Our objectives were to measure concentrations of glucose, insulin, insulin-like-growth-factor-binding-protein-1 (IGF BP1) and beta-hydroxybutyrate (BOHB) in amniotic fluid (AF), and establish if these concentrations were associated with emergence of maternal gestational diabetes mellitus (GDM). AF samples (n=408) were collected following routine amniocentesis (12-22 weeks gestation). Glucose and insulin concentrations were elevated in our GDM mother-infant pairs, where GDM was associated with a 176g increase in birth weight. Logistic regression showed that AF glucose but not insulin was associated with developing GDM. Non-linear Bayesian probability plots showed that when 2nd trimester glucose was plotted against insulin increases in both were predictive of the subsequent emergence of GDM. In conclusion, our findings show that: (1) AF glucose but not insulin predicts subsequent emergence of GDM and (2) these observed elevations provide evidence that the fetus of GDM mothers is being exposed early in-utero to metabolic perturbations (i.e. elevated glucose) that may have important long-term metabolic consequences for their future development.

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Amniotic fluid (AF) is a protective pool and a resource of amino acids for the growing fetus. In study 1, we investigated if any of these AF amino acids at mid gestation were associated with fetal development in humans. Nineteen amino acids differed across birth weight percentiles. Arginine, 3-methyl histidine and tryptophan were positive predictors of birth weight, while ornithine was a negative predictor. In study 2, we used a diet induced model of IUGR to see if specific AF amino acids were predictive of fetal weight near term. Methionine and phenylalanine were modified by diet, and 12 amino acids were independently modified by gestational age, respectively. Cysteine, lysine, methionine and tyrosine were predictors of fetal weight. Thus, the AF amino acid pool is associated in animals and humans with fetal growth.

Using second trimester amniotic fluid (AF), the objectives of this study were two-fold: 1) to investigate the relationship between AF glucose and insulin levels as a predictor of macrosomia and 2) to create a risk profile for macrosomia (LGA> 90th percentile) using a combination of AF glucose and insulin concentrations. Amniotic fluid samples were obtained from non-diabetic women (n = 542) undergoing age-related amniocentesis (12th to 22nd week). AF glucose was quantified using a standard hexokinase assay and AF insulin was quantified using the Beckman Access ultrasensitive assay system. Although LGA infants were found to have significantly higher concentrations of insulin and glucose in their 2nd trimester AF, logistic regressions showed that neither alone predicted the outcome of macrosomia. However, a Bayesian two-dimensional contour map plotted the risk for LGA using both AF glucose and insulin. The two-dimensional contour map illustrated the value in considering AF glucose and insulin together to predict LGA in newborns.

To investigate the relation between amniotic fluid (amf) constituents and human fetal growth and birth weight (b.wt), amf was collected from 395 pregnant women undergoing routine amniocentesis at 14--16 weeks' gestation at the Royal Victoria (RVH), Jewish General (JGH), and St. Mary's (SMH) Hospitals. The fluid was analyzed for total protein, albumin, urea nitrogen, creatinine, uric acid, glucose, beta-hydroxybutyrate (betaHBA), and lactate. Maternal and neonatal data were collected from a questionnaire at the time of recruitment and from medical charts post-delivery. The mean b.wt in our population was 3409 +/- 552g. Birth weight differed significantly by infant gender, maternal height (ht), and prepregnancy weight (wt), as determined by one-way analysis of variance (ANOVA). Of the amf constituents measured, glucose showed strong evidence of being a potential predictor of b.wt, such that for each mmol/L increase in amf glucose a 119.4g increase in b.wt was observed. Lactate showed a similar but weaker tendency toward predictive value. Ongoing research is currently being done to further examine the role of human amf constituents in predicting b.wt, the goal being to develop a predictive model that would aid in preparing for and preventing aberrations in fetal growth.

The objectives of the study were to measure the concentrations of albumin, transferrin, IgG and uric acid in 2nd trimester amniotic fluid (AF) and to establish if these concentrations were associated with infant birth outcomes. / Amniotic fluid samples (n=230) were collected from mothers undergoing routine amniocentesis (12-20 wk). Maternal characteristics like height, pre-pregnancy weight, age, smoking status, parity and infant gender, birth weight and gestational age were collected from questionnaires and obstetrical medical chart review. AF samples were analyzed by capillary zone electrophoresis (CZE). / The results showed that the 2nd trimester AF uric acid was a significant predictor of infant birth weight (grams) and transferrin was negatively associated with gestational age in term infants.

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