Haugen Guttorm, Bollerslev Jens, Henriksen Tore
Department of Obstetrics, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
University of Oslo, Oslo, Norway.
Acta Obstet Gynecol Scand. 2016 Jun;95(6):683-9. doi: 10.1111/aogs.12913. Epub 2016 May 11.
Our aim was to study umbilical and fetal cerebral arterial blood flow velocity waveforms related to fetal biometric measures and maternal body mass index, glucose levels and parity following maternal oral glucose loading.
The study had an experimental design in a cross-sectional observational study including 105 low-risk pregnancies (30-32 weeks of gestation). Ultrasound Doppler measurements of umbilical and middle cerebral arterial (UA and MCA) velocity waveforms were performed before and at 2 h after completed 75-g oral glucose tolerance tests (OGTT). We assessed changes in UA and MCA pulsatility indices (PI).
MCA PI was significantly reduced following OGTT (p < 0.001); these changes were not related to changes in fetal heart rate (r = -0.11, p = 0.278). UA PI was also significantly reduced following OGTT (p = 0.033); these changes were related to fetal heart rate (r = -0.47, p < 0.001). This reduction was not significant (p = 0.230) when the PI values were adjusted for fetal heart rate. The ratio MCA PI to UA PI was reduced (p = 0.001). The effect of OGTT on MCA PI was not related to fetal abdominal circumference whereas the effect on the adjusted UA PI values was correlated to abdominal circumference (r = -0.20, p = 0.045) but not to abdominal circumference Z-score (r = -0.16, p = 0.115). The influence of OGTT on the Doppler parameters as well as heart rates was not related to prepregnant body mass index, glucose levels before or after OGTT, parity, fetal sex or gestational age.
Maternal glucose loading seems to decrease fetal cerebral blood flow impedance independent of fetal size.
我们的目的是研究母体口服葡萄糖负荷后，与胎儿生物测量指标、母体体重指数、血糖水平及产次相关的脐动脉和胎儿脑动脉血流速度波形。
本研究采用实验设计，为横断面观察性研究，纳入105例低风险妊娠（妊娠30 - 32周）。在完成75克口服葡萄糖耐量试验（OGTT）前及试验结束后2小时，对脐动脉和大脑中动脉（UA和MCA）的血流速度波形进行超声多普勒测量。我们评估了UA和MCA搏动指数（PI）的变化。
OGTT后MCA PI显著降低（p < 0.001）；这些变化与胎儿心率变化无关（r = -0.11，p = 0.278）。OGTT后UA PI也显著降低（p = 0.033）；这些变化与胎儿心率相关（r = -0.47，p < 0.001）。当对PI值进行胎儿心率校正后，这种降低无统计学意义（p = 0.230）。MCA PI与UA PI的比值降低（p = 0.001）。OGTT对MCA PI的影响与胎儿腹围无关，而对校正后的UA PI值的影响与腹围相关（r = -0.20，p = 0.045），但与腹围Z评分无关（r = -0.16，p = 0.115）。OGTT对多普勒参数及心率的影响与孕前体重指数、OGTT前后的血糖水平、产次、胎儿性别或孕周无关。
母体葡萄糖负荷似乎可降低胎儿脑血流阻抗，且与胎儿大小无关。
