Miodovnik M, Lavin J P, Harrington D J, Leung L, Seeds A E, Clark K E
Am J Obstet Gynecol. 1982 Nov 1;144(5):594-600. doi: 10.1016/0002-9378(82)90233-2.
Previous studies from our laboratory have shown that beta hydroxybutyrate crosses the ovine placenta in small amounts during maternal hyperketonemia and produces significant reductions in fetal PaO2 and increased fetal lactate levels. The present study evaluates the effects of fetal hyperketonemia on fetal and maternal cardiovascular and biochemical parameters. Pregnant ewes (110 to 120 days' gestation) were instrumented with catheters in the femoral artery, femoral vein, and uterine veins, and electromagnetic flow probes were placed on the middle uterine arteries. The fetal carotid artery and jugular vein were catheterized, and a catheter and balloon were placed in the amniotic fluid. Beta hydroxybutyrate (0.44 mmole/min) and antipyrine (0.03 mmole/min) were simultaneously infused directly into the fetal jugular vein for 90 minutes. The fetal beta hydroxybutyrate level increased from a baseline of 0.12 +/- 0.08 to 6.80 +/- 0.46 mmoles/L and was associated with a significant decrease in fetal PaO2 (23.7 +/- 2.4 to 16.0 +/- 0.4 mm Hg) and a large increase in the fetal lactate (1.85 +/- 0.27 to 5.43 +/- 0.92 mmoles/L) at 90 minutes. The present results suggest that during fetal hyperketonemia fetal oxygenation is significantly reduced and may contribute to the increased perinatal mortality in the pregnant diabetic patient.
我们实验室之前的研究表明，在母体高酮血症期间，β-羟基丁酸少量穿过绵羊胎盘，导致胎儿动脉血氧分压显著降低，胎儿乳酸水平升高。本研究评估胎儿高酮血症对胎儿和母体心血管及生化参数的影响。对妊娠110至120天的怀孕母羊，在股动脉、股静脉和子宫静脉中插入导管，并将电磁流量探头置于子宫中动脉上。对胎儿颈动脉和颈静脉进行插管，并在羊水中放置一根导管和一个球囊。将β-羟基丁酸（0.44毫摩尔/分钟）和安替比林（0.03毫摩尔/分钟）同时直接注入胎儿颈静脉90分钟。胎儿β-羟基丁酸水平从基线的0.12±0.08毫摩尔/升升至6.80±0.46毫摩尔/升，并在90分钟时伴有胎儿动脉血氧分压显著降低（从23.7±2.4毫米汞柱降至16.0±0.4毫米汞柱）以及胎儿乳酸大幅增加（从1.85±0.27毫摩尔/升升至5.43±0.92毫摩尔/升）。目前的结果表明，在胎儿高酮血症期间，胎儿氧合显著降低，这可能是导致糖尿病孕妇围产期死亡率增加的原因。
