von Normwertkurven für das Geburtsgewicht. 120. Tagung DGGG Rostock; 2004
• 20 Haeusler M C, Konstantiniuk P, Dorfer M et al. Amniotic fluid insulin testing in gestational diabetes: safety and acceptance of amniocentesis.  Am J Obstet Gynecol. 1998;  179 917-920
• 21 Durnwald C, Huston-Presley L, Amini S et al. ation of body composition of large-for-gestational-age infants of women with gestational diabetes mellitus compared with women with normal glucose tolerance levels.  Am J Obstet Gynecol. 2004;  191 804-808
• 22 Greco P, Vimercati A, Hyett J et al. The ultrasound assessment of adipose tissue deposition in fetuses of “well controlled” insulin-dependent diabetic pregnancies.  Diabet Med. 2003;  20 858-862
• 23 Schaefer-Graf U M, Kjos S L, Bühling K J et al. Amniotic fluid insulin levels and fetal abdominal circumference at time of amniocentesis in pregnancies with diabetes.  Diabet Med. 2003;  20 349-354
• 24 Kainer F, Weiss P A, Hüttner U et al. Ultrasound growth parameters in relation to levels of amniotic fluid insulin in women with diabetes type-I.  Early Hum Dev. 1997;  49 113-121
• 25 Karcaaltincaba D, Buyukkaragoz B, Kandemir O et al. Gestational Diabetes and Gestational Impaired Glucose Tolerance in 1653 Teenage Pregnancies: Prevalence, Risk Factors and Pregnancy Outcomes.  J Pediatr Adolesc Gynecol. 2010;  Epub ahead of print
• 26 Bühling K J, Mönnich J, Henrich W et al. Association between amniotic fluid insulin in the second trimester, maternal glucose tolerance and fetal malformations.  Z Geburtshilfe Neonatol. 2004;  208 226-231
• 27 Buchanan T A, Kjos S L, Montoro M N et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes.  Diabetes Care. 1994;  17 275-283
• 28 Rigano S, Ferrazzi E, Radaelli T et al. Sonographic Measurements of Subcutaneous Fetal Fat in Pregnancies Complicated by Gestational Diabetes and in Normal pregnancies.  Croat Med J. 2000;  41 240-244
• 29 Parretti E, Carignani L, Cioni R et al. Sonographic evaluation of fetal growth and body composition in women with different degrees of normal glucose metabolism.  Diabetes Care. 2003;  26 2741-2748
• 30 Farah N, Harrold E, Fattah C et al. Are there sex differences in Fetal Abdominal Subcutaneous Tissue (FAST) Stuart Bmeasurements?.  Eur J Obstet Gynecol Reprod Biol. 2010;  148 118-120