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Maternal-fetal glucose metabolism and fetal growth retardation. Is there an association?
J M Piper1, N T Field, K Higby
1Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, USA.
Insights
In pregnancies without hypertension, altered maternal glucose metabolism may lead to fetal growth restriction. However, fetal glucose levels may not reflect this, remaining normal despite growth delays.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Perinatal Medicine
Background:
- Maternal glucose metabolism plays a crucial role in fetal development.
- Understanding the relationship between maternal metabolic changes and fetal growth is essential for identifying risks.
Purpose of the Study:
- To investigate if decreased maternal glucose response in normotensive pregnancies causes fetal hypoglycemia and hypoinsulinemia, leading to delayed fetal growth.
- To examine maternal and fetal glucose and insulin levels in pregnancies at risk for growth retardation.
Main Methods:
- Oral glucose tolerance tests were performed on pregnant patients with and without risk factors for growth retardation.
- Maternal glucose and insulin levels were evaluated during the test.
- Fetal metabolic parameters were assessed through cord blood glucose and insulin measurements.
Main Results:
- Normotensive pregnancies at risk for growth retardation exhibited lower maternal glucose levels compared to controls (91 vs. 116 mg/dL; P < .05).
- A trend towards lower maternal insulin levels was observed in at-risk pregnancies, but maternal insulin/glucose ratios were normal.
- No significant differences were found in fetal glucose or insulin levels between the groups.
Conclusions:
- Maternal glucose metabolism is altered in nonhypertensive pregnancies with a risk of delayed fetal growth.
- Despite maternal metabolic alterations, fetal glucose regulation may be maintained, showing normal levels even in cases of fetal growth retardation.
Objective:
To test the hypothesis that in normotensive pregnancies decreased maternal glucose response leads to relative fetal hypoglycemia and hypoinsulinemia, which result in delayed fetal growth.
Study Design:
We enrolled patients with and without risk factors for growth retardation. Each underwent an oral glucose tolerance test with both glucose and insulin evaluation. Cord blood was obtained for glucose and insulin evaluation.
Results:
The normotensive pregnancies at risk had lower maternal glucose levels (index, 91 vs. 116 mg/dL; P < .05), a trend toward lower maternal insulin levels (index, 398 vs. 483 muIU/mL; P = NS) and normal maternal insulin/glucose ratios. We found no differences, however, in the fetal metabolic parameters (glucose 83 vs. 78 mg/dL, insulin 17 vs. 24 muIU/mL; P = NS).
Conclusion:
Maternal glucose metabolism is altered in nonhypertensive pregnancies, with a risk of delayed fetal growth; however, the fetal glucose response may remain normal in the face of fetal growth retardation.