Pulmonary phospholipids in amniotic fluid of pathologic pregnancies: relationship with clinical status of the newborn

Abstract

We evaluated phospholipids, C-peptide and Cortisol levels in amniotic fluid of 203 pathologic pregnancies (63, class A, B and C diabetics; 11 class D, F and H diabetics; 44 preclampsia and 85 Rh-isoimmunization); the control group was 82 normal pregnant women. There was an acceleration of fetal pulmonary maturation in women with preclampsia and severe Rh-isoimmunization in class D, F and H diabetics (at 34 weeks gestation the incidence of mature surfactant (lecithin/sphingomyelin ≥2.7 and presence of phosphatidyl-glycerol) in these groups was 30%, 50% and 100%, respectively, while it was zero in the control group). At 37 and 38 weeks only 44.4% of the class A, B and C diabetics had mature surfactant and there was a significant difference with respect to the control group (x²=4.9; p<0.05); C-peptide levels in these diabetics (class A, B and C) were higher than in controls (p<0.001); in pregnant women with accelerated fetal lung maturation they were lower. We demonstrated a close relationship between fetal pulmonary maturity and the type of surfactant in amniotic fluid, which was independent of gestational age.

Key Words:

• hyaline membrane disease (HMD)
• lecithin/sphingomyelin ratio (US)
• phosphatidyl-glycerol (PG)
• pregnancy-induced hypertension (PIH)
• surfactant
• transient tachypnoea of the newborn (TTN)