Effects of intravenous glucose injections on human fetal breathing movements and gross fetal body movements at 38 to 40 weeks' gestational age

Added sugar intake during pregnancy: Fetal behavior, birth outcomes, and placental DNA methylation

Pregnancy is a critical time for the effects of environmental factors on children's development. The effect of added sugar intake on fetal development and pregnancy outcomes remains understudied despite increasing dietary intake in the United States. This study investigated the effect of added sugar on fetal programming by examining the association between maternal added sugar consumption, fetal movement, birth outcomes, and placental DNA methylation. Further, primary human fibroblasts were cultured under normal or high glucose conditions to assess the effect of high glucose exposure on cells' DNA methylation. We found that higher added sugar intake across pregnancy was associated with reduced 3rd-trimester fetal movement (p < .05) and shorter gestation (p < .01). Our sample size was not powered to detect the alteration of individual placental CpG with genome-wide significance. However, a secondary analysis suggested that added sugar consumption was associated with differential methylation of functionally related gene families across pregnancy. Consistent with this, high glucose exposure in primary cultured human fibroblasts altered the methylation of 17% of all CpGs, providing converging evidence for an effect of sugar on DNA methylation. Our results suggest that diets high in added sugar during pregnancy may have implications for offspring health via prenatal programming effects measurable before birth.

Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases

Introduction

The term multiple primary tumor (MPT) is used to describe cases where two or more primary tumors show no histopathological similarities in between. Multiple primary tumor cases have begun to increase in recent years as a result of the increase in life expectancy because of the increase in life standards and progress in diagnostic methods. In this study, MPT cases with periampullary tumors that underwent Whipple procedure were discussed in the light of literature data.

Materials and methods

The patient files of 223 cases with periampullary tumors that underwent Whipple procedure in our hospital during the last 6 years were examined retrospectively. More than one primary tumor was detected in 21 patients.

Results

Periampullary carcinomas were detected as a second primary tumor in 18 patients. First primary tumor was periampullary carcinoma in 3 patients that underwent Whipple procedure. After the Whipple procedure, 5 patients died due to early complications in the first 30 days and 6 patients died due to metastases and additional problems that developed during follow-up.

Discussion

The incidence of MPT has been reported as 0.7 to 14.5% in the literature. Most of them are multiple primary case presentations. In patient management, it is recommended that each tumor should be evaluated independently of its own characteristics, and treatment and follow-up should be planned accordingly.

Conclusion

The MPT cases are increasing. The possibility of MPT as well as metastasis should be kept in mind during the evaluation of tumor foci seen during diagnosis and follow-up of patients. The characteristics of each tumor, survival, and prognosis should be evaluated separately and the most appropriate treatment should be offered to the patient. It is recommended that synchronic primary tumors which are considered to be surgically resectable without metastasis should be removed in the same session.How to cite this article: Dilek ON, Ozsay O, Karaisli S, Gür EÖ, Er A, Haciyanli SG, Kar H, Dilek FH. Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases. Euroasian J Hepato-Gastroenterol 2018;8(1):1-5.

The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia

Introduction

Liver involvement is common in hematological malignancies, but the incidence and pattern of liver injury vary among the different types. The aims of our study were to determine the incidence and clinical course of acute hepatitis and the important factors for its development in patients with leukemia after chemotherapy.

Materials and methods

All patients with the diagnosis of leukemia who were treated at the Department of Hematology between January 2008 and January 2013 were included in the study. A detailed medical history, clinical and laboratory findings, treatment modalities, complications, and clinical course were recorded retrospectively.

Results

A total of 124 patients (64 females) with the diagnosis of leukemia were included in the study. The mean age was 45.2 years (16-89 years) and mean follow-up time was 29.7 months (0.25-192 months). A total of 43 (34.6%) patients had acute hepatitis after chemotherapy. Pattern of liver injury was hepatocellular in 31 patients, cholestasis in 2, and mix in 10 patients. Age (p = 0.001), hepatitis B surface antigen (HBsAg, p = 0.007), acute leukemia (p < 0.001), positive blood culture (p = 0.004), the amount of transfused red blood cell (p = 0.001), and amount of transfused platelets (p = 0.002) were significantly different under univariate analysis between the acute hepatitis group and the nonacute hepatitis group. Under multivariate analysis, only acute lymphoblastic leukemia (ALL) was identified as independent predictive factor for development of acute hepatitis after starting chemotherapy.

Conclusion

Acute and self-limited hepatitis develops in the substantial proportion of patients with leukemia. The most important factor for development of acute hepatitis is the type of leukemia.

How to cite this article: Kaya M, Akdogan R, Uçmak F, Ayyildiz MO, Karakus A, Kaplan MA. The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia. Euroasian J Hepato-Gastroenterol 2018;8(1):31-37.

Cross-validation Studies of a Novel Low-cost Hepatitis B Virus Quantitative Polymerase Chain Reaction System

Aim

This research focused on the results of the cross-validation program related with the performance of a Cuban novel low-cost real-time quantitative polymerase chain reaction (qPCR) assay for hepatitis B virus (HBV) quantification developed by the Therapeutic Vaccine against Hepatitis B Department, Vaccines Division, Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba.

Materials and methods

Dilution series with the plasmid standard at concentrations of 900,000 to 0.09 copies/reaction (c/r) were made for each PCR instrument. The mean cycles threshold (Ct) values and PCR efficiency were compared among the cyclers. Hepatitis B virus-positive serum samples were used for the calculation of reproducibility of the HBV assay. Biotecon Diagnostics (BCD) also ordered the oligo sequences from a second supplier and compared the PCR performance to those provided from the CIGB.

Results

All PCR cyclers were able to detect concentrations up to 0.09 c/r. However, below the concentration of 9 c/r, the variation of results increased within and between the cyclers. The PCR efficiency showed satisfying results. The overall coefficient of variation (CV) cycler values were 1.29 and 0.91% for M6 and M19 respectively. No significance was observed between the different primer suppliers.

Conclusion

The HBV assay was performed with a good concordance between the five real-time instruments from different suppliers. The HBV assay was also performed with a high reproducibility for samples with a high and a low viral load. The HBV assay is robust against different primer suppliers.

How to cite this article: Aguiar J, Silva JA, García G, Guillén G, Aguilar JC. Cross-validation Studies of a Novel Low-cost Hepatitis B Virus Quantitative Polymerase Chain Reaction System. Euroasian J Hepato-Gastroenterol 2018;8(1):38-41.

Primary Gastric Lymphoma: Clinicopathological Profile

Introduction

Gastrointestinal tract (GIT) is the most common site of involvement of extranodal non-Hodgkin’s lymphoma (NHL). There is regional variation in anatomical distribution of extranodal NHL, stomach being the most common site followed by small intestine. Primary gastric lymphoma (PGL) predominantly involves the antrum and corpus of the stomach. It arises from mucosa-associated lymphoid tissue (MALT) and is of B-cell lineage and often associated with Helicobacter pylori infection. Primary gastric lymphoma often presents with nonspecific symptoms. The present study was undertaken to ascertain the clinicopathological characteristics of PGL at a tertiary care center in South India.

Materials and methods

It is a retrospective study from 2006 to 2016. Patient’s data were obtained from institutional medical records. The histopathology slides were reviewed. The relevant immunohistochemistry (IHC) markers done were leukocyte common antigen (LCA), CD3, CD20, CD79a, CD10, Bcl-2, Bcl-6, CD5, Cyclin D1, CD138, and Ki-67. Correlating with the immunoprofile, further subtyping was done.

Results

A total of 405 patients of NHL were seen during the study period, out of which 43 patients were PGL. There were 32 males and 11 females, with M:F of 2.9:1. The mean age at diagnosis was 58 years. Abdominal pain and new-onset dyspepsia were the commonly observed presenting symptoms. The common site of involvement was antrum (20). Diffuse large B-cell lymphoma (DLBCL) was the most common histological subtype. Helicobacter pylori infection was seen in 18 (41%) patients. Majority of the patients were in stages II and III.

Conclusion

In our study, the initial presentation of PGL was with nonspecific symptoms like abdominal pain and new-onset dyspepsia. High degree of suspicion of such symptoms and biopsy of all suspicious lesions is essential for early detection. Diffuse large B-cell lymphoma was the most common histological subtype seen in our study.

How to cite this article: Malipatel R, Patil M, Rout P, Correa M, Devarbhavi H. Primary Gastric Lymphoma: Clinicopathological Profile. Euroasian J Hepato-Gastroenterol 2018;8(1):6-10.

Nature of Host Immunity during Hepatitis B Virus Infection and designing Immune Therapy

Hepatitis B virus (HBV) infections represent one of the major public health problems in global context. More than 2 billion people in the world have been infected with this virus at some point of time in their life and millions are chronically infected, indicating that chronic HBV-infected subjects remain as a living source of HBV transmission. The public health impact of this is tremendous. Considerable numbers of chronic HBV-infected individuals would eventually develop progressive liver diseases and their complications like hepatic failure, liver cirrhosis (LC), and hepatocellular carcinoma (HCC). Epidemiological studies have suggested that about 0.6 to 1.2 million people die annually from HBV-related liver diseases. These figures about death due to HBV and sufferings from HBV-related diseases indicate a notion of medical emergencies about HBV. In addition to these, the impact of HBV on health care delivery system moves beyond these numbers of HBV-related patients and HB-related deaths. This is because significant insights have already been developed about epidemiology, virology, and pathogenesis of HBV. Also, an effective and widely used preventive vaccine is available against HBV. In addition to these, antiviral drugs against HBV have been developed from early 1980s and several such drugs are now available commercially in the open market around the worldwide. Unfortunately, the ongoing therapeutic regimens could not stand the test of time and new insights about HBV pathogenesis are required for the development of new, novel, and evidence-based therapies for chronic HBV infections.

How to cite this article: Akbar SMF, Al-Mahtab M, Khan SI. Nature of Host Immunity during Hepatitis B Virus Infection and designing Immune Therapy. Euroasian J Hepato-Gastroenterol 2018;8(1):42-46.

Diagnostic and Prognostic Role of Serum Interleukin-6 in Malignant Transformation of Liver Cirrhosis

Aim

Alpha-fetoprotein (AFP) is still the most commonly used and the single most recommended marker in the diagnosis of hepatocellular carcinoma (HCC). Interleukin (IL)-6 is a circular cytokine and its role on carcinogenesis in various hematological and solid tumors is clearly documented. A combination of serum IL-6 and AFP may provide beneficial information regarding early diagnosis of HCC. In this study, the effect of plasma IL-6 level in the diagnosis of HCC was investigated.

Materials and methods

A total of 130 patients with liver cirrhosis, together with 30 control cases were enrolled in the trial. A diagnosis of HCC was present in 75 patients (57.6%) in the liver cirrhosis group. Blood samples were obtained from the enrolled study and control cases. Alpha-fetoprotein was quantified by chemiluminescent method. Plasma IL-6 levels of samples obtained at -80°C were quantified by human IL-6 BMS213/2 BMS213/2TEN kit.

Results

The HCC patients were older than the patients in the cirrhosis group (p = 0.016). On comparison of the HCC patients with the control group, AFP (p < 0.001) and IL-6 (p < 0.001) were significantly higher among the HCC patients. Comparison of HCC patients with liver cirrhosis cases with no diagnosis of HCC revealed significantly high AFP (p < 0.001) and IL-6 levels (p < 0.001) in HCC group. Cutoff value for IL-6 was calculated as 5.73 (pg/mL). No difference was detected in AFP (p = 0.600) and IL-6 (0.344) in all three subgroups. A total of 17 patients died during a mean follow-up period of 32.9 months. No correlation was found between mean AFP values and IL-6 values and survival rates.

Conclusion

Plasma IL-6 level was found to be significant in the diagnosis of HCC. Alpha-fetoprotein and IL-6 provided no advantage in terms of early diagnosis of HCC and no correlation was observed between these markers and survival.

How to cite this article: Yakut M, Özkan H, Karakaya MF, Erdal H. Diagnostic and Prognostic Role of Serum Interleukin-6 in Malignant Transformation of Liver Cirrhosis. Euroasian J Hepato-Gastroenterol 2018;8(1):23-30.

The Consequences of Preterm Birth and Chorioamnionitis on Brainstem Respiratory Centers: Implications for Neurochemical Development and Altered Functions by Inflammation and Prostaglandins

Preterm birth is a major cause for neonatal morbidity and mortality, and is frequently associated with adverse neurological outcomes. The transition from intrauterine to extrauterine life at birth is particularly challenging for preterm infants. The main physiological driver for extrauterine transition is the establishment of spontaneous breathing. However, preterm infants have difficulty clearing lung liquid, have insufficient surfactant levels, and underdeveloped lungs. Further, preterm infants have an underdeveloped brainstem, resulting in reduced respiratory drive. These factors facilitate the increased requirement for respiratory support. A principal cause of preterm birth is intrauterine infection/inflammation (chorioamnionitis), and infants with chorioamnionitis have an increased risk and severity of neurological damage, but also demonstrate impaired autoresuscitation capacity and prevalent apnoeic episodes. The brainstem contains vital respiratory centers which provide the neural drive for breathing, but the impact of preterm birth and/or chorioamnionitis on this brain region is not well understood. The aim of this review is to provide an overview of the role and function of the brainstem respiratory centers, and to highlight the proposed mechanisms of how preterm birth and chorioamnionitis may affect central respiratory functions.

Intake of Bifidobacterium longum and Fructo-oligosaccharides prevents Colorectal Carcinogenesis

INTRODUCTION

We aimed to investigate the effects of intake of yogurt containing Bifidobacterium longum (BB536-y) and fructo-oligosaccharides (FOS) in preventing colorectal carcinogenesis in healthy subjects, and the preventive effects of short-chain fatty acids (SCFA), whose production was enhanced by the intake of BB536-y and FOS, in human colon cancer cell lines.

MATERIALS AND METHODS

The subjects were 27 healthy persons who were divided into a group taking yogurt containing BB536 (BB536-y group; n = 14) and a group taking yogurt containing BB536 and FOS (BB536-y with FOS group; n = 13) once a day for 5 weeks. The feces were sampled before and after the intake to analyze the amount of SCFA in the feces and the profile of intestinal flora, such as putrefactive bacteria and Bacteroides fragilis enterotoxin (ETBF). Subsequently, human colon cancer cell lines (DLD-1 cells, WirDr cells) were cultured in the presence of SCFA (butyric acid, isobutyric acid, acetic acid) in order to evaluate the cell growth-inhibitory activity of SCFA (WST-8 assay) by calculating the IC50 value from the dose-response curve.

RESULTS

Intake of BB536-y increased the total amount of SCFA in the feces and significantly suppressed the detection rate of ETBF and growth of putrefactive bacteria. Intake of BB536-y with FOS was associated with a higher Bifidobacterium detection rate than that of BB536-y alone. The contents of butyric acid, isobutyric acid, and acetic acid, namely, of SCFA, were also decreased. Analysis of the results of culture of DLD-1 cells and WirDr cells in the presence of butyric acid, isobutyric acid, and acetic acid revealed that each of the substances showed significant cell growth-inhibitory activity, with the activity being the highest for butyric acid, followed by that for isobutyric acid and acetic acid.

CONCLUSION

These findings suggest that intake of both BB536-y and BB536-y with FOS prevents colorectal carcinogenesis.How to cite this article: Ohara T, Suzutani T. Intake of Bifidobacterium longum and Fructo-oligosaccharides prevents Colorectal Carcinogenesis. Euroasian J Hepato-Gastroenterol 2018;8(1):11-17.

Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease

Introduction

Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV.

Materials and methods

In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated.

Results

Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evaluation of CLD was: Sensitivity 92.3%, specificity 66.7%, accuracy 90.0%, positive predictive value (PPV) and negative predictive value (NPV) were 96.6 and 46.2% respectively. True positive was 84 cases, false positive 3 cases, false negative 7 cases, and true negative 6 cases. If we consider cut-off value as 909 in the evaluation of EV in CLD, then true positive was 85 cases, false positive 3 cases, false negative 6 cases, and true negative 6 cases. From this, by calculation, sensitivity was 93.4%, specificity 66.7%, accuracy 91%, PPV 96.6%, and NPV 50%.

Conclusion

The platelet count/spleen index may be proposed to be a safe and reliable mean of screening of EV in CLD patients; however, case-control study would be required to validate this.

How to cite this article: Hossain E, Ahammed F, Saha SK, Foez SA, Rahim MA, Noor-e-Alam SM, Abdullah AS. Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2018;8(1):18-22.

The effect of glucose administration on perceived fetal movements in women with decreased fetal movement, a double-blinded placebo-controlled trial

OBJECTIVE

To assess the effect of maternal glucose administration on perceived fetal movements.

STUDY DESIGN

This was a randomized, double-blinded placebo-controlled trial. Patients 28-41 weeks singleton gestation complaining of decreased fetal movements (DFM) were assigned to receive either 500 cc dextrose 5% (group A) or 500 cc normal saline (group B) intravenously. Primary outcome was number of fetal movements recorded during the following 30 min. Secondary outcomes included need for admission or induction of labor owing to persistent DFM. Maternal glucose levels were taken before and after intervention. A sample size of 50 patients was planned in order to detect a 30% increase in fetal movements in group A.

RESULTS

Between February 2011 and April 2013, 50 patients were recruited. Demographic characteristics were similar among groups. There was no difference in the number of fetal movements recorded (7±6 vs 8.8±6 movements/30 min, group A and B, respectively, P=0.39). Similar number of patients had persistent DFM that required admission (8 vs 10 patients, P=0.77, OR 1.4, confidence interval (CI) 0.38-5.3); of those admitted, similar number of patients had induction of labor (3 vs 6 patients, P=0.64, OR 0.4, CI 0.03-3.8). Maternal glucose levels were similar at recruitment (88±19 vs 83±15 mg dl(-1) P=0.36) but were significantly higher in group A (161±37 vs 75±15 mg dl(-1) P<0.0001) after intervention.

CONCLUSION

In women with DFM, maternal glucose administration has no effect on perceived fetal movement and its clinical use is questionable.

Maternal glucose administration for facilitating tests of fetal wellbeing

BACKGROUND

Antenatal maternal glucose administration has been suggested to improve the efficiency of antepartum fetal heart rate testing.

OBJECTIVES

The objective of this review was to assess the merits or adverse effects of antenatal maternal glucose administration in conjunction with tests of fetal wellbeing.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).

SELECTION CRITERIA

All published and unpublished randomized controlled trials assessing the merits of antenatal maternal (oral or intravenous) glucose administration in conjunction with tests of fetal wellbeing.

DATA COLLECTION AND ANALYSIS

Both review authors independently extracted data and assessed trial quality. Authors of published and unpublished trials were contacted for further information.

MAIN RESULTS

A total of two trials, involving 708 participants, were included. Antenatal maternal glucose administration did not decrease the incidence of non-reactive antenatal cardiotocography tests.

AUTHORS' CONCLUSIONS

Antenatal maternal glucose administration has not been shown to reduce non-reactive cardiotocography. More trials are needed to further substantiate this and to determine not only the optimum dose, but also to evaluate the efficacy, predictive reliability, safety and perinatal outcome of glucose administration in conjunction with cardiotocography and also other tests of fetal wellbeing.

Sonographic study of the relationship between gestational diabetes mellitus and fetal activity

OBJECTIVE

To evaluate the relationship between gestational diabetes mellitus (GDM) and fetal activity.

MATERIALS AND METHODS

We prospectively studied 18 pregnant patients with GDM and 20 pregnant patients with normal glucose screening test. An ultrasound equipment was used to perform a 30 min transabdominal sonographic recording for each patient. Each ultrasound exam was recorded using a DVD recorder. Fetal activity was analyzed using duration and number of episodes of fetal breathing and body movements. The recordings were analyzed using a stopwatch in order to accurately evaluate each recording. The data was statistically analyzed using the parametric and non-parametric t-test.

RESULTS

The results of the study indicated that there was a significant correlation (p = 0.007) between the duration of fetal breathing movement and GDM. Fetuses of mothers suffering from GDM had a significantly longer duration of fetal breathing movements compared with fetuses of non diabetic mothers. In addition, the total duration of fetal activity (time of fetal body movements plus fetal breathing movements) was significantly higher (p = 0.005) in GDM compared with non GDM pregnancies. The difference in fetal body movements between GDM and normal pregnancies was not statistically significant.

CONCLUSION

The results of this study support the hypothesis that GDM has a direct influence on fetal activity. The significance of this finding should be further evaluated.

Influence of maternal carbohydrate intake on fetal movements at 14 to 16 weeks of gestation

OBJECTIVE

Ultrasonographic assessment of fetal movements at 14 to 16 weeks of gestation before and after maternal oral intake of carbohydrate.

DESIGN

Thirty consecutive healthy pregnant women between 14 and 16 weeks of gestation were scanned transvaginally. Real-time ultrasound recordings of 20 min duration were performed in the fasting state and after an oral intake of 110 g of glucose. The number of fetal movements, body and limb movements and breathing movements were evaluated. Fetal movements were quantified using a digital chronometer, and the percentage of time spent moving and the rate of movements per minute were then calculated. Data was statistically analyzed using the simple and Wilcoxon paired t-test.

RESULTS

Absolute number of fetal movements, body movements, rotation movements, time spent moving and rate of movements per minute showed a statistically significant increase after maternal intake of carbohydrate (p < 0.0001).

CONCLUSIONS

Maternal oral intake of 110 g of carbohydrate significantly increases fetal movements at 14 to 16 weeks of gestation, thus allowing better ultrasonographic viewing of the fetus.

Fetal cyclic motor activity in diabetic pregnancies: sensitivity to maternal blood glucose

Spontaneous fetal movement in the last third of human gestation is dominated by irregular oscillations on a scale of minutes (cyclic motility, CM). The core properties of these oscillations are stable during the third trimester of gestation in normal fetuses, but disrupted by poorly controlled maternal diabetes. Here we investigated whether fetal CM is linked to short-term instabilities in maternal glucose metabolism. The fetuses of 40 mothers with type I (n = 28) or gestational (n = 12) diabetes were studied one to six times between 27 and 40 postmenstrual weeks of gestation. Fetal movement and maternal blood glucose concentration were measured during two separate periods of fetal activity in each session. Fetal CM was quantified with spectral analysis. Early in the third trimester, changes in the rate of oscillation in fetal CM between the two periods of activity were inversely related to changes in maternal blood glucose levels. Fetal CM was unrelated to concurrent maternal blood glucose levels at any point in the third trimester. The pattern of results suggests that disruption of the temporal organization of spontaneous fetal motor activity in pregnancies complicated by maternal diabetes represents an acute response to fluctuations in the metabolic environment rather than an alteration of CM development.

Maternal glucose administration for facilitating tests of fetal wellbeing

BACKGROUND

Antenatal maternal glucose administration has been suggested to improve the efficiency of antepartum fetal heart rate testing.

OBJECTIVES

The objective of this review was to assess the merits or adverse effects of antenatal maternal glucose administration in conjunction with tests of fetal wellbeing.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register in June 2001.

SELECTION CRITERIA

All published and unpublished randomized controlled trials assessing the merits of antenatal maternal (oral or intravenous) glucose administration in conjunction with tests of fetal wellbeing.

DATA COLLECTION AND ANALYSIS

Both reviewers independently extracted data and assessed trial quality. Authors of published and unpublished trials were contacted for further information.

MAIN RESULTS

A total of two trials with a total of 708 participants were included. Antenatal maternal glucose administration did not decrease the incidence of non-reactive antenatal cardiotocography tests.

REVIEWER'S CONCLUSIONS

Antenatal maternal glucose administration has not been shown to reduce non-reactive cardiotocography. More trials are needed to further substantiate this and to determine not only the optimum dose, but also to evaluate the efficacy, predictive reliability, safety and perinatal outcome of glucose administration in conjunction with cardiotocography and also other tests of fetal wellbeing.

Maturation of body and breathing movements in 24-33 week-old fetuses threatening to deliver prematurely

Maturation of spontaneous fetal body and breathing movements of 24- to 33-week-old fetuses in 168 pregnancies threatening to deliver prematurely were examined on the basis of newborn outcome (premature compromised, premature healthy, term healthy). Maturation of fetuses in 60 low-risk pregnancies delivering as healthy full-term infants served as a normative comparison group. Each fetus was observed for 30 min; the amount of body and breathing movements were noted and an estimation of amniotic fluid volume was made. The pattern of behavioural maturation was similar for all outcome groups; with advancing gestation there was a decrease in body movements and an increase in breathing movements. Both reduced activity levels and advanced behaviours were observed in the high-risk outcome groups. The high-risk fetuses had reduced levels of body movements which increased with better outcome and, an earlier onset of increased amounts of breathing, occurring at 30 weeks in contrast to 33 weeks for the comparison group. In the presence of ruptured membranes, those high-risk fetuses who were born prematurely had less breathing compared to those who delivered at term. Similar maturation patterns among high- and low-risk outcome groups suggests normal/typical functional development in the high-risk fetal groups. The observed differential behaviours were associated with prematurity and most likely associated with events leading to premature labour.

Fetal breathing movements in late diabetic pregnancy: relationship to fetal heart rate patterns and Braxton Hicks' contractions

In type-1 diabetic pregnancy, the occurrence of fetal breathing movements (FBM) was studied in relation to the fetal heart rate patterns (HRPs) A and B and to Braxton Hicks' contractions. Simultaneous 2-h recordings of fetal heart rate and body, eye and breathing movements were available for analysis (n = 44). These recordings were made in 20 fetuses of diabetic women at 32-38 weeks of gestation. Uterine activity was monitored at 36 and 38 weeks. For all recordings combined, the median incidences of FBM during HRPs A and B were 23% and 41%, respectively (NS). At low overall breathing activity (< 50% of total observation time), FBM were more numerous during HRP B than during HRP A in 83% of the recordings. However, if the overall breathing activity exceeded 50% of time FBM were preferentially made during HRP A in 93% of the recordings. This relationship was most pronounced at 38 weeks. These results corroborate our previous findings in the healthy near-term fetus. They show even more clearly that the state-dependent occurrence of FBM depends on the fetus' drive to breathe. During the recordings, breathing activity remained unchanged at all gestational ages studied, in contrast to the gradual decline in FBM seen in normal pregnancy. Braxton Hicks's contractions had no effect on FBM, which differs from the specific distribution of FBM during uterine contractions as previously found in uncomplicated pregnancies. We conclude that FBM in late diabetic pregnancy are not influenced by Braxton Hicks' contractions and that they do not show a clear-cut state-dependency. The (neural) mechanism underlying FBM differs from that in normal pregnancy.

Is there scientific support for the use of juice to facilitate the nonstress test?

In this article, a review of the literature is presented regarding the practice of administering fruit juice to facilitate the nonstress test (NST). Seven studies were found that investigated the relationship between the administration of natural or artificial glucose and the NST. No support was found for the use of juice or glucose to facilitate the NST as commonly administered in practice or as noted in textbooks. Therefore, the practice and textbook references to it should be questioned. The use of rituals undermines the professionalism of nursing practice.

What is the minimum number of heart rates necessary to evaluate fetal conditions at different gestational ages?

Our objective was to determine the minimum number of fetal heart rates (FHRs) needed to assess various fetal conditions adequately, focusing on FHR changes in relation to gestational age. We used probability distribution matrices previously derived from 10,934,604 FHRs of 743 uncomplicated fetuses. These matrices were made at nine consecutive 2-week intervals between 23 and 40 weeks' gestation, from which samples were taken after assigning random numbers to FHRs in sequence. As a variable, the difference rate (%) between the sample probability distribution matrix and its corresponding age-group probability distribution matrix was calculated. Scattergrams of difference rates vs. a given number of FHR samplings were analyzed using piecewise linear regression. One critical point per age-group emerged, ranging between 9000 and 10,000 beats, for all age-groups. A linear decrease in the difference rate was noted with a step-by-step increase in random sampling size of FHRs until reaching the critical point, beyond which the difference rate remained constant between 25-33%. The critical points indicate that the minimum number of FHRs for assessment of the fetus at 23-40 weeks' gestation is almost the same, between 9000 and 10,000, with 67-75% baseline variability (so called beat-to-beat variability) and 25-33% long-term variability regardless of advance in gestation.

Patterns of breathing movements in the near-term human fetus: relationship to behavioural states

The occurrence of fetal breathing movements was studied in relation to fetal behavioural states 1F and 2F, as recognized by the heart rate patterns A and B, respectively. Simultaneous recordings of fetal heart rate and body, eye and breathing movements were available for analysis (n = 88). These recordings, lasting > or = 2 h, had been made in healthy near-term fetuses during the afternoon or evening, starting about 1 h after the maternal meal. In the majority of recordings fetal breathing activity was lower during heart rate pattern A than during pattern B, but as the opposite occurred in 29/88 recordings (33%), the interstate difference was not significant (P = 0.052). Detailed analysis revealed that breathing movements were more numerous during pattern B than during pattern A if the incidence of breathing during a particular time period was low (30-40% of time). At a high overall breathing incidence (> 40%), however, breathing movements were more often present during pattern A than during pattern B. The latter occurred especially in the first hour of recording, i.e. less distant in time from maternal meals. We conclude that fetal breathing activity is generally higher during state 2F than during state 1F, but a clear-cut state-dependency is absent. Secondly, the relationship between the incidences of breathing during states 1F and 2F depends on the 'drive' or motivation (presumably the blood glucose content) to breathe.

The effect of maternal intravenous glucose administration on fetal activity

OBJECTIVE

The study was designed to objectively evaluate the effect of maternal intravenous glucose infusion on fetal activity.

STUDY DESIGN

Twenty-one volunteers at 30.7 +/- 3.0 weeks' gestation were objectively evaluated for fetal activity with a Doppler monitor before and during an intravenous glucose test. Baseline fetal activity monitoring began 10 minutes before a fasting blood glucose level was obtained. A standard 1-hour intravenous glucose tolerance test was then performed, and fetal activity monitoring was continued for the duration of the test. Twenty-one women at 29.8 +/- 3.0 weeks' gestation volunteered to serve as controls and were continuously monitored for fetal activity. The control patients did not receive intravenous glucose.

RESULTS

Linear regression analysis revealed an increase in fetal activity in both groups; however, the increase in the glucose infusion group was significantly greater than in the control group.

CONCLUSIONS

Maternal glucose infusion causes short-term stimulation of fetal activity; however, some other factor in the monitoring process also stimulates fetal activity.

Fetal breathing movements before oxytocin induction in prolonged pregnancies

Fetal breathing movements were recorded before elective labor induction in 65 patients with uncomplicated prolonged pregnancies. Breathing activity was observed in 41 patients and was absent in 24. Comparison of these two groups indicated that the induction period was significantly shorter and the oxytocin requirement significantly lower in the group with no fetal breathing movements (mean, 319.3 vs 648.5 minutes and 1133.7 vs 2708.4 mIU, respectively). These findings remained valid regardless of Bishop scores. The data suggest that fetal breathing movements are predictive of the effectiveness of oxytocin induction in prolonged pregnancies.

Growth and motor development in fetuses of women with type-1 diabetes. III. First trimester quantity of fetal movement patterns

Delayed emergence of movement patterns and disturbances in the development of behavioural states are often observed in the fetuses of diabetic women. The developmental course of specific fetal movement patterns was studied in 20 women with type-1 diabetes during the first trimester of pregnancy. The aim was to investigate whether maternal diabetes also has an effect on the rate of occurrence and temporal patterning of fetal movements. Real-time ultrasound recordings with a duration of 1 h were made once a week between the 7th and 17th week postmenstrual age in order to quantify fetal movements. The data were compared to those obtained in a group of uncomplicated pregnancies. The developmental trends in the occurrence of movement patterns were similar to those in the control fetuses, with the exception of startles. Before the 9th week of gestation, fetal movements occurred less frequently; this was related to the quality of maternal glucose control. After 12 weeks, the overall incidence was higher than in the control group, due to an increase in the incidence of breathing movements. The rate of breathing movements was generally slower than in the control group.

Body and breathing movements in near-term fetuses and newborn infants of type-1 diabetic women

The generation of body and breathing movements was studied in relation to behavioural states in near-term fetuses (n = 12) and newborn infants (n = 7) of women with well-controlled type-1 diabetes. Results obtained from low-risk fetuses (n = 12) and neonates (n = 14) were used for comparison. Before birth, 2-h recordings were made of fetal heart rate and of fetal body movements, breathing and eye movements; the neonates were studied polygraphically during 6 h for heart rate, body movements, respiration, eye movements and EEG-pattern. The generation of body movements was similar in the fetuses of the diabetic and control groups. After birth, the duration per burst was longer in the diabetic group, both in state 1 and state 2, resulting in increased incidences. The incidence of fetal breathing movements tended to be higher in the diabetic group, but differences with the control group did not reach statistical significance. Breathing rate was considerably slower in fetuses of diabetic women than in control fetuses, both in C1F (P less than 0.001) and C2F (P less than 0.002). This indicates altered regulation of breathing movements in diabetic pregnancy. In the neonates, breathing rate was identical in both groups. In either group breathing was slower in state 1 than in state 2; such a difference was not present before birth. Periodic breathing occurred more often in the infants of diabetic women, especially in state 2 (P less than 0.02). Behavioural state organization was poor in the diabetic group, both before and after birth and resembled that of more immature fetuses and infants. The continuity of the poor behavioural state regulation from prenatal into postnatal life indicates that this cannot be attributed to the instantaneous unfavourable condition before birth.

Fetal lung maturity in diabetic pregnancies: relation among amniotic fluid insulin, prolactin, and lecithin

Insulin, prolactin, and lecithin phosphorus levels were measured in 97, 62, and 44 amniotic fluid samples from third trimester normal, gestational diabetic, and insulin-dependent diabetic patients, respectively. There was no difference in lecithin phosphorus concentration (index of fetal lung maturity) among the three groups. The amniotic fluid insulin level was significantly higher in insulin-dependent diabetic patients, whereas there was no difference in amniotic fluid prolactin levels among the groups. Correlations of amniotic fluid prolactin levels with both lecithin phosphorus and insulin levels were not statistically significant in any of the groups. This is probably because amniotic fluid prolactin is decidual, rather than fetal, in origin. Even though amniotic fluid insulin levels, which reflect fetal levels, were significantly higher in insulin-dependent diabetic patients, there was no difference in the amniotic fluid lecithin phosphorus concentration in diabetic pregnancies compared with that in normal pregnancies. Moreover, there was a positive, and not a negative, correlation between amniotic fluid insulin and amniotic fluid lecithin phosphorus levels in diabetic pregnancies. These results do not support the theory that fetal hyperinsulinemia results in delayed pulmonic maturation in diabetic pregnancies.

Potential hazards of hypoglycaemia in the parturient

Hypoglycaemia can cause serious problems in anaesthetized patients, due to blockade by anaesthesia of the usual compensatory mechanisms. Gravid women develop hypoglycaemia more readily than non-pregnant patients because they live in a state of "accelerated starvation." Three cases are described of healthy parturients undergoing elective Caesarean section under lumbar epidural analgesia whose post-blockade hypotension was difficult to reverse until their low blood glucose concentrations had been normalized. Further investigations of the role played by blood glucose concentrations in the maintenance of cardiovascular homeostasis in pregnant women are indicated. In the meantime, a preanaesthetic blood glucose determination will facilitate measures to ensure a normal blood glucose level before induction of anaesthesia for Caesarean section.

Decreased fetal movements with sustained maternal hyperglycemia using the glucose clamp technique

The purpose of this study was to evaluate the effect of sustained maternal hyperglycemia (120 mg/dl) on fetal activity. The glucose infusion study group was comprised of nine healthy gravidas between 36 and 40 weeks' gestation, and six patients served as controls. The protocol design included an overnight fast for all patients. Fetal movements were evaluated by external fetal monitoring. A 2-hour preinfusion evaluation of fetal activity served as the baseline control for each patient studied. Study patients then received a glucose infusion by a glucose clamp technique to maintain a sustained hyperglycemia of 120 mg/dl for 3 hours. After the glucose infusion, fetal movements were observed for 1 hour. Control patients received a saline infusion for 2 hours after a 2-hour baseline evaluation. Maternal hyperglycemia was associated with a significant decrease of fetal movements greater than 1 second duration during the first hour of glucose infusion. Fetal movements returned to baseline during the second and third hours of glucose infusion. Saline infusion was not associated with a decrease in fetal activity. We conclude that sustained maternal hyperglycemia is associated with a transient decrease in fetal movement during the first hour of glucose infusion followed by a return to the control (preinfusion) level of fetal activity. These data may have implications in the study of fetal behavior in diabetes mellitus.

Maternal dietary substrates and human fetal biophysical activity. I. The effects of tryptophan and glucose on fetal breathing movements

To study the effects of L-tryptophan and glucose on fetal breathing activity, we examined 40 women with normal term pregnancies, randomly assigned to four equal groups who either continued fasting (group C), received 1 gm of oral tryptophan (group T), received 100 gm of oral glucose (group G), or received both substrates (group T + G). Studies lasted 210 minutes, during which fetal breathing movements were observed with real-time ultrasonography and entered and analyzed for incidence, rate, and variability on a microcomputer. Plasma glucose and tryptophan levels were determined every 30 minutes. The incidence of fetal breathing movements declined in group C and rose significantly in the other groups. Breathing rates were unchanged in groups C and T but rose significantly in groups G and T + G during peak breathing intervals. Breath interval variability did not change significantly in any study group. Maternal administration of tryptophan is associated with an alteration in fetal breathing activity but to a lesser degree than that observed after maternal glucose loading.

Disposition of ethanol and activity of hepatic and placental alcohol dehydrogenase and aldehyde dehydrogenases in the third-trimester pregnant guinea pig for single and short-term oral ethanol administration

The disposition of ethanol and its metabolite, acetaldehyde, and the activity of alcohol dehydrogenase (ADH) and aldehyde dehydrogenases (ALDH) were determined in the third-trimester pregnant guinea pig following single and 7-day oral administration of ethanol (0.5 g X kg maternal body weight-1 X day-1). Animals were killed at each of selected times after the single and seventh ethanol dose. For both ethanol dosage regimens, the maternal and fetal blood and brain ethanol concentrations were virtually identical during the elimination phase of the time-course study. There was initial slow transfer of ethanol into amniotic fluid, followed by significantly higher ethanol concentration in amniotic fluid relative to maternal and fetal blood during the elimination phase. Acetaldehyde was measurable in maternal blood, maternal brain, and fetal brain at concentrations that were low and variable. For both ethanol dosage regimens, ADH activity was measurable only in maternal liver. Low Km ALDH activity was measurable only in maternal liver and fetal liver. High Km ALDH was measurable in maternal liver, fetal liver, and placenta and was significantly greater in maternal liver. The data indicate that there is bidirectional placental transfer of ethanol in the maternal-fetal unit; the elimination of ethanol from the maternal and fetal compartments is regulated by maternal hepatic biotransformation involving ADH; the amniotic fluid is a reservoir for ethanol in utero; the low Km ALDH in fetal liver protects the fetus from ethanol-derived acetaldehyde in the maternal circulation; and short-term maternal administration of once-daily, low-dose ethanol does not produce major changes in ethanol disposition and the activity of the enzymes involved in ethanol biotransformation.

The development of cyclic motility in fetuses of diabetic mothers

The cyclic organization of spontaneous movement was studied longitudinally in 22 fetuses of diabetic mothers (FDMs) during the third trimester of gestation and quantified with spectral analysis. Cyclic motility at frequencies between .08 and 1.22 cycles/min was found in all fetuses, although it was temporarily absent in 12 of the 22 fetuses at some time between 25 and 38 weeks. While some parameters of cyclic motility changed little, the frequency of the dominant motility cycle doubled from .24 to .48 cycle/min between 28 and 36 weeks, and the relative strength of motility cycles in the band between .18 and 1.02 cycles/min decreased temporarily at 36 weeks. These developmental changes and the common absence of cyclic motility contrast sharply with previous findings in normal fetuses, and (except for its absence) are accounted for by a subgroup of FDMs whose mothers' blood glucose levels were least well controlled during the third trimester of gestation. The presence of cyclic motility in all FDMs provides further evidence that cyclic activation is a basic property of the developing central nervous system in the human, as it appears to be in other vertebrates. However, the differences between FDMs and normal fetuses suggest that the development of cyclic motility is sensitive to disturbances in the fetal metabolic environment.

Effects of maternal glucose ingestion on human fetal breathing movements at weeks 24 and 28 of gestation

The incidence of human fetal breathing movements was studied in normal pregnancies before and after administration of 50 g glucose or a placebo (water) at 24 and 28 weeks. Glucose or water was given to the same women on two separate days in a randomised order. No significant differences were present among the results on the placebo-day and the control period of the glucose-day at either gestational age. On the glucose-day, the incidence rose significantly from 3.6 to a maximum of 11.6% at 24 weeks, and from 6.7 to 30.2% at 28 weeks. At both ages the maximum was found 90-120 min after the intake of glucose. It is concluded that already at 24 weeks gestation the human fetus reacts with an increase of fetal breathing movements after the administration of glucose to the mother.

The fetal behavioural states: an ultrasonic study

In order to accurately detect the fetal behavioural state, we simultaneously measured fetal heart rate and multiple fetal activities in 27 healthy pregnant women at 38 to 40 weeks of gestation. We ultrasonically identified gross body movements, breathing movements and micturition. Analysis of fetal heart rate allowed us to distinguish two different patterns of fetal behaviour: active and quiet phases. The frequency distribution of the analysed fetal events was significantly different in these two phases. These data suggest that a complete biophysical profile of the fetus is effective in differentiating behavioural states and may improve the predictive accuracy of fetal heart rate analysis alone.

Effects of maternal ethanol infusion on fetal cardiovascular and brain activity in lambs

Ethanol (1 gm/kg of maternal body weight administered over 1 hour) was infused intravenously into 11 chronically prepared pregnant ewes between 128 to 137 days' gestation. Fetal breathing movements were suppressed for 9 hours following ethanol administration, and both high- and low-voltage fetal electrocortical activity were suppressed for 3 hours and replaced by intermediate-voltage electrocortical activity. Fetal blood gases and pH were not altered. These data support the hypothesis that ethanol suppresses fetal breathing movements by a direct central mechanism rather than indirectly by alteration of electrocortical activity.

Hyperinsulinemia in myotonic dystrophy: identity of the maternal factor causing the neonatal myotonic dystrophy syndrome

An environmental factor acting on the fetus is thought to cause a neonatal syndrome characterized by marked muscular hypotonia, lack of respiratory drive and feeding difficulties, in some infants born to mothers with myotonic dystrophy. Mortality is high, especially amongst those babies born prematurely, but muscle strength and tone improve rapidly in survivors. Nevertheless, most survivors have physical deformities and mental retardation and are thought to develop myotonic dystrophy later. We propose that alterations in maternal insulin secretion (usual in myotonic dystrophy subjects) alter fetal blood glucose and amino acid levels and retard growth and maturation of fetal skeletal muscle. This leads to severe muscular hypotonia in affected infants. Also, we suggest that infants who die during the perinatal period may not have inherited the defective autosomal dominant gene that causes myotonic dystrophy.

Characteristics of glucose-stimulated breathing movements in human fetuses with intrauterine growth retardation

The characteristics of fetal breathing movements were analyzed in 13 fetuses who were intrauterine growth retarded and in a comparison group of 13 well-grown fetuses. The numbers of minutes of breathing activity per hour were similar for the two groups; the increase (p less than 0.05) after maternally administered glucose was due to longer (p less than 0.05) and more frequent (p less than 0.05) breathing episodes, and was mainly deep breathing. The deep breathing rate increased significantly (p less than 0.05) after glucose. The two groups exhibited similar low occurrences of shallow breathing (less than 5 minutes per hour) throughout the experiments. No significant differences could be demonstrated between intrauterine growth-retarded and well-grown fetuses with respect to the amount, rate, and pattern of breathing activity during fasting or after oral administration of glucose to the mother.

Absence or impaired response of fetal breathing to intravenous glucose is associated with pulmonary hypoplasia in congenital myotonic dystrophy

Two fetuses of a patient affected with myotonic dystrophy were studied ultrasonically from 28 to 34 weeks' gestation. After a 1-hour observation period, an intravenous injection of 25 gm of 50% glucose solution was given to the mother. Fetal breathing movements were 0% during the control period and increased to only 10% at 90 minutes after the injection of glucose; the episode lasted approximately 30 minutes. The infants, who were delivered at 33 and 35 weeks, had generalized hypotonia, normal arterial cord blood gases, and died shortly after birth from pulmonary insufficiency, in spite of maximum ventilatory support. Postmortem pulmonary hypoplasia was confirmed by a lung weight/body weight ratio of less than 0.019. We postulate that fetal breathing activity and its response to the injection of glucose may be a potential clinical test by which normal fetuses can be differentiated from fetuses affected by neuromuscular disorders, including myotonic dystrophy.

Maternal glucose injections do not alter the suppression of fetal breathing following maternal ethanol ingestion

In order to determine whether intravenous injections of glucose could reverse the effects of maternal ingestion of ethanol (0.25 gm/kg), glucose (25 gm intravenously) or an equal volume of saline solution was administered to eight pregnant women at 37 to 40 weeks' gestation after ingestion of ethanol. Fetal breathing movements were abolished within 30 minutes after ingestion of ethanol and were not increased by maternal intravenous injections of glucose. Maternal heart rate was increased by ethanol. The disposition of ethanol in maternal blood was not altered by injection of glucose, and fetal gross body movements were not influenced by maternal ingestion of ethanol or by injections of glucose after ethanol.

Effect of intravenous glucose injection on human maternal and fetal heart rate at term

The effects of maternal intravenous glucose administration (25 gm) on maternal heart rate, fetal heart rate, gross fetal body movements, and fetal heart rate accelerations was measured in 11 healthy pregnant women at 38 to 40 weeks' gestational age. Mean maternal heart rate increased from 78.3 +/- 0.8 bpm during the control period to 82.7 +/- 0.5 bpm at 30 to 85 minutes following glucose injections (p less than 0.01). Mean fetal heart rate rose from 137.8 +/- 0.4 bpm to 142.4 +/- 0.3 bpm at 50 to 95 minutes following injections (p less than 0.001). The incidence of gross fetal body movements and the number, duration, and amplitude of fetal heart rate accelerations did not change following glucose injection. We conclude that maternal glucose administration near term results in a small but significant increase in the mean maternal heart rate and fetal heart rate and no change in the incidence of gross fetal body movements or in fetal heart rate accelerations.

The rate and regularity of breathing movements in the normal and growth-retarded fetus

The rate and regularity of fetal breathing movements (FBM) were determined in 14 women with uncomplicated singleton pregnancies, eight of whom were between 30 and 33 weeks gestation and six between 37 and 40 weeks gestation. Similar observations were made in 19 women with pregnancies complicated by severe intrauterine growth retardation, 11 of whom were between 30 and 33 weeks and eight between 37 and 40 weeks. In normal pregnancy recordings of breath-to-breath intervals showed that FBM became more regular with advancing gestational age, and the rate [breaths/min, mean (SEM)] slowed from 57.2 (1.3) at 30-33 weeks to 47.9 (0.8) at 37-40 weeks. FBM in the growth-retarded group were regular at each gestation studied and the rate was even slower than in the normal group at term, being 41.9 (1.2) at 30-33 weeks and 41.1 (1.0) at 37-40 weeks. Hyperoxia and hypercapnia appeared to have no consistent effect on fetal breathing rate. Fasting for greater than 12 h considerably reduced the rate of FBM in the normal fetus but only marginally so in those with growth retardation. It is concluded that the pattern of FBM provides more information about the fetus than the amount of time spent breathing, particularly when growth is retarded.

Ultrasonic measurement of rate and depth of human fetal breathing: effect of glucose

A recently developed ultrasonic tracking device was used to determine the effect of maternal intravenous glucose infusion on amplitude and frequency of breathing movements in six healthy human fetuses at 38 to 40 weeks' gestation. Following a 2-hour observation period, an intravenous injection of either 25 gm of a 50% glucose solution or an equal volume of saline was given to the mother. Observations were continued for a further 4 hours. Fetal rib cage and abdominal diameters were measured continuously with the ultrasonic tracking device and the information was recorded on a strip chart recorder for later analysis. Breath interval and incidence measurements were highly correlated with data obtained by an independent technique (r greater than or equal to 0.90). During the first 80 minutes after glucose injection, total fetal trunk movement recorded during breathing movements increased from 1.5 +/- 0.2 to 2.9 +/- 0.4 mm (P less than 0.05). There was no significant change in the frequency or variability of fetal breathing movements after glucose infusion.

The effect of maternal glucose administration on the specificity of the nonstress test

To determine whether maternal glucose administration can decrease the incidence of false positive nonstress tests, 296 nonstress tests were performed on 235 high-risk obstetric patients in a prospective controlled study. Patients were alternately given a 50 gm oral glucose drink or an equal volume of water 30 minutes prior to the commencement of each test. Among "fed" patients (last meal within 2 hour of the nonstress test) whether receiving glucose or water, and "fasted" patients who received glucose, there was no significant difference in the percentage of reactive tests at either 20 minutes (65.2%) or 40 minutes (87.3%) of testing. However, patients fasting and receiving water had a significantly decreased percentage of reactive tests, both at 20 minutes (48.3%, P less than 0.01) and at 40 minutes (76.7%, P less than 0.05). Glucose administered to fasted patients resulted in an increase in the incidence of reactive tests, although this was not statistically significant. Glucose administration had no effect on the nonstress test results when administered to fed patients.