SUMMARY1. Transfer of fatty acids across the placenta was studied in anaesthetized rabbits at 28-days gestation by measuring umbilical venous-arterial differences, by injection of labelled palmitate into the mother and observing its appearance in the foetus, by injection of labelled palmitate into the foetus and measuring its appearance in the mother and the foetal clearance rate.2. The release of fatty acids and glycerol by foetal adipose tissues was investigated in vitro by measuring the effect of addition of noradrenaline to the incubation medium and in vivo by measuring the effect of noradrenaline infusion into the foetus on circulating glycerol and free fatty acid concentrations.3. In anaesthetized rabbits at 28-days gestation the maternal circulating free fatty acid concentrations were high and there was a positive umbilical venous-arterial difference. High maternal free fatty acid concentrations were associated with high umbilical venous-arterial differences.4. Label was present in the foetus in 2 min and reached a peak in 3 min after injection of labelled palmitate into the mother. Label appeared in the maternal circulation in 1 min after injection into the foetus. The half-life of labelled palmitate was of the order of 30-60 sec in both mother and foetus.5. Foetal white adipose tissue released both free fatty acids and glycerol into the medium and the rate of release increased four to five fold after addition of noradrenaline. Infusion of noradrenaline in the foetus led to a rise in glucose and glycerol concentrations, but the change in free fatty acid concentrations was not significant.6. It was concluded that (i) free fatty acids can cross the rabbit placenta in amounts sufficient to provide the fatty acid components of stored 30 M. C. ELPHICK, D. G. HUDSON AND D. HULL triglyceride and structural lipids; (ii) placental transport of free fatty acids depends in part on maternal blood concentration and on foetal uptake; (iii) foetal circulating free fatty acids are continually exchanging with fatty acid pools in the placenta and with the maternal circulating free fatty acids.

SUMMARY1. The passage of fatty acids across the placenta was studied in 28 day pregnant rabbits (i) by comparing the fatty acid distribution in plasma free fatty acids (FFA) of umbilical cord artery and vein with that in maternal plasma and (ii) by infusing the doe at a constant rate with labelled palmitic, linoleic or arachidonic acids. During the infusion maternal and foetal plasma FFA specific activities were measured.2. The mean levels of all the fatty acids studied (from twelve to twenty carbon atoms) were similar in both the umbilical vein plasma and maternal arterial plasma FFA, except for arachidonic acid, which was higher in foetal blood. The relative distribution of the fatty acids in umbilical arterial plasma was similar to that in the vein, but at lower concentrations. The mean cord venous-arterial difference for each fatty acid correlated positively with the mean maternal arterial levels, with the exception of arachidonic acid.3. During the constant infusion experiments the specific activities of the fatty acids in the maternal and foetal circulating FFA pools rose rapidly during the first 4 min then rose only slowly. Palmitic and linoleic acids were cleared from the maternal circulation in a similar manner and crossed the placenta at similar rates.4. The average foetal specific activity in plasma FFA reached 15 % of the maternal level for both palmitate and linoleate. The figure for arachidonic acid was half that for palmitic acid infused at the same time.5. It is concluded that (i) all the major fatty acids present in foetal adipose tissue cross the placenta, (ii) the net transport of each fatty acid depends in part on maternal concentrations, (iii) the rate of metabolism of palmitic and linoleic acids is the same and both cross the placenta at the same rate. Proportionately less foetal arachidonic acid is derived from maternal FFA, and (iv) the results suggest a second placental source of arachidonic acid and possibly also of other fatty acids.

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The Department of Health in England has long encouraged the routine measurement of clinical outcomes in mental health services but has now decided to use outcome measures as part of a new payments system - Payment by Results. We examine how these two policies should or might interact.

Summary The concentration of free fatty acids was measured in blood taken from the umbilical artery and vein of 29 infants during elective Caesarean section and compared with levels in maternal venous blood. The mean venous‐arterial (v–a) difference was 0·07 mEq/1. There was a direct and significant correlation between the umbilical v–a difference and maternal venous concentrations.

SUMMARY1. Lipase activity was measured in rabbit placental tissue fragments in late pregnancy. The activity in incubated tissue was greater with heparin (69 %), reduced by NaCi (90 %), but not affected by acetone or ether.2. Pregnant rabbits (28-days gestation) were given triglyceride emulsions intravenously and the change in profile of fatty acids in the maternal and umbilical artery and vein plasma free fatty acid (FFA) measured.3. Those fatty acids predominant in the emulsion were higher in concentration in the umbilical vein FFA than in the maternal plasma FFA and the venous-arterial difference was altered such that the placental transfer of FFA was enriched in a pattern corresponding to the profile of the fatty acids in the emulsion.4. It is concluded that (i) the rabbit placenta shows considerable lipase activity and the lipase has the same characteristics as clearing-factor (lipoprotein) lipase, (ii) triglyceride infused into the mother is taken up by the placenta and hydrolysed, and (iii) the fatty acids so released paw through the placenta and are taken up by the foetus.

Six patients near term were given an intravenous infusion of a fat emulsion (Intralipid) a few hours before normal delivery or Caesarean section. Six other non-infused patients were studied as controls. Maternal venous and umbilical venous and arterial blood samples were taken at delivery and analyzed for individual fatty acid concentrations in triglyceride, free fatty acid (FFA) and phospholipid fractions. The emulsion, being rich in oleic and linoleic acids, affected the composition of the maternal triglycerides. The fetal lipids were also altered and the infusions resulted in large positive umbilical venous-arterial (v-a) differences in FFA and triglyceride fatty acid concentrations, but this was not the case for phospholipid concentrations. The fatty acids with the largest v-a differences were those prominent in the emulsion.

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