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Fetal hyperinsulinism in rhesus isoimmunization

G Brown, R Brown, E Hey

    American Journal of Obstetrics and Gynecology
    |July 15, 1978
    PubMed
    Summary

    Severe rhesus isoimmunization in babies can lead to elevated fetal insulin levels before birth. Fetal ascitic fluid glucose levels remain stable, but hyperinsulinism is linked to high fetal calcium.

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    Area of Science:

    • Perinatology
    • Neonatology
    • Endocrinology

    Background:

    • Rhesus isoimmunization is a significant concern in pregnancy.
    • Fetal ascitic fluid analysis provides insights into fetal well-being.
    • Understanding fetal metabolic and electrolyte balance is crucial for managing high-risk pregnancies.

    Purpose of the Study:

    • To investigate insulin and glucose levels in fetal ascitic fluid of fetuses with severe rhesus isoimmunization.
    • To examine the relationship between fetal insulin levels and glucose transfer from mother to fetus.
    • To analyze electrolyte composition, particularly calcium, in fetal ascitic fluid in cases of hyperinsulinism.

    Main Methods:

    • Analysis of peritoneal ascitic fluid collected from fetuses prior to intrauterine transfusion.
    • Measurement of glucose and electrolyte concentrations in fetal ascitic fluid and maternal plasma.
    • Assessment of fetal insulin levels.

    Main Results:

    • Elevated fetal insulin levels were observed in some fetuses with severe rhesus isoimmunization up to one month before delivery.
    • Fetal ascitic fluid glucose levels were consistently about 10 mg/100 ml lower than maternal plasma glucose, irrespective of insulin levels.
    • Fetal ascitic fluid electrolyte composition closely mirrored maternal plasma, with a notable exception of high calcium in cases of fetal hyperinsulinism.

    Conclusions:

    • Severe rhesus isoimmunization can be associated with pre-delivery fetal hyperinsulinism.
    • The maternal-fetal glucose gradient appears independent of fetal or maternal insulin levels in this context.
    • Elevated fetal calcium in ascitic fluid may be a marker for fetal hyperinsulinism in rhesus isoimmunized pregnancies.

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