Effects of gastric nutritional supplementation on fetal umbilical uptake of nutrients.

Abstract

Intrauterine nutritional supplementation may be of therapeutic benefit to the malnourished, growth-retarded fetus. Using 14 chronically catheterized, third trimester fetal lambs, we evaluated the effects of gastric infusions of amino acids and glucose on umbilical uptake of alpha-amino nitrogen, glucose, lactate, and oxygen. When amino acids were infused, amino nitrogen was gained through the intestine at an average rate equal to 45% of fetal umbilical uptake of amino nitrogen. There were no consistent changes in umbilical uptake of the measured nutrients, except for a small decrease in umbilical uptake of oxygen (P less than 0.05). No relationship were found between changes in fetal amino nitrogen levels or changes in fetal-maternal amino nitrogen concentration gradients and umbilical uptake of amino nitrogen. When glucose was infused, glucose was absorbed through the intestine at an average rate equal to 42% of fetal umbilical uptake of glucose. There were no changes in umbilical uptake of amino nitrogen, lactate, or oxygen. Umbilical uptake of glucose decreased, however, in inverse proportion to both the glucose infusion rate (P less than 0.005) and the rise in fetal glucose concentration (P less than 0.025). This limited the quantity of glucose that could be gained by the fetus, via gastrointestinal supplementation. During the infusions, we also observed a change in the pattern of fetal lower body blood flow. There was a 12% decrease in the mean umbilical blood flow (P less than 0.005) and a 22% increase in mean intestinal flow (P less than 0.05).