title: Lactate in cord blood and its relation to fetal gluconeogenesis in at term deliveries.
abstract: BACKGROUND
  In the human fetus, an increased lactate and glucose level can be anticipated when hypoxia and stress are present and is likely to be a function of both anaerobic metabolism and catecholamine-mediated glycogenolysis/glycolysis.
  
  
  OBJECTIVE
  We assessed if measurement of lactate in cord artery blood after vaginal and cesarean delivery may predict glucose concentration.
  
  
  METHODS
  Umbilical artery cord blood lactacidemia, acidemia, and glucose concentration was tested by 'mini-lab' Radiometer ABL90 FLEX analyzers (Radiometer®, Copenhagen, Denmark) after vaginal delivery (VD), spontaneous (n=493) and by vacuum extractor (n=41) or by cesarean delivery (CD), elective (n=120) and emergency (n=68) in at term, vigorous neonates delivered from March to December 2012 at the 2nd level maternity ward of Policlinico Abano Terme, Abano Terme (Italy).
  
  
  RESULTS
  Cord blood lactacidemia and glucose levels were significantly higher in VD by vacuum extractor than in all other groups (5.32±1.96mmol/L, p=0.050 and 103.6±30.5mg/dL, p<0.001, respectively) and significantly lower in elective CD group (1.77±0.99mmol/L, p<0.001 and 69.8±13.0mg/dL, p<0.001). The cord blood lactate concentration was significantly and positively correlated with glucose levels (r=0.434, p<0.001), but significantly and negatively correlated with pH (r=-0,662, p<0.001), NaHCO3(-) (r=-0,802, p<0.001), and base excess (BE) (r=-0,698, p<0.001). However, in multivariate linear regression analysis, only BE, PaCO2 and cord blood lactate were significant predictive variables (R(2)=0.410; p<0.001) of glucose levels at birth.
  
  
  CONCLUSIONS
  Cord blood artery lactate and glucose concentration are significantly and positively correlated at birth in healthy, at term vaginally and cesarean delivered neonates, but BE is the best indicator of activated fetal gluconeogenesis.
authors: Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy. Electronic address: vincenzo.zanardo@libero.it.
authors: Vincenzo
authors: V
authors: Zanardo
authors: Tennessee Institute of Fetomaternal and Infant Health, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors: Giancarlo
authors: G
authors: Mari
authors: Division of Social Statistics and Demography, University of Southampton, United Kingdom.
authors: Federico
authors: F
authors: de Luca
authors: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors: Giovanni
authors: G
authors: Scambia
authors: Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy.
authors: Pietro
authors: P
authors: Guerrini
authors: Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy.
authors: Gianluca
authors: G
authors: Straface
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D005943:Gluconeogenesis; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D019344:Lactic Acid
keywords: At term delivery; Umbilical cord artery acidemia; Umbilical cord artery glucose; Umbilical cord artery lactacidemia