Prediction of fetal outcome by urinary estriol, maternal serum placental lactogen, and alpha-fetoprotein in diabetes and hepatosis of pregnancy.

Urinary estriol, serum placental lactogen (hPL), and alphafetoprotein (AFP) levels were investigated in singleton pregnancies of 75 diabetic women and 84 women with obstetric hepatosis. Fetal distress was demonstrated in 19 diabetic patients (25%) and in 18 cases of obstetric hepatosis (21%). Low urinary estriol correctly predicted fetal distress in 26% of the cases of diabetes and in 29% of the cases of hepatosis. False pathologic readings were found in 9% of pregnancies in either group. Diabetes was associated with higher than normal hPL levels with overlap of levels between cases with fetal distress and normal outcome. hPL levels were higher than normal and correctly predicted fetal distress in 2 of 18 cases of hepatosis (11%) with no false pathologic values. In diabetes, AFP predicted fetal distress in 2 of 4 cases in which a subsequent perinatal death occurred, and 1 additional case of fetal distress. False pathologic values were found in 4% of cases. Maternal AFP levels were normal in 2 cases of closed neural tube anomalies. In cases of hepatosis, AFP gave no information. In combination, estriol and AFP determinations gave correct information in 35% of diabetic pregnancies with pernatal morbidity or death. In hepatosis, estriol and hPL pointed out 33% of the cases of fetal distress.