Amniotic Fluid Glucose Concentration Research Articles

Association and Correlation Between Amniotic Fluid Index and Glucose Concentration.

Purpose: To study the association and correlation between the amniotic fluid index, random glucose concentration, and serum glucose concentration after avoiding oral intake of sugar in a pregnant female with polyhydramnios.Methods: The research was performed on pregnant women with polyhydramnios (n=104 ) after 28 weeks. USG was performed using a SAMSUNG HS 70A (Samsung Electronics Pvt. Ltd., Seoul, South Korea) and a GE Voluson P8 (GE Healthcare, Little Chalfont, UK). We measured amniotic fluid index and took a blood sample for hemoglobin (Hb)A1C, fasting blood glucose, post-prandial and random blood glucose, and also performed a glucose tolerance test in pregnant women.Results: This is a prospective study, all 104 patients that were recruited in this study were pregnant females with polyhydramnios mainly from the urban and rural zone with different age groups (between 21 and 37 years). In our study, we observed that after avoiding oral intake of sugar in pregnant females with polyhydramnios, it was concluded that the amnionic fluid index lies towards the lower side. Polyhydramnios is more common in the urban zone and among older pregnant females. Out of 104 pregnant females with polyhydramnios, 82 were diagnosed with gestational diabetes after 28 weeks.Conclusion: In this study, we have concluded that the earliest and most sensitive predictor for gestational diabetes is a rise in the amniotic fluid index which could have been prevented by avoiding oral intake of sugar. Early prediction of gestational diabetes can be made by amniotic fluid index even before glucose concentration. We observed that by reducing oral intake of sugar, the amniotic fluid index drops down in pregnant females

Canine Neonatal Assessment by Vitality Score, Amniotic Fluid, Urine, and Umbilical Cord Blood Analysis of Glucose, Lactate, and Cortisol: Possible Influence of Parturition Type?

Simple SummaryParturition as a stressful event may influence puppies’ neonatal morbidity and mortality. The purpose of this study was to investigate the impact of parturition type on stress in newborn puppies, their weight gains, and survival in the first week postpartum. One hundred and twenty-three puppies were divided into three groups: vaginal parturition, emergency, and elective cesarean section. The Apgar score was assessed 5, 15, and 60 min postpartum, and samples of amniotic fluid, umbilical blood, and urine were collected for lactate, glucose, and cortisol concentration measurements. Although emergency cesarean section puppies had the highest cortisol concentration of all groups, their Apgar score at 5 min postpartum was comparable to the vaginal parturition group, which had the highest lactate levels. There were no significant differences between groups regarding relative growth rate. The type of parturition had no impact on puppies’ survival in our study, but supportive treatment was provided for non-vital puppies in stress. Non-invasive analysis of amniotic fluid and/or urine could help in the assessment of the neonatal vitality.The objective of this study was to investigate the impact of parturition type on vitality in newborn puppies, their weight gains, and survival in the first week postpartum. One hundred and twenty-three puppies were divided in three groups: vaginal parturition (VP), emergency (EM-CS), and elective cesarean section (EL-CS). Apgar scores were assessed 5, 15, and 60 min postpartum. Lactate and glucose concentrations were measured in amniotic fluid and umbilical blood; cortisol concentrations were measured in amniotic fluid and puppy urine. Puppies’ weight gain was tracked daily for 7 days postpartum. Apgar score at 5 and 15 min was significantly better in the VP group. EL-CS puppies had significantly lower umbilical blood and amniotic fluid lactate concentrations compared to the VP group, which also had higher umbilical blood lactate concentration than EM-CS puppies. The cortisol concentration in the amniotic fluid and in urine differed significantly between the groups, with the highest concentration in the EM-CS, followed by the VP group. Glucose concentration in amniotic fluid was higher in the VP group than EM-CS group. The type of parturition had no impact on puppies’ weight gain or their survival at birth; however, supportive treatment was provided for non-vital puppies. Non-invasive analysis of puppies’ fluids could help in the assessment of the neonatal vitality.

Prediction of early neonatal infection in pregnancies with prelabour rupture of membranes

Background: The uncertainty of predicting which pregnancies will have early onset neonatal infection (EONI) with prelabour rupture of membranes (PROM) is a challenge to obstetricians because presence of this condition impacts the decision to do expectant or active management of the case. The most common maternal markers of infection used in our practice are C-reactive protein, white blood cell count, and amniotic fluid glucose concentration. Objective: The primary objective of the study is to evaluate the accuracy of measuring C-reactive protein and leukocytes in maternal serum and amniotic fluid glucose concentration to predict early onset neonatal infection. The secondary objective of the study is to determine maternal fetal outcome in pregnancies with prelabour rupture of membranes. Material and methods: This prospective cross-sectional study enrolled 170 pregnant patients who experienced prelabour rupture of chorioamniotic membranes.. The maternal serum and amniotic fluid samples were taken at admission and later used to analyze whether/how the test results were a predictor of early onset neonatal infection. Results: Â C-reactive protein concentrations were significantly associated with early onset neonatal infection. Maternal CRP had 92.0% sensitivity and specificity of 62.8 % for predicting early onset neonatal infection. Maternal serum white blood cell count and amniotic fluid glucose concentrations estimation after pre-labour rupture of membranes showed poor predictive value in neonatal early onset infection. Conclusion: C-reactive protein was more sensitive in predicting Early Onset Neonatal Infection than either white blood cell count or amniotic fluid glucose concentration.

Amniotic fluid rapid biomarkers are associated with intra-amniotic infection in preterm pregnancies regardless of the membrane status.

The objective of this study was to evaluate the association of amniotic fluid lactate dehydrogenase and glucose concentrations with microbial invasion of amniotic cavity and histologic chorioamnionitis before 37 pregnancy weeks in women with or without preterm premature rupture of membranes. Amniocentesis was performed on 70 women with suspected intra-amniotic infection. Standard biochemical methods, molecular microbiology and culture techniques were used. Histopathological examination of the placenta was performed. Thirty (48%) women had microbial invasion of the amniotic cavity (MIAC), 53 (76%) women had histological chorioamnionitis and 28 women had both. The cutoff values for MIAC and histological chorioamnionitis were 429 IU l(-1) for lactate dehydrogenase and 0.7 mmol l(-1) for glucose. Both end points occurred equally often regardless of the membrane status. Increased amniotic fluid lactate dehydrogenase and decreased glucose were associated with MIAC and histological chorioamnionitis. However, test performance was of limited value.

Subsequent gestational diabetes mellitus prediction in advanced maternal age using amniotic fluid glucose concentration during second trimester genetic amniocentesis

This prospective study aimed to present the reference range of amniotic fluid glucose (AFglu) among second trimester pregnant women in southern Thailand, to evaluate the possibility of predicting subsequent gestational diabetes mellitus (GDM) using AFglu, and to estimate AFglu cut-off levels for identifying pregnancies at high or low risk for subsequent GDM in singleton pregnancies undergoing genetic amniocentesis due to advanced maternal age. A total of 438 eligible pregnant women were analysed, among whom 58 were subsequently diagnosed as having GDM. The reference range that included the central 95% of AFglu values at 16, 17 and 18 weeks of gestation in women not subsequently developing GDM was determined from a linear regression model. Logistic regression was used to identify predictors of subsequent GDM. Odds ratio of subsequent diagnosed GDM participant increased by 7% for each 1 mg/dl increase in AFglu. Risk of subsequent GDM was also increased in women aged over 36 years and in 17–18 weeks compared to 16 weeks of gestation. Depending on gestational and maternal age, AFglu levels above 51 to 75 mg/dl were at elevated risk of subsequent GDM (likelihood ratio 2.38). We conclude that AFglu tended to decrease with increasing of gestational age. Gestational age and maternal age accompanied with elevated AFglu are predictive factors for subsequent GDM.

Vaginally obtained amniotic fluid samples in the diagnosis of subclinical chorioamnionitis.

Preterm birth is often caused by infection or inflammation. High concentration of lactate dehydrogenase and low concentration of glucose in amniotic fluid obtained by amniocentesis are associated with subclinical chorioamnionitis. We evaluated amniotic fluid lactate dehydrogenase and glucose concentrations in relation to histologic chorioamnionitis in vaginally obtained samples. In a prospective study, vaginally obtained amniotic fluid samples were collected from 53 women with preterm prelabor rupture of membranes at 23(+4) to 34(+5) weeks of gestation at University Hospital, Helsinki, Finland. Amniotic fluid lactate dehydrogenase and amniotic fluid glucose were measured by immunochemiluminometric assays. Histopathologic examination of placenta was performed. The main outcome measure was histologic chorioamnionitis. Median concentration of vaginally obtained amniotic fluid lactate dehydrogenase was higher in women with histologic chorioamnionitis than in women without (1400 IU/L vs. 784.5 IU/L, p = 0.005). By receiver operating characteristics curve the optimal cut-off for amniotic fluid lactate dehydrogenase in relation to histologic chorioamnionitis was 1029 IU/L (sensitivity 65%, specificity 69%, positive predictive value 83% and negative predictive value 46%). Amniotic fluid lactate dehydrogenase concentrations showed striking fluctuation in repeat samples. Amniotic fluid glucose concentrations did not differ among women with or without histologic chorioamnionitis (0 mmol/L vs. 0.65 mmol/L, p = 0.20). Elevated amniotic fluid lactate dehydrogenase was associated with histologic chorioamnionitis, but decreased amniotic fluid glucose was not. However, the clinical value of vaginally obtained amniotic fluid lactate dehydrogenase is limited because of high sample-to-sample variability. Better biomarkers for optimal timing of delivery in women with preterm prelabor rupture of membranes are needed.

Second trimester maternal plasma and amniotic fluid adipokines in women who will develop gestational diabetes mellitus

Objective: To study the adipokines concentration and glucose homoeostasis in the early-second trimester of women who will develop gestational diabetes mellitus (GDM).Materials and methods: Maternal plasma and fetal amniotic fluid samples were prospectively collected between 2006 and 2007 at the time of mid-trimester amniocentesis. Eight patients found to be affected by GDM were compared with 10 control patients with a normal pregnancy course. Adipokines leptin and adiponectin, as well as insulin and glucose concentration both in amniotic fluid and maternal plasma were compared between cases and controls. HOMA-IR (homeostatic model assessment for insulin resistance) was also calculated both for amniotic fluid and maternal serum.Results: The amniotic fluid adiponectin concentration was higher in women who would develop GDM than in controls (29.9 ng/ml, 95% CI 26.7–49.8 ng/ml, versus 14.9 ng/ml, 95% CI 13.5–18.8 ng/ml), p < 0.05). No difference was shown for leptin both in amniotic fluid and maternal serum. Insulin concentrations in the amniotic fluid were found to be lower in GDM than in controls, while HOMA-IR-index resulted lower in amniotic fluid and higher maternal serum (p < 0.05).Conclusions: Our data suggests that an earlier alteration in the fetal glucose metabolism will precede the glucose dysmetabolism in pregnancies later complicated by GDM.

Second trimester amniotic fluid glucose, uric acid, phosphate, potassium, and sodium concentrations in relation to maternal pre-pregnancy BMI and birth weight centiles

Objective: To study the evolution profile of amniotic fluid (AF) glucose, uric acid, phosphate, potassium, and sodium, in the second trimester of pregnancy, and explore the possible relations between the concentration of these components and maternal, as well as neonatal characteristics.Methods: AF of 52 pregnant women was analyzed using an automatic multichannel analyzer. Maternal age, pre-pregnancy Body Mass Index (BMI), inter-pregnancy intervals, and smoking status were derived from questionnaires. Information on pregnancy and delivery was collected from medical records.Results: Uric acid increased (r = 0.423, p < 0.01), while phosphate and glucose concentrations decreased during the period of 16–26th week of pregnancy (r = −0.590, p < 0.001 and r = −0.314, p < 0.05, respectively). Maternal pre-pregnancy BMI was significantly correlated with AF uric acid concentration (r = 0.460, p < 0.01) and marginally with AF glucose (r = 0.274, p = 0.052) and sodium (r = 0.254, p = 0.070) levels. Multiple linear regression indicated that mid-trimester AF uric acid and phosphate levels were significantly related to birth weight centiles (R2 = 0.345, p < 0.05).Conclusions: Our results suggest that: (a) AF phosphate levels reflect gestational age to a satisfactory extent, (b) maternal pre-pregnancy BMI is significantly correlated with AF uric acid concentration, and (c) in appropriate for gestational age infants, AF phosphate and uric acid levels may serve as potential biomarkers of birth weight centiles. Further studies on AF composition may help to unravel the biochemical pathways underlying fetal development and could offer insight on the potential impact of maternal nutritional management on fetal growth regulation.

Bacteria and endotoxin in meconium-stained amniotic fluid at term: could intra-amniotic infection cause meconium passage?

Background: Meconium-stained amniotic fluid (MSAF) is a common occurrence among women in spontaneous labor at term, and has been associated with adverse outcomes in both mother and neonate. MSAF is a risk factor for microbial invasion of the amniotic cavity (MIAC) and preterm birth among women with preterm labor and intact membranes. We now report the frequency of MIAC and the presence of bacterial endotoxin in the amniotic fluid of patients with MSAF at term.Materials and methods: We conducted a cross-sectional study including women in presumed preterm labor because of uncertain dates who underwent amniocentesis, and were later determined to be at term (n = 108). Patients were allocated into two groups: (1) MSAF (n = 66) and (2) clear amniotic fluid (n = 42). The presence of bacteria was determined by microbiologic techniques, and endotoxin was detected using the Limulus amebocyte lysate (LAL) gel clot assay. Statistical analyses were performed to test for normality and bivariate comparisons.Results: Bacteria were more frequently present in patients with MSAF compared to those with clear amniotic fluid [19.6% (13/66) versus 4.7% (2/42); p < 0.05]. The microorganisms were Gram-negative rods (n = 7), Ureaplasma urealyticum (n = 4), Gram-positive rods (n = 2) and Mycoplasma hominis (n = 1). The LAL gel clot assay was positive in 46.9% (31/66) of patients with MSAF, and in 4.7% (2/42) of those with clear amniotic fluid (p < 0.001). After heat treatment, the frequency of a positive LAL gel clot assay remained higher in the MSAF group [18.1% (12/66) versus 2.3% (1/42), p < 0.05]. Median amniotic fluid IL-6 concentration (ng/mL) was higher [1.3 (0.7–1.9) versus 0.6 (0.3–1.2), p = 0.04], and median amniotic fluid glucose concentration (mg/dL) was lower [6 (0–8.9) versus 9 (7.4–12.6), p < 0.001] in the MSAF group, than in those with clear amniotic fluid.Conclusion: MSAF at term was associated with an increased incidence of MIAC. The index of suspicion for an infection-related process in postpartum women and their neonates should be increased in the presence of MSAF.

Clinical significance of amniotic fluid glucose concentration in polyhydramnios

Objective: To evaluate whether amniotic fluid glucose concentration can predict poor neonatal outcome in cases with polyhydramnios as an overall assessment. Methods: In this retrospective study, we have reviewed 42 consecutive pregnant women with singleton gestations complicated with polyhydramnios who gave birth at one tertiary care center between January 2003 and September 2010. Perinatal clinical findings were reviewed, and the neonatal outcome, such as livebirth or stillbirth and early neonatal death, was compared. A p value less than 0.05 was considered to be significant. Results: Thirteen of 42 neonates had a poor outcome, including stillbirth or early neonatal death. Multiple logistic regression analysis showed that amniotic fluid glucose (p = 0.042) was significant factor influencing poor neonatal prognosis [odds ratio 0.66; 95% confidence interval 0.44–0.98]. Receiver operating characteristics curve and sensitivity and specificity curve showed that the optimal cut-off value of amniotic fluid glucose concentration for predicting poor neonatal outcome was 17 mg/dl. Conclusions: Amniotic glucose concentration less than 17 mg/dl and the presence of congenital heart anomaly were better predictors for a poor postnatal outcome in cases with polyhydramnios.

Evaluation of a Universal Real-Time Polymerase Chain Reaction for Detection of Amniotic Fluid Infection in Premature Rupture of Membranes

Managing preterm rupture of membranes (PPROM) is a balance between benefits of prolonging gestation and the risks of perinatal infection. This study evaluates a real-time polymerase chain reaction (PCR) for the detection of amniotic fluid infection and neonatal complications by amniocentesis following PPROM. A total of 61 singleton pregnancies with PPROM were analyzed retrospectively, including histopathologic examination of the placenta and neonatal complications. The real-time PCR detects a highly conserved sequence of the bacterial 16S ribosomal DNA, and its efficacy was compared with standard tests including amniotic fluid glucose concentration, lactate dehydrogenase level, and maternal white cells count and C-reactive protein levels. Sensitivity and specificity were similar for PCR (64% and 85%) and standard tests (58% and 80%). However, the PCR technique has the additional advantage of possible identification of the bacteria through sequencing and has a much better positive predictive value in the occurrence of neonatal complications (60% for PCR versus 35% for standard tests). The latency period between premature rupture of the membranes and delivery was not related to the incidence of histopathologic signs of infection in the placenta or the umbilical cord and was inversely related to the incidence of neonatal complications.

Fetal exposure to altered amniotic fluid glucose, insulin, and insulin-like growth factor-binding protein 1 occurs before screening for gestational diabetes mellitus.

OBJECTIVEWe explored the possibility that perturbations in amniotic fluid glucose, insulin, and insulin-like growth factor–binding protein 1(IGFBP1) and/or metabolic acids exist before routine screening for GDM.RESEARCH DESIGN AND METHODSWe selected consenting mother-infant pairs (n = 408) who met our inclusion criteria (singleton pregnancy, no genetic abnormalities, and no preexisting diabetes) and for whom sufficient amniotic fluid and appropriate medical information were available. We compared birth outcomes and second trimester amniotic fluid glucose, insulin, IGFBP1 concentrations, and amniotic fluid lactic, β-hydroxybutyric, and uric acids of mothers with gestational diabetes mellitus (GDM) (n = 52) with those of mothers with no diagnosis of GDM at >24 weeks (n = 356).RESULTSHigher amniotic fluid glucose, lactic acid, uric acid, and insulin and lower IGFBP1 concentrations were present by 15.1 ± 0.1 weeks in mothers in whom GDM was subsequently diagnosed. However, logistic regression showed that second trimester amniotic fluid glucose, but not insulin, IGFBP1, or metabolic acids was associated with an increased odds ratio (1.2 [95% CI 1.052–1.338]) for diagnosis of GDM at 24–28 weeks. In addition, probability contour maps that accounted for nonlinear relationships among the dynamically changing amniotic fluid constituents showed an increased risk for GDM with elevated second trimester amniotic fluid glucose in combination with either elevated amniotic fluid insulin or low amniotic fluid IGFBP1CONCLUSIONSFetuses are exposed to increased amniotic fluid glucose before 15 weeks of gestation, suggesting that metabolic perturbations are underway before diagnosis and that earlier screening and intervention may be warranted.

Intra-amniotic infection increases amniotic lamellar body count before 34 weeks of gestation

Objective. To examine the lamellar body count (LBC) value in intra-amniotic infection cases and evaluate its association with the incidence of respiratory distress syndrome (RDS).Methods. Three hundred sixty-five amniotic fluid (AF) samples were obtained at caesarean section from 27 to 38 weeks of gestation. LBC and glucose concentrations in AF were measured with no centrifugation. We defined AF glucose concentrations <0.8 mmol/L and positive C-reactive protein (CRP) of the neonates as intra-amniotic infection.Results. An LBC cutoff value of 29,500/μL resulted in 94.0% sensitivity, 82.4% specificity, and 99.1% negative predictive value (NPV) for RDS. Neonates with glucose concentrations <0.8 mmol/L in AF and positive CRP had no RDS and significantly higher LBC values than controls before 34 weeks of gestation (17.0 vs. 4.3, p < 0.05 and 25.5 vs. 5.0, p < 0.05, respectively), but there were no significant differences after 34 weeks of gestation.Conclusions. LBC is an accurate predictor of foetal lung maturity and our LBC cutoff value had a high NPV for predicting RDS. We showed that intra-amniotic infection was associated with significantly higher LBC values than the value in controls before 34 weeks of gestation, which correlated with a low incidence of RDS.

Diagnostic value of the matrix metalloproteinase-8 rapid test for detecting microbial invasion of the amniotic cavity

The purpose of this paper was to compare the MMP-8 PTD Check (MPC) test with other indirect tests for detecting microbial invasion of the amniotic cavity (MIAC). Amniotic fluid (AF) was analyzed in 155 women for white blood cell (WBC) count, glucose concentration, and an MPC test and evaluated for MIAC using cultures for aerobic/anaerobic bacteria and mycoplasmas and polymerase chain reaction (PCR) of chlamydia. The median AF glucose concentration was lower and the median AF WBC count was higher in women with MIAC than in women without MIAC (p < 0.01 and p < 0.001, respectively). Also, the positive rate of the MPC test was higher in women with MIAC than in women without MIAC (p < 0.001). The sensitivities of AF glucose concentration, AF WBC count, and the MPC test for the detection of MIAC were 58.6%, 75.9%, and 86.2%, respectively. The specificities for the detection of MIAC were 76.2%, 80.2%, and 74.6%, respectively. We conclude that the MPC test is a rapid, easily performed, and accurate indirect method for detecting MIAC.

Amniotic fluid content of glucose, C-peptide and insulin in normal and diabetic pregnancies.

Glucose, C-peptide and insulin concentrations in amniotic fluid were measured in 63 women, 19 of whom had insulin-dependent diabetes. The amniotic fluid glucose concentration was higher in the diabetic (37.4 +/- 4.1) than in the normal women (19.4 +/- 5.1 mg/dl; P less than 0.01). The amniotic fluid insulin concentration was higher in diabetic than non diabetic women (15.9 +/- 3.1 versus 8.9 +/- 2.1 microU/ml; P less than 0.01). The C-peptide concentration was also higher in the amniotic fluid of diabetic women than normal (1.60 +/- 0.66 vs 0.26 +/- 0.15 nmol/l; P less than 0.001). The lecithin/sphingomyelin (L/S) ratio in the amniotic fluid was greater than 2 in 61 mothers; only two diabetic patients had an L/S ratio lower than 2. Five neonates of diabetic mothers were macrosomic and three of these were also hypoglycaemic. A negative correlation was observed in diabetic women between insulin and C-peptide concentrations in the amniotic fluid and Apgar score of the newborn infants both at 1 and 5 minutes; no correlation was found on the contrary with the amniotic glucose. In the prognostic evaluation of the fetus with a diabetic mother one must consider many parameters. Among these more consideration must be given to the levels of C-peptide and insulin in amniotic fluid than to glucose level.

Are myo-inositol, glucose and zinc concentrations in amniotic fluid of fetuses with spina bifida different from controls?

Associations are reported between myo-inositol, glucose, zinc and the occurrence of spina bifida. To gain more insight into the pathogenesis of spina bifida, the concentrations of myo-inositol, glucose and zinc were determined in amniotic fluids from pregnancies with a spina bifida or unaffected control fetus. Amniotic fluids of 27 pregnancies complicated by spina bifida and 49 controls were collected at the Department of Obstetrics and Gynecology of the University Medical Center Nijmegen in the Netherlands. Myo-inositol, glucose and zinc concentrations were determined. By indication, the samples were taken at different gestational ages. Therefore, the data were evaluated using multiple linear regression analysis to adjust for gestational age. Amniocentesis was performed at a more advanced gestational age in the spina bifida group than in controls. In the spina bifida group, amniotic fluid myo-inositol, glucose and zinc concentrations gradually declined throughout pregnancy. At a gestational age of 15 weeks, the estimated mean amniotic fluid glucose and zinc concentrations in the spina bifida group were, respectively, significantly lower (p< or =0.5) and higher (p< or =0.5) compared with the control group. At the same gestational age, the estimated mean myo-inositol concentrations were comparable in both groups. At a gestational age of 38 weeks, the estimated mean myo-inositol, glucose and zinc concentrations were not significantly different in the spina bifida compared with the control group. This study may suggest that a derangement in zinc and glucose transfer or metabolism is associated with spina bifida. Since compounds in amniotic fluid are only a very crude marker of the actual fetal condition, studies that focus on the metabolism of these compounds on tissue or even cellular level should be performed to clarify their role in the pathogenesis and future prevention of spina bifida.

Amniotic fluid matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection

OBJECTIVE: To assess the potential role of amniotic fluid (AF) matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection. METHODS: Eighty-four women with singleton gestations with preterm contraction, preterm labor, preterm premature rupture of membranes, or clinical suspicion of intra-amniotic infection were studied. Amniotic fluid was obtained by transabdominal amniocentesis before starting any treatment. Intra-amniotic infection was defined as the presence of a positive AF culture. Amniotic fluid glucose concentration, leukocytes, matrix metalloproteinase-9, and interleukin-6 were determined. RESULTS: Amniotic fluid matrix metalloproteinase-9 and interleukin-6 levels were significantly higher in women with intra-amniotic infection than in those without. With intra-amniotic infection, levels of matrix metalloproteinase-9 significantly correlated with interleukin-6 ( r = 0.813, P < .001). Each of matrix metalloproteinase-9 and interleukin-6 significantly correlated with AF leukocytes and inversely correlated with AF glucose. Using AF cutoff levels of 13.6 ng/mL for matrix metalloproteinase-9 and 11.4 ng/mL for interleukin-6, the sensitivity, specificity, and positive and negative predictive values for diagnosing intra-amniotic infection were 77% versus 73%, 100% versus 79%, 100% versus 61%, and 90% versus 86%, respectively. Combining AF matrix metalloproteinase-9 with interleukin-6 slightly improved the sensitivity and the negative predictive values in diagnosing intra-amniotic infection. CONCLUSIONS: Amniotic fluid matrix metalloproteinase-9 and interleukin-6 are significantly elevated in women with intra-amniotic infection. Amniotic fluid matrix metalloproteinase-9 is an accurate biochemical marker in predicting intra-amniotic infection with better sensitivity, specificity, and positive and negative predictive values than interleukin-6.

Amniotic fluid microflora in asymptomatic women at mid-gestation.

The presence and composition of amniotic fluid (AF) microflora, as well as AF glucose concentration and white blood cell (WBC) count, were investigated in 22 consecutive asymptomatic women with intact membranes at mid-gestation. AF was retrieved by trans-abdominal amniocentesis. Three of the 22 women (13.6%) had microorganisms in their AF: Chlamydia trachomatis in 2 and both Corynebacterium group absolute nonfermenter (ANF) group and Propionibacterium spp. in 1. No differences were found in clinical characteristics, glucose concentration or WBC count in patients with and without microorganisms in their AF.

Enzyme-histochemically detectable glucose-6-phosphatase is present in chorion laeve trophoblasts of human fetal membranes.

The purpose of the present study was to demonstrate the presence of glucose-6-phosphatase (G6Pase) in fetal membranes from various gestational ages (20-40 weeks of gestation). Ultrastructural enzyme-histochemical analysis of G6Pase was performed using cerium and lead as capturing agents. Precipitates indicating G6Pase activity were present mainly in the endoplasmic reticulum and partly in the nuclear envelope of chorion laeve trophoblasts, but absent in amniotic epithelial cells. Stringent histochemical control experiments performed ensured specific detection of G6Pase activity. The results indicate that histochemically detectable G6Pase is present in the chorion laeve trophoblasts of human fetal membranes. This enzyme may have some physiological significance in carbohydrate metabolism in human fetal membranes and regulation of amniotic fluid glucose concentration.

Correlation between amniotic fluid glucose concentration and amniotic fluid volume in pregnancy complicated by diabetes

Objective: Pregnancies complicated by diabetes are frequently characterized by an increased volume of amniotic fluid, and the pathophysiologic mechanism of this increase is not known. Our goal was to evaluate the relationship between amniotic fluid glucose concentration and the amniotic fluid index in pregnancies complicated by insulin-treated diabetes and to compare it with that seen in normal pregnancies. Study Design: Amniotic fluid index and amniotic fluid glucose levels were measured before elective repeated cesarean delivery in 41 women with insulin-treated diabetes and in 35 women without diabetes. Only singleton gestations without anomalous fetuses were included. Women with diabetes were hospitalized for approximately 4 weeks before delivery, during which time glycemic control was optimized. Amniotic fluid index and amniotic fluid glucose concentration were correlated with each other and were compared between the groups with and without diabetes. Results: The mean amniotic fluid index was significantly increased in the diabetes group (16.6 ± 5.0 cm in the diabetes group vs 13.4 ± 3.5 cm in the control group; P = .002). The amniotic fluid glucose concentration was also significantly greater in the diabetes group than in the control group (39 ± 17 mg/dL in the diabetes group vs 24 ± 11 mg/dL in the control group; P < .001). Among women with diabetes the amniotic fluid glucose concentration was significantly correlated with the amniotic fluid index ( r = 0.32; P = .04), a correlation not found among the control women. The mean fasting blood glucose concentration among the women with diabetes for the week before amniocentesis was 82 ± 11 mg/dL. Conclusion: The amniotic fluid index parallels the amniotic fluid glucose level among women with diabetes. This finding raises the possibility that the hydramnios associated with diabetes is a result of increased amniotic fluid glucose concentration. (Am J Obstet Gynecol 2000;182:901-4.)