Abstract
Ovine fetal hyperinsulinemia is associated with increased oxygen consumption, increased glucose uptake and decreased arterial O2 content. We used eight mixed breed ewes with 114-132 day singleton pregnancies to measure the magnitude and distribution of fetal cardiac output in order to define the causes of insulin-induced hypoxemia. During an uninfused control period and again after 12, 24 and 48 hours of exogenous insulin infusion (0.05U/kg/hr), we measured umbilical vein-artery whole blood concentrations of glucose and oxygen. We used the distribution of each of four microsphere injections to determine total cardiac output and organ blood flow. Insulin infusion was associated with increasing insulin concentration following a 12 hour lag period. We confirmed an increase in cardiac output (+19%, P<0.02) and a progressive fall in arterial O2 content (0.33mM to 0.23mM, P<.001). During insulin infusion, blood flow increased to the brain (+50%, P<0.05), adrenal (+56%, P<0.01), and carcass (+44%, P<0.02). Placental blood flow did not change during infusion and fell when expressed as a percentage of cardiac output (45% to 34%, P<.002). The hypoxemia during insulin infusion occurs as a result of increased O2 consumption without a corresponding increase in placental blood flow. If similar effects occur in humans, hyperinsulinemic hypoxia may account for the near term fetal and neonatal mortality among women with poorly controlled diabetes.
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Milley, J., Rosenberg, A., Philipps, A. et al. 1376 CIRCULATORY EFFECTS OF HYPERINSULINEMIA IN THE NEAR TERM OVINE FETUS. Pediatr Res 15 (Suppl 4), 672 (1981). https://doi.org/10.1203/00006450-198104001-01405
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DOI: https://doi.org/10.1203/00006450-198104001-01405