Department of Fetal Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
Norwegian Advisory Unit on Women's Health, Oslo University Hospital- Rikshospitalet, Oslo, Norway.
FASEB J. 2020 Sep;34(9):12481-12491. doi: 10.1096/fj.202000766R. Epub 2020 Jul 30.
Glucose is a major energy substrate for the fetus, including liver, heart, and brain metabolism. The umbilical vein (UV) blood flow supplies the fetal liver directly from the placenta, whereas a fraction is shunted via ductus venosus (DV) to the fetal systemic circulation bypassing the fetal liver. We hypothesized UV glucose concentration to be a major regulator of the distribution of glucose supply between the fetal liver and DV, and explored the influence of maternal metabolic status on this distribution. We included 124 healthy women with normal singleton pregnancies, scheduled for elective cesarean section. UV and DV blood flow measurements were performed by Doppler ultrasound immediately before, and blood samples were obtained during surgery. UV blood flow was significantly correlated with DV blood flow, liver blood flow, and the DV shunting fraction, while UV glucose concentration was not. For normal-weight mothers, the maternal-fetal glucose gradient was positively correlated with DV shunting fraction, and negatively with liver blood flow. For the fetuses of the overweight mothers no such correlation was found. This indicates that within the normal physiological range the human fetus makes adaptations of blood flow to ensure individual needs related to the offered maternal energy supply.
葡萄糖是胎儿的主要能量底物，包括肝脏、心脏和大脑代谢。脐静脉 (UV) 血流直接从胎盘供应胎儿肝脏，而一部分通过静脉导管 (DV) 分流到胎儿体循环，绕过胎儿肝脏。我们假设 UV 葡萄糖浓度是调节葡萄糖供应在胎儿肝脏和 DV 之间分配的主要因素，并探讨了母体代谢状态对这种分布的影响。我们纳入了 124 名健康的单胎妊娠妇女，计划行择期剖宫产术。在手术前通过多普勒超声进行 UV 和 DV 血流测量，并采集血液样本。UV 血流与 DV 血流、肝脏血流和 DV 分流分数显著相关，而 UV 葡萄糖浓度则没有。对于正常体重的母亲，母胎葡萄糖梯度与 DV 分流分数呈正相关，与肝脏血流呈负相关。对于超重母亲的胎儿则没有发现这种相关性。这表明在正常生理范围内，人类胎儿会通过血流适应来确保与提供的母体能量供应相关的个体需求。
