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. 2013 Jan;17(1):60-8.
doi: 10.4103/2230-8210.107851.

In utero fuel homeostasis: Lessons for a clinician

P N Suman Rao  1 , A Shashidhar, C Ashok
Affiliations

In utero fuel homeostasis: Lessons for a clinician

P N Suman Rao et al. Indian J Endocrinol Metab. 2013 Jan.

Abstract

Fetus exists in a complex, dynamic, and yet intriguing symbiosis with its mother as far as fuel metabolism is concerned. Though the dependence on maternal fuel is nearly complete to cater for its high requirement, the fetus is capable of some metabolism of its own. The first half of gestation is a period of maternal anabolism and storage whereas the second half results in exponential fetal growth where maternal stores are mobilized. Glucose is the primary substrate for energy production in the fetus though capable of utilizing alternate sources like lactate, ketoacids, amino acids, fatty acids, and glycogen as fuel under special circumstances. Key transporters like glucose transporters (GLUT) are responsible for preferential transfers, which are in turn regulated by complex interaction of maternal and fetal hormones. Amino acids are preferentially utilized for growth and essential fatty acids for development of brain and retina. Insulin, insulin like growth factors, glucagon, catecholamines, and letpin are the hormones implicated in this fascinating process. Hormonal regulation of metabolic substrate utilization and anabolism in the fetus is secondary to the supply of nutrient substrates. The knowledge of fuel homeostasis is crucial for a clinician caring for pregnant women and neonates to manage disorders of metabolism (diabetes), growth (intrauterine growth restriction), and transitional adaptation (hypoglycemia).

Keywords: Fetus; fuel; glucose; metabolism.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Uterine, fetal, and uteroplacental glucose uptake rates as functions of maternal (a, b) or fetal (c) arterial plasma glucose concentrations in pregnant sheep (reproduced from Ref 5)
Figure 2
Figure 2
Energy substrates transported to and deposited in the fetus
Figure 3
Figure 3
Energy and nutrient substrates transfer to fetus (adapted from Ref 8)
Figure 4
Figure 4
Fasting and fed states in pregnancy (adapted from Ref 8)
Figure 5
Figure 5
Effect of maternal hyperglycaemia on the fetus in normal and diabetic pregnancies (adapted from Ref 7) A Normal pregnancy, B Diabetic pregnancy
See this image and copyright information in PMC

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