Liver function tests and glucose and lipid metabolism in growth-restrictedfetuses

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 norma l karyotypes and no congenital infections. Venous pH, partial pressure of o xygen, hematocrit, glucose, uric acid, urea, creatinine, total protein, tot al and direct bilirubin, aspartate aminotransferase, alanine aminotransfera se, gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase, creatinine kinase, triglycerides, and choles terol were measured and compared with our reference range. Results: Ultrasound measurements of abdominal circumference 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 tr iglyceride levels (r = -0.65). Compared with fetuses with present end-diast olic velocities in the umbilical artery, the eight with absent end-diastoli c velocities had lower pH (median z score -4.31), partial pressure of oxyge n (median z score -2.39), glucose (median z score = -2.01), and cholesterol (median z score = -2.34), and higher gamma-glutamyltransferase (median z s core = 2.43), lactic dehydrogenase (median = 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 circu mference, 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. Trigl yceride levels were inversely related to fetal size independent of Doppler results. High triglyceride levels might reset fetal homeostatic mechanisms, leading to disturbances df lipid metabolism in later life. (C) 1999 by The American College of Obstetricians and Gynecologists.