Continuous maternal glucose infusion during labor: effects on maternal and fetal glucose and lactate levels.
Fetal and neonatal glucose and lactate levels and acid-base balance after continuous maternal infusion of 5% dextrose at 180 mL/h (9 g/h) was compared with 0.9% saline solution in a prospective, randomized study from selected monitored labors. An infusion of 5% dextrose produced significantly increased glucose levels in maternal (p < 0.01), cord artery (p < 0.01), and cord vein (p < 0.001) blood. An increased maternal insulin level was also present (p < 0.05), but no differences in cord insulin levels were observed. beta-Hydroxybutyrate was lower in maternal (p < 0.05) and cord vein (p < 0.01), but not in cord artery blood, after maternal dextrose infusion. No significant changes occurred in blood lactate levels between the two groups in either mother, fetus, cord, or neonate. Acid-base balance in cord blood did not differ between the two groups. Maternal infusion of 5% dextrose at 180 mL/h (9 g/h), compared with saline solution, produces higher glucose levels in both mother and fetus, but increased insulin concentrations only in the mother. Dextrose infusion also lowers beta-hydroxybutyrate in maternal and cord vein blood. No differences were seen in lactate levels or cord acid-base balance. Both regimens seem safe according to risks for lactacidosis and neonatal hypoglycemia in the normoxemic, normal size fetus.
Department of Obstetrics and Gynecology, County Hospital of Ostersund, Sweden.
L
L
Nordström
S
S
Arulkumaran
S
S
Chua
S
S
Ratnam
I
I
Ingemarsson
M
M
Kublickas
B
B
Persson
N
N
Shimojo
M
M
Westgren
D020155:3-Hydroxybutyric Acid; D000136:Acid-Base Equilibrium; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D007262:Infusions, Intravenous; D007328:Insulin / Q000097:blood; D007743:Labor, Obstetric; D007773:Lactates / Q000097:blood*; D019344:Lactic Acid; D011247:Pregnancy; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage
D001786:Blood Glucose; D006885:Hydroxybutyrates; D007328:Insulin; D007773:Lactates; D019344:Lactic Acid; D012965:Sodium Chloride; D005947:Glucose; D020155:3-Hydroxybutyric Acid