Fetus and Neonate is a series of practical, focused texts which concentrate on that critical period of human development, from late fetal to neonatal life. Each volume in the series examines a particular body system, looking at the physiological mechanisms which underlie the transition from intrauterine to extrauterine life, the pathophysiological processes which may occur, and the application of new basic scientific knowledge to the clinical situation. This volume, prepared by an authoritative team of internationally renowned contributors, looks in depth at the growth of the fetus and neonate. It is introduced with an overview of physiology and endocrin- ology of normal growth, before considering new insights into the patho- physiology of growth impairment and their clinical applications. Several chapters focus on fetal growth retardation and the challenges this poses for the clinician. The measurement and assessment of fetal growth and well-being are also fully addressed. An important theme is the role of disturbances in 'programming' of growth in the early develop- ment of the fetus in producing adult diseases. This stimulating book brings together all the disciplines relevant to this important scientific and clinical area. GROWTH Fetus and Neonate: Physiology and Clinical Applications Volume 1: The Circulation Volume 2: Breathing Volume 3: Growth GROWTH Edited by MARK A. HANSON JOHN A. D. SPENCER CHARLES H. RODECK Department of Obstetrics and Gynaecology, University College London Medical School, UK CAMBRIDGE UNIVERSITY PRESS Published by the Press Syndicate of the University of Cambridge The Pitt Building, Trumpington Street, Cambridge CB2 1RP 40 West 20th Street, New York 10011-4211, USA 10 Stamford Road, Oakleigh, Melbourne 3166, Australia ©Cambridge University Press 1995 First published 1995 Printed in Great Britain at the University Press, Cambridge A catalogue record for this book is available from the British Library Library of Congress cataloguing in publication data Growth/edited by Mark A. Hansen, John A. D. Spencer, Charles H. Rodeck. p. cm.-(Fetus and nconate; v. 3) Includes index. ISBN 0-521-45522-7 (hardback) 1. Fetus-Growth. 2. Fetal growth retardation. I. Hanson, Mark A. II. Spencer, John A. D. III. Rodeck, Charles H. IV. Scries. [DNLM: 1. Fetal Development-physiology. 2. Fetal Growth Retardation. WQ 210.5 G879 1995] RG13.G76 1995 6I2.6'47—dc20 DNLM/DLC for Library of Congress 95-6496 C1P ISBN 0 521 45522 7 hardback PN Contents Preface to the series ix List of contributors xi Part I: Physiology 1 Placental transfer I.M. Doughty andC.P. Sibley 3 2 Nutrient requirements for normal fetal growth and metabolism A.L. Fowden 31 3 Hormonal control of fetal growth D.J. Hil , 57 4 Insulin-like growth factors and their binding proteins P.D. Gluckman 97 5 Metabolism and growth during neonatal and postnatal development M.E. Symonds 117 Part II: Pathophysiology 6 Experimental restriction of fetal growth J. A. Owens, P. C. Owens and J. S. Robinson 139 7 Placental changes in fetal growth retardation T.Y. Khong \11 8 Human fetal blood gases, glucose, lactate and amino acids in IUGR R. Montemagno and P. Soothil 201 9 Glucose and fetal growth derangement J.M.Bassett 223 10 Fetal programming of human disease D.J.P. Barker and H. Y. Sultan 25 Part III: Clinical applications 11 Clinical assessment of placental function J.F.Pearson 211 12 Measurement of human fetal growth S.C. Robson and T. C. Chang 297 13 Assessment of fetal well-being in growth-retarded fetuses G.H.A. Viser 327 Index 347 Preface to the series The factual burden of a science varies inversely with its degree of maturity P. Medawar 'Two Conceptions of Science': 'Anglo-Saxon Attitudes', Henry Tizard Memorial Lecture, Encounter 143, August 1965 The idea for a series on the applications of fetal and neonatal physiology to clinical medicine came from the need of our students for something intermediate between a textbook and review articles. Textbooks provide breadth of coverage but tend to lack critical discussion. Reviews can provide such discussion but represent the view of one authority and may need a balance. For the student, such reviews are not a substitute for original papers and are better taken after consumption of a full course of such papers rather than as hors d'oeuvres to them. We envisage the readership of the series as 'students' of the subject in the widest sense, from undergraduates learning about fetal and neonatal physiology as part of a basic science degree or preclinical medical students, to postgraduate and postdoctoral scientists and clinicians spe- cializing in obstetrics, neonatology or paediatrics. We decided that all needs would best be met by producing a series of multiauthored volumes. This will allow rapid production of short texts that will keep the material focused whilst still allowing the subject to be reviewed from several points of view. None the less, we have decided to adopt a 'systems' approach because it has the advantages of simplicity and conformity to textbooks of physiology. The chapters in each volume of the series are arranged in sections: Physiology, Pathophysiology and Clinical Applications. They are not intended to be all-inclusive but rather to demonstrate the applications of basic scientific research to clinical medicine via improved understanding of pathophysiological processes. IX