Effects of maternal glucose infusion on fetal acid-base status in human pregnancy.
The maternal and fetal metabolic effects of three commonly used intravenous fluids administered before regional anesthesia were studied in 32 gravid women undergoing elective cesarean section at term. Patients were randomized into one of three groups to receive 1 L of either 5% dextrose (50 gm of glucose) or Ringer's lactate or isotonic saline solution before epidural anesthesia. Acute glucose infusion resulted in maternal hyperglycemia, hyperinsulinemia, and an increase in the blood lactate level. Cord blood glucose, insulin, and lactate levels were also increased in this group. The key finding of this study was the significant lowering of pH in the umbilical cord vein (7.31 +/- 0.04) and artery (7.21 +/- 0.06) in the glucose-infused group when compared with the non-glucose infusion groups (p less than 0.05). Confounding perinatal factors such as maternal position, maternal hypotension, and prolonged time of surgery did not influence the fetal acid-base status. Thus acute maternal glucose infusion in normal patients can cause fetal hyperglycemia, metabolic acidosis, and neonatal hypoglycemia. These findings may be of particular clinical importance when fetal distress or fetal hypoxemia is due to other perinatal events. Under these circumstances, acute maternal glucose infusion may further contribute to fetal metabolic acidosis.
Philipson
E H
EH
Department of Obstetrics, Case Western Reserve University School of Medicine, Cleveland Metropolitan General Hospital, OH 44109.
Kalhan
S C
SC
Riha
M M
MM
Pimentel
R
R
D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001786:Blood Glucose / Q000032:analysis; D002585:Cesarean Section; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D005440:Fluid Therapy; D005947:Glucose / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007022:Hypotension / Q000097:blood; D007328:Insulin / Q000097:blood; D007552:Isotonic Solutions; D007773:Lactates / Q000097:blood; D011247:Pregnancy / Q000097:blood*; D000077325:Ringer's Lactate; D012965:Sodium Chloride
D001786:Blood Glucose; D007328:Insulin; D007552:Isotonic Solutions; D007773:Lactates; D000077325:Ringer's Lactate; D012965:Sodium Chloride; D005947:Glucose