1. Maternal foetal and neonatal calcium, phosphorus and glucose values, with special emphasis on the role of the placenta in their regulation
- Author
-
Khattab, Abd El-Khalik
- Subjects
612.015 - Abstract
1. In 23 nomal pregnancies and labours the following results were obtained - (a) At 36 weeks of pregnancy: serum calcium was below normal adult levels (8.5 mg. per 100 ml.), phosphorus below normal (2.7 mg. per 100 ml.), but blood glucose within normal limits (94 per 100 ml.) (b) At 38 weeks of pregnancy: serum calcium, phosphorus and blood glucose were 8.5, 2.8, 89.0 mg. per 100 ml. respectively, again with mild hypocalcaemia and hypophosphataemia, but with normal blood glucose values for an adult. (c) At delivery: serum calcium was highest in the foetal blood (10.4 mg. per 100 ml.), followed by neonatal values (9.4 mg. per 100 ml.) and lowest in the maternal blood (8.6 mg. per 100 ml.) Possible explanations concerning the role of the placenta were given. • Plasma phosphorus was highest in neonatal blood (4.4 mg. per 100 ml.), lowest in maternal blood (2.5 mg. per 100 ml.) and foetal values were inbetween (4.1 per 100 ml.) • Blood glucose was highest in maternal blood (110 mg. per 100 ml.) followed by foetal blood (87.0 mg. per 100 ml.) and lowest in neonatal blood (71.0 mg. per 100 ml.) Passage of glucose from the mother to the foetus across a transplacental gradient, by diffusion, diffusion-utilization or by active secretion has been discussed (d) First dav values: within 12 hours after birth, the babies' serum calcium falls, phosphorus rises and glucose values drop (8.9, 4.9, 45.0 mg. per 100 ml. respectively). (e) Fourth day values: There is a further drop in serum calcium (8.4 mg. per 100 ml.), a further rise in phosphorus (6.2 mg. per 100 ml.) and also a rise in blood glucose (65 .0 mg. per 100 ml.) (f) Correlations: At the time of delivery there is a highly significant positive correlation between maternal, foetal and neonatal calcium, phosphorus and glucose values, with P varying from less than 0.0001 up to 0.08. The clinical implication of this finding has been discussed. There is no significant correlation between the birth weight of the baby, and foetal and neonatal values for calcium, phosphorus and glucose. 2. In six normal cases, a glucose-infusion during labour raised the maternal blood glucose, with the placenta having been capable of transmitting this extra load of glucose to the foetus. In a patient with severe pre-eclampsia, the placenta could not transmit a similar extra load of glucose. This was taken as an indirect proof of placental insufficiency in the latter case. 3. In 55 normal full-term newborn babies the following results were obtained - (a) Serum calcium* drops very gradually from 9*6 mg. per 100 ml. at birth to 8.9, 8.5, 8.3 and 8.3 mg. per 100 ml. on the first, second, third and fourth days of life respectively. Early starvation, temporary functional hypoparathyroidism and hyperphosphataemia may be aetiologic factors in this drop. (b) Plasma phosphorus: rises gradually from 4.4 mg. per 100 ml. at birth to 4.7, 4.7, 5.1 and 6.1 mg. per 100 ml. on the first, second, third and fourth days of life respectively. Early starvation with tissue destruction, renal immaturity with phosphate retention and excessive phosphate intake in cow's milk were put forward to explain this hyperphosphataemia. (c) Blood glucose: drops from 71.0 mg. at birth to 50 mg. per 100 ml. on the 1st day, probably due to hyperinsulinism. Then it rises to 55, 65, 71 per 100 ml. on the 2nd, 3rd and 4th days respectively, possibly due to development of insulin antagonists of the anterior pituitary and adrenals. (d) Correlations: A significantly positive correlation between glucose on 1st day and glucose on 4th day has been found (P = less than 0.01). A significantly negative correlation between glucose and phosphorus on 1st day has been found (P = 0.02). 4. In 16 sets of twins first day hypoealcaemia was demonstrated, also the average serum calcium was higher in the first than in the second, while the blood glucose was higher in the larger of the twins. The effect of birth order on serum calcium was explained through the hypocalcaemic action of corticosteroids, while the effect of birth weight on blood glucose was explained through the hepatic glycogen stores. 5. Placental insufficiency as indicated by inability of the placenta to transmit calcium and glucose from the mother to the foetus has been demonstrated in 4 cases of severe pre-eclampsia, in 2 cases of prolonged gestation with dysmaturity and in one case of placenta praevia. On the other hand, the placental transmission of calcium and glucose was normal in 2 prolonged gestations but with normal birth weight babies, in 3 immature deliveries, in 4 elderly primigravidae, and in 12 mild cases of pre-eclampsia. 6. In two babies of diabetic mothers, hypocalcaemia, hyperphosphataemia and hypoglycaemia has been demonstrated in the neonatal period. Placental transmission was intact in the first case, but impaired in the second, probably because of a super-imposed toxaemia.
- Published
- 1965