Key result
A 150-minute hyperinsulinaemic hypoglycaemic clamp (blood glucose ~2.2 mmol/l) increased fetal heart rate accelerations and slightly decreased umbilical artery pulsatility index.
Why the study?
Does induced hypoglycaemia affect fetal heart activity and umbilical artery Doppler velocity waveforms in pregnant women with insulin-dependent diabetes mellitus?
Does induced hypoglycaemia affect fetal heart activity and umbilical artery Doppler velocity waveforms in pregnant women with insulin-dependent diabetes mellitus?
Induced maternal hypoglycemia in the third trimester of pregnancy in women with insulin-dependent diabetes increases fetal heart rate accelerations without apparent harmful effects on umbilical artery blood flow.
Induced maternal hypoglycemia may alter fetal cardiac activity without apparent harm in IDDM; hypothesis-generating and should not yet change practice.
OBJECTIVE: To study the effect of induced hypoglycaemia on fetal wellbeing as indicated by fetal heart rate and umbilical artery flow velocity waveforms. DESIGN: A prospective experimental investigation. SETTING: High risk pregnancy unit and diabetes research unit at Karolinska Institutet, Danderyd Hospital, a university affiliated hospital. PARTICIPANTS: Ten women with insulin-dependent diabetes mellitus in the third trimester of pregnancy. INTERVENTIONS: The fetal heart rate, the blood flow velocity waveforms in the umbilical artery and the maternal catecholamine levels were investigated during a 150-minute hyperinsulinaemic hypoglycaemic clamp with induction and maintenance of an arterial blood glucose level of about 2.2 mmol/l. MAIN OUTCOME MEASURES: 1. Fetal: changes of fetal heart rate pattern and pulsatility index of the umbilical artery flow velocity waveforms. 2. Maternal: levels of plasma adrenaline and plasma noradrenaline. RESULTS: Maternal hypoglycaemia was associated with an increase in frequency and amplitude of fetal heart rate accelerations, a slight decrease in the pulsatility index of the umbilical artery and a rise in the maternal catecholamine levels. CONCLUSIONS: We speculate that the increased number of fetal heart rate accelerations reflects an increased sympathico-adrenal activity during the hypoglycaemia clamp. No potentially harmful effects on the fetus were observed in the fetal heart rate or in the umbilical artery Doppler waveform analysis during hypoglycaemia.
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Björklund et al. (1996) studied Insulin-dependent diabetes mellitus in pregnancy (n=10). Hyperinsulinaemic hypoglycaemic clamp was evaluated on Changes of fetal heart rate pattern and pulsatility index of the umbilical artery flow velocity waveforms. A 150-minute hyperinsulinaemic hypoglycaemic clamp (blood glucose ~2.2 mmol/l) increased fetal heart rate accelerations and slightly decreased umbilical artery pulsatility index.
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