Insulin and Glucose Levels in Umbilical Cord Blood After Infusions of Glucose and Glucose With Insulin to Women in Labour

Abstract

Insulin and glucose levels were measured in eleven women in labour and in the umbilical arterial and venous blood of their babies. Twelve women received an infusion of 10 per cent glucose at a rate of 1 g. per minute for an average of 42.2 minutes. Thirteen women were given a similar infusion, and crystalline zinc insulin was added in a concentration of 1 unit to 3 g. of glucose. The average infusion time was 48 -5 minutes.Exogenous insulin did not improve the transplacental passage of glucose. The infusion of glucose with insulin caused an eighteenfold increase in insulin level of the women in labour. This change was not reflected by the levels of insulin in umbilical blood. Similar umbilical insulin levels after both types of infusion show that exogenous insulin does not pass from the mother to the fetus during labour. An increase in the insulin level of umbilical blood began 22 minutes after the start of the infusion. This most probably reflects the poor capacity of the fetal pancreas to react to changes in blood glucose levels. 121

The Effect of Glucose in the Prenatal Treatment of Small-for-Date Fetuses

“…After completion of the series it is possible to say that there is no difference showing a better effect of glucose with insulin infusions. Since it is also known that insulin is not passing the placental barrier in the course of labour [Sabata et al, 1970b], we feel that the infusion of glucose alone is sufficient.…”

Der Einfluss niederprozentiger Kohlenhydratlösungen auf den mütterlichen und fetalen Stoffwechsel unter der Geburt

“…Die Zunahme beim Feten folgt ebenfalls dem mütterlichen Anstieg, jedoch in sehr unterschiedlicher Form. Dadurch verschwinden die straffen Beziehungen zwischen mütterlichen und fetalen Konzentrationen (5,14). Der Vorteil solcher Glukoseinfusionen muss einerseits in der Verbesserung des fetalen Säure-Basen-Status (7, 13) und anderseits in der Auffüllung der Glykogendepots mit der gleichzeitigen Vermei dung postpartaler Hypoglykämien (14) wegen der überschiessenden Laktatzunahme (15).…”

“…Subpartuale Glukoseinfusionen führen bei der Mutter zu einer früh einsetzenden, noch höhe ren Insulinkonzentration. Eine gleichzeitige Zunahme der fetalen Insulinkonzen-tration, allerdings gegenüber der mütterlichen deutlich verzögert, wurde von verschiedenen Untersuchern festgestellt (3,4,10,14). Es scheint jedoch, dass mindestens der reife Fetus nur bei massiver und/oder langanhaltender Hyper glykämie mit einer Erhöhung des Plasmainsulinspiegels antwortet (9,10,18).…”

The Effect of Prenatal Fructose Infusions upon Metabolic Condition of the Newborn

“…A short-term postnatal hypoglycaemia of the newborn, however, takes place that is caused by an increased insulin mobiliza tion (11,12). When comparing the effect of postnatal administration of glucose and fructose we found that after fructose the direct stimulation of insulin production was smaller and did not bring about a subsequent hypoglycaemia, yet a simultaneous increase in lactic acid levels was observed (8,9).…”