The impact of umbilical vein blood flow and glucose concentration on blood flow distribution to the fetal liver and systemic organs in healthy pregnancies

Opheim, Gun Lisbet; Holme, Ane Moe; Holm, Maia Blomhoff; Michelsen, Trond M.; Zahid, Saba Muneer; Roland, M; Henriksen, Tore; Haugen, Guttorm

doi:10.1096/fj.202000766r

Cited by 10 publications

(10 citation statements)

References 45 publications

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“…Overall, the analyzed research papers point out a possible connection between fetal liver indices and GDM; however, the base of evidence is too small to conclude that these parameters can serve as predictors of GDM in pregnancy. Consequently, further research is needed to clarify the relationship between fetal liver indices and GDM and, if our hypothesis is confirmed, to delineate cutoff values for the variables that could predict the development of GDM [5,24,37,68,69,[85][86][87][88][89][90][91][92][93]. Only one study, conducted by Perovic et al (2014), proposed an FLL of 39 mm as a predictor of GDM [37].…”

Section: Fetal Liver Length Measurements By Ultrasound-any Value?mentioning

confidence: 86%

“…In the analyzed papers, the most investigated fetal liver indices were FLL (n = 5) and FLV (n = 5). Overall, the subjects with GDM had higher FLL and FLV versus comparators, with several studies revealing associations between FLL and (or) FLV and anthropometric (BMI or BW in particular) or carbohydrate metabolism indices (FPG or HbA1c) [5,24,37,68,69,[85][86][87][88][89][90][91][92][93]. Interestingly, Boito et al (2007) demonstrated that if glycemia is adequately controlled and if GDM is appropriately treated, the FLV is similar between GDM and NGT pregnancies [86].…”

Section: Fetal Liver Length Measurements By Ultrasound-any Value?mentioning

confidence: 99%

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A Glimpse at the Size of the Fetal Liver—Is It Connected with the Evolution of Gestational Diabetes?

Cozma

Găman

Dobrică

et al. 2021

IJMS

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Gestational diabetes mellitus (GDM) is defined as an impairment of glucose tolerance, manifested by hyperglycemia, which occurs at any stage of pregnancy. GDM is more common in the third trimester of pregnancy and usually disappears after birth. It was hypothesized that the glycemic status of the mother can modulate liver development and growth early during the pregnancy. The simplest modality to monitor the evolution of GDM employs noninvasive techniques. In this category, routinely obstetrical ultrasound (OUS) examinations (simple or 2D/3D) can be employed for specific fetal measurements, such as fetal liver length (FLL) or volume (FLV). FLL and FLV may emerge as possible predictors of GDM as they positively relate to the maternal glycated hemoglobin (HbA1c) levels and to the results of the oral glucose tolerance test. The aim of this review is to offer insight into the relationship between GDM and fetal nutritional status. Risk factors for GDM and the short- and long-term outcomes of GDM pregnancies are also discussed, as well as the significance of different dietary patterns. Moreover, the review aims to fill one gap in the literature, investigating whether fetal liver growth can be used as a predictor of GDM evolution. To conclude, although studies pointed out a connection between fetal indices and GDM as useful tools in the early detection of GDM (before 23 weeks of gestation), additional research is needed to properly manage GDM and offspring health.

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Section: Fetal Liver Length Measurements By Ultrasound-any Value?mentioning

confidence: 86%

Section: Fetal Liver Length Measurements By Ultrasound-any Value?mentioning

confidence: 99%

A Glimpse at the Size of the Fetal Liver—Is It Connected with the Evolution of Gestational Diabetes?

Cozma

Găman

Dobrică

et al. 2021

IJMS

View full text Add to dashboard Cite

show abstract

“…The maternal metabolic status seems to influence the fetal response to a maternal meal: in a healthy population, increased umbilical flow to liver was observed in normal weight, but not in overweight mothers [ 17 ]. Further, the maternal-fetal glucose gradient correlated negatively with umbilical flow to liver in pregnancies of normal weight, but not overweight women [ 18 ]. Inadequate glycemic control is more frequent in patients with type 1 diabetes with high BMI [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…The distribution of the umbilical blood is influenced by maternal BMI in pregnancies without diabetes [ 17 ]. In normal weight women the maternal-fetal glucose gradient was found to correlate with the distribution of the umbilical flow to the fetal liver, while in overweight mothers no such correlation was found [ 18 ]. In pregnancies with PGDM, we found that the proportion of umbilical venous return distributed to the fetal liver was graded according to maternal HbA 1C [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight

et al. 2021

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Objectives To assess how maternal body mass index and gestational weight gain are related to on fetal venous liver flow and birthweight in pregnancies with pre-gestational diabetes mellitus. Methods In a longitudinal observational study, 49 women with pre-gestational diabetes mellitus were included for monthly assessments (gestational weeks 24–36). According to the Institute Of Medicine criteria, body mass index was categorized to underweight, normal, overweight, and obese, while gestational weight gain was classified as insufficient, appropriate or excessive. Fetal size, portal flow, umbilical venous flow and distribution to the fetal liver or ductus venosus were determined using ultrasound techniques. The impact of fetal venous liver perfusion on birthweight and how body mass index and gestational weight gain modified this effect, was compared with a reference population (n = 160). Results The positive association between umbilical flow to liver and birthweight was more pronounced in pregnancies with pre-gestational diabetes mellitus than in the reference population. Overweight and excessive gestational weight gain were associated with higher birthweights in women with pre-gestational diabetes mellitus, but not in the reference population. Fetuses of overweight women with pre-gestational diabetes mellitus had higher umbilical (p = 0.02) and total venous liver flows (p = 0.02), and a lower portal flow fraction (p = 0.04) than in the reference population. In pre-gestational diabetes mellitus pregnancies with excessive gestational weight gain, the umbilical flow to liver was higher than in those with appropriate weight gain (p = 0.02). Conclusions The results support the hypothesis that umbilical flow to the fetal liver is a key determinant for fetal growth and birthweight modifiable by maternal factors. Maternal pre-gestational diabetes mellitus seems to augment this influence as shown with body mass index and gestational weight gain.

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“…Several studies have been conducted investigating the association between fetal liver blood flow volume and maternal pregravid BMI (62), gestational weight gain (63), serum glucose level (64)(65)(66), and fetal growth restriction (67). More recent report showed the correlation between fetal liver blood flow volume and placental corticotrophin releasing hormone, which is a paracrine determinant of the placental vasculature (68).…”

Section: Fetal Liver Blood Flow Volume and Infant Body Compositionmentioning

confidence: 99%

Newer Insights Into Fetal Growth and Body Composition

et al. 2021

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Based on epidemiological and experimental evidence, the origins of childhood obesity and early onset metabolic syndrome can be extended back to developmental processes during intrauterine life. It is necessary to actively investigate antecedent conditions that affect fetal growth by developing reliable measures to identify variations in fetal fat deposition and body composition. Recently, the resolution of ultrasonography has remarkably improved, which enables better tissue characterization and quantification of fetal fat accumulation. In addition, fetal fractional limb volume has been introduced as a novel measure to quantify fetal soft tissue volume, including fat mass and lean mass. Detecting extreme variations in fetal fat deposition may provide further insights into the origins of altered fetal body composition in pathophysiological conditions (i.e., fetal growth restriction or fetal macrosomia), which are predisposed to the metabolic syndrome in later life. Further studies are warranted to determine the maternal or placental factors that affect fetal fat deposition and body composition. Elucidating these factors may help develop clinical interventions for altered fetal growth and body composition, which could potentially lead to primary prevention of the future risk of metabolic dysfunction.

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The impact of umbilical vein blood flow and glucose concentration on blood flow distribution to the fetal liver and systemic organs in healthy pregnancies

Cited by 10 publications

References 45 publications

A Glimpse at the Size of the Fetal Liver—Is It Connected with the Evolution of Gestational Diabetes?

A Glimpse at the Size of the Fetal Liver—Is It Connected with the Evolution of Gestational Diabetes?

Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight

Newer Insights Into Fetal Growth and Body Composition

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