The Weiss Concept Management of Diabetes Based on Maternal Glucose Combined with Amniotic Fluid Insulin
Taking into account all these uncertainties, Weiss had already begun, in the eighties, to implement the first fetal-based strategy of GDM management to target women who would benefit from intensive treatment. Tight glucose control with intensified insulin therapy was limited to pregnancies with fetal
hyperinsulinism diagnosed by determination of amniotic fluid insulin (21), which reflects urinary excretion of fetal insulin (22). On the basis of his data it was found that only about 20% of the fetuses have some evidence of fetal hyperinsulinism (insulin levels >90th percentile) (23), and diabetic fetopathy was only seen when third trimester amniotic fluid was above 17 mU/ml. The level of amni-otic fluid insulin was also used to adjust the insulin dosage in women with preexisting diabetes resulting in serial amniocentesis in some women. Although the Weiss approach was impressive because of the direct access to the fetus it has not been widely adopted in clinical practice because it requires an invasive and expensive diagnostic strategy.
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