Fetal doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women

E. Albert Reece, Zion Hagay, Alistair B. Roberts, Nancy DeGennaro, Carol J. Homko, Meredith Connolly-Diamond, Robert Sherwin, William V. Tamborlane, Michael Peter Diamond

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

OBJECTIVE: This study was undertaken to assess human fetal behavior and fetal blood flow after insulin-induced symptomatic maternal hypoglycemia of sufficient magnitude to elicit counterregulatory hormones and a symptomatic response. STUDY DESIGN: Plasma glucose was lowered from approximately 95 mg/dl to 45 mg/dl in decrements of 10 mg/dl every 40 minutes with the insulin clamp technique. In 10 insulin-dependent diabetic women in the third trimester, the fetus was studied by monitoring fetal heart rate and recording fetal body and beathing movements and by performing Doppler waveform analysis with real-time ultrasonography. Maternal levels of glucagon, cortisol, epinephrine, and growth hormone were measured at each plasma glucose level. RESULTS: The mean number of fetal limb and body movements at the start of the study was 25 +- 16 per 15 minutes, which increased to a mean of 38 ± 28 at a glucose level of 60 mg/dl and then declined to a mean of 23 ± 10 at a glucose level of approximately 45 mg/dl. These changes, however, did not achieve statistical significance. In addition, no significant reductions in fetal breathing movements or heart rate were observed, although maternal epinephrine and growth hormone levels were significantly (p < 0.001) increased. No consistent changes in Doppler velocity waveforms were observed. CONCLUSION: These data suggest that fetal well-being remains unaltered in spite of moderate maternal hypoglycemia in diabetic women.

Original languageEnglish (US)
Pages (from-to)151-155
Number of pages5
JournalAmerican Journal of Obstetrics and Gynecology
Volume172
Issue number1 PART 1
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

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Hypoglycemia
Pregnant Women
Mothers
Insulin
Glucose
Epinephrine
Growth Hormone
Fetal Heart
Fetal Movement
Fetal Heart Rate
Third Pregnancy Trimester
Glucagon
Fetal Blood
Hydrocortisone
Ultrasonography
Respiration
Fetus
Extremities
Heart Rate
Hormones

Keywords

  • Diabetes mellitus
  • Doppler ultrasonography
  • fetal behavior
  • fetal blood flow
  • fetal hypoglycemia

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Fetal doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women. / Reece, E. Albert; Hagay, Zion; Roberts, Alistair B.; DeGennaro, Nancy; Homko, Carol J.; Connolly-Diamond, Meredith; Sherwin, Robert; Tamborlane, William V.; Diamond, Michael Peter.

In: American Journal of Obstetrics and Gynecology, Vol. 172, No. 1 PART 1, 01.01.1995, p. 151-155.

Research output: Contribution to journalArticle

Reece, EA, Hagay, Z, Roberts, AB, DeGennaro, N, Homko, CJ, Connolly-Diamond, M, Sherwin, R, Tamborlane, WV & Diamond, MP 1995, 'Fetal doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women', American Journal of Obstetrics and Gynecology, vol. 172, no. 1 PART 1, pp. 151-155. https://doi.org/10.1016/0002-9378(95)90105-1
Reece, E. Albert ; Hagay, Zion ; Roberts, Alistair B. ; DeGennaro, Nancy ; Homko, Carol J. ; Connolly-Diamond, Meredith ; Sherwin, Robert ; Tamborlane, William V. ; Diamond, Michael Peter. / Fetal doppler and behavioral responses during hypoglycemia induced with the insulin clamp technique in pregnant diabetic women. In: American Journal of Obstetrics and Gynecology. 1995 ; Vol. 172, No. 1 PART 1. pp. 151-155.
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