Liver Function Tests and Glucose and Lipid
Metabolism in Growth-Restricted Fetuses
ALISTAIR ROBERTS, MD, SIMONA NAVA, MD, LUISA BOCCONI, MD,
SARAH SALMONA, MD, AND UMBERTO NICOLINI, MD
Objective: To assess hematologic and biochemical blood
variables in growth-restricted fetuses and relate them to
biophysical measurements.
Methods: Blood was sampled from 22 growth-restricted
fetuses. All had normal karyotypes and no congenital infec-
tions. Venous pH, partial pressure of oxygen, hematocrit,
glucose, uric acid, urea, creatinine, total protein, total and
direct bilirubin, aspartate aminotransferase, alanine amino-
transferase, -glutamyltransferase, alkaline phosphatase,
lactic dehydrogenase, amylase, pseudocholinesterase, creat-
inine kinase, triglycerides, and cholesterol were measured
and compared with our reference range.
Results: Ultrasound measurements of abdominal circum-
ference correlated with fetal pH (r 0.64), partial pressure of
oxygen (r 0.52), glucose (r 0.67), total bilirubin (r
0.54), lactic dehydrogenase (r 0.48), and triglyceride
levels (r 0.65). Compared with fetuses with present
end-diastolic velocities in the umbilical artery, the eight
with absent end-diastolic velocities had lower pH (median z
score 4.31), partial pressure of oxygen (median z score
2.39), glucose (median z score 2.01), and cholesterol
(median z score 2.34), and higher -glutamyltransferase
(median z score 2.43), lactic dehydrogenase (median z
score 3.75), urea (median z score 1.33), creatinine
(median z score 1.23), and triglyceride levels (median z
score 1.71). Only triglycerides correlated with abdominal
circumference, independent of Doppler results.
Conclusion: Growth-restricted fetuses with absent end-
diastolic velocities in the umbilical artery had more marked
acidemia, hypoxemia, hypoglycemia, and abnormal liver
function than those with end-diastolic velocities. Triglycer-
ide levels were inversely related to fetal size independent of
Doppler results. High triglyceride levels might reset fetal
homeostatic mechanisms, leading to disturbances of lipid
metabolism in later life. (Obstet Gynecol 1999;94:290 – 4.
© 1999 by The American College of Obstetricians and
Gynecologists.)
Assessment of chromosome status and fetal acid-base
balance was considered by some authors an important
adjunct in the evaluation of certain pregnancies compli-
cated by fetal growth restriction (FGR).
1
Fetal partial
pressure of oxygen and pH at blood sampling were
poorly associated with perinatal outcome,
2
but it was
suggested that long-term neurologic impairment might
be predicted by intrauterine fetal acidemia.
3
It is un-
known whether fetal blood variables other than acid-
base balance are related to outcome, and there is little
information about liver function in growth-restricted
fetuses, despite the decrease in liver size
4
and changes
in liver blood supply
5
that accompany the condition.
Changes in fetal acid-base balance can be predicted by
changes in fetal Doppler evaluation of umbilical cord
flow.
2,6–8
Whether that is true of other metabolic
changes in the fetus needs to be investigated.
There was a surge of interest in the association
between fetal size at birth and adult diseases, including
hypertension, diabetes, hypercholesteremia, and heart
disease.
9 –11
Changes in fetal metabolic homeostasis
from FGR might provide clues about such associations.
The aim of this study was to investigate acid-base
balance, hematologic, and biochemical variables in
growth-restricted fetuses and relate them to fetal mea-
surements, Doppler evaluation of cord flow, and amni-
otic fluid volumes, well-recognized perinatal risk fac-
tors.
Materials and Methods
Twenty-two consecutive growth-restricted fetuses had
blood sampling during 1991–1995. The mothers were
normotensive and free of diseases associated with FGR.
Median gestational age was 24 weeks (range 21–38
weeks). Fetal blood sampling was done to investigate
chromosome status and seek evidence of intrauterine
infection. Each fetus had normal karyotype, no evi-
dence of infection on the basis of standard immunologic
From the 1st Department of Obstetrics and Gynecology, University of
Milano, Clinica Mangiagalli, Milano, Italy.
290 0029-7844/99/$20.00 Obstetrics & Gynecology
PII S0029-7844(99)00235-5