OBJECTIVE: To test whether the human fetus accommodates to the increasing glucose requirements of late pregnancy with an increased maternal-fetal glucose concentration gradient and whether there are differences in pregnancies with fetal growth restriction (FGR) according to clinical severity. METHODS: Umbilical venous glucose concentration was measured in 77 normal pregnancies (appropriate for gestational age [AGA]) and 42 pregnancies complicated by FGR at the time of fetal blood sampling. In 40 AGA and in all FGR cases, a maternal "arterialized" blood sample was collected simultaneously. Growth-restricted fetuses were subdivided into three groups according to fetal heart rate (FHR) recordings and Doppler measurements of the umbilical artery pulsatility index (PI): group 1 (normal FHR and PI; 12 cases), group 2 (normal FHR, abnormal PI; 17 cases) and group 3 (abnormal FHR and PI; 13 cases). RESULTS: In normal pregnancies with increasing gestational age, there was a significant decrease (P < .001) of umbilical venous glucose concentration and a significant increase of the maternal-fetal glucose concentration difference (P < .001). In addition, there was a significant relation between fetal and maternal glucose concentrations (P < .001). In FGR pregnancies, the maternal-fetal glucose concentration difference was significantly higher in fetuses of groups 2 and 3 compared with normal pregnancies and FGR pregnancies of group 1. CONCLUSION: In human pregnancy, the fetal glucose concentration is a function of both gestational age and the maternal glucose concentration. In FGR pregnancies, as an accommodation of the fetus to a restricted placental size and placental glucose transport capacity, the maternal-fetal glucose concentration difference is increased, and this increase is a function of the clinical severity.
OBJECTIVE: To test whether the human fetus accommodates to the increasing glucose requirements of late pregnancy with an increased maternal-fetal glucose concentration gradient and whether there are differences in pregnancies with fetal growth restriction (FGR) according to clinical severity. METHODS: Umbilical venous glucose concentration was measured in 77 normal pregnancies (appropriate for gestational age [AGA]) and 42 pregnancies complicated by FGR at the time of fetal blood sampling. In 40 AGA and in all FGR cases, a maternal "arterialized" blood sample was collected simultaneously. Growth-restricted fetuses were subdivided into three groups according to fetal heart rate (FHR) recordings and Doppler measurements of the umbilical artery pulsatility index (PI): group 1 (normal FHR and PI; 12 cases), group 2 (normal FHR, abnormal PI; 17 cases) and group 3 (abnormal FHR and PI; 13 cases). RESULTS: In normal pregnancies with increasing gestational age, there was a significant decrease (P < .001) of umbilical venous glucose concentration and a significant increase of the maternal-fetal glucose concentration difference (P < .001). In addition, there was a significant relation between fetal and maternal glucose concentrations (P < .001). In FGR pregnancies, the maternal-fetal glucose concentration difference was significantly higher in fetuses of groups 2 and 3 compared with normal pregnancies and FGR pregnancies of group 1. CONCLUSION: In human pregnancy, the fetal glucose concentration is a function of both gestational age and the maternal glucose concentration. In FGR pregnancies, as an accommodation of the fetus to a restricted placental size and placental glucose transport capacity, the maternal-fetal glucose concentration difference is increased, and this increase is a function of the clinical severity.
Authors: Barton C Staat; Henry L Galan; Jeri E F Harwood; Gene Lee; Anna Maria Marconi; Cinzia L Paolini; Alex Cheung; Frederick C Battaglia Journal: J Clin Endocrinol Metab Date: 2012-04-27 Impact factor: 5.958
Authors: Lawrence P Reynolds; Pawel P Borowicz; Kimberly A Vonnahme; Mary Lynn Johnson; Anna T Grazul-Bilska; Dale A Redmer; Joel S Caton Journal: J Physiol Date: 2005-03-10 Impact factor: 5.182