Axially chiral N-benzyl-N,7-dimethyl-5-phenyl-1, 7-naphthyridine-6-carboxamide derivatives as tachykinin NK1 receptor antagonists: determination of the absolute stereochemical requirements

A potent and orally active NK1 antagonist, trans-N-[3, 5-bis(trifluoromethyl)benzyl]-7,8-dihydro-N, 7-dimethyl-5-(4-methylphenyl)-8-oxo-1,7-naphthyridine-6-carboxamide (1t), was shown to exist as a mixture of separable and stable (R)- and (S)-atropisomers (1t-A and 1t-B) originating from the restricted rotation around the -C(6)-C(=O)- bond; the antagonistic activities of 1t-A were ca. 6-13-fold higher than those of 1t-B. Analogues of 1t (3), which have (S)- and (R)-methyl groups at the benzylic methylene portion of 1t, were prepared and separated into the diastereomeric atropisomers, 3a-A, 3a-B and 3b-A, 3b-B, in enantiomerically pure forms. Among the four isomers of 3, the (aR, S)-enantiomer (3a-A) exhibited the most potent antagonistic activities with an IC50 value of 0.80 nM (in vitro inhibition of [125I]BH-SP binding in human IM-9 cells) and ED50 values of 9.3 micrograms/kg (iv) and 67.7 micrograms/kg (po) (in vivo inhibition of capsaicin-induced plasma extravasation in guinea pig trachea), while the activity of the (aS,R)-enantiomer (3b-B) was the weakest with an IC50 value of 620 nM. The structure-activity relationships in this series of antagonists indicate that the (R)-configuration at the axial bond and the stacking (or stacking-like) conformation between the two phenyl rings as shown in 1t-A and 3a-A are essential for high-affinity binding and suggest that the amide moiety functions as a hydrogen bond acceptor in the interaction with the receptor.

Effect of experimentally induced urethral obstruction and surgical decompression in utero on renal development and function in rabbits

To investigate the effect of urethral obstruction during late fetal life on renal development and function, we developed a rabbit fetal model of obstructive nephropathy to examine the pathological and biochemical consequences of urethral obstruction and beneficial effects of early surgical decompression. Animals were divided into four groups, i.e., obstructed, early decompressed, late decompressed, and control. Fetal renal development was evaluated by histological examination and counting the number of glomeruli in the four groups. The number of renal glomeruli correlated with gestational age in the normal fetus (r = 0.90, P < 0.0001). Urethral ligation on gestational day 25 (full-term, 31 days) resulted in thinning of the renal cortex and significantly decreased the number of renal glomeruli. The concentration of urinary microalbumin was higher when urethral obstruction was maintained for 3 days than 1 day after urethral obstruction, although urinary beta2- microglobulin, Na, Cl, and osmotic pressure did not change during this period. Decompression of urethral obstruction 1 day after induction of urethral obstruction resulted in improvement in the severity glomerular hypoplasia compared with late decompression (P < 0.01). Our results suggest that the rabbit fetal model simulates fetal urethral obstruction in humans, and indicates that early surgical decompression may be effective in restoration of normal renal function.

Detection and assessment of pyelectasis in the fetus: relationship to postnatal renal function

OBJECTIVE

To assess the relationship between fetal pyelectasis determined by ultrasonography and postnatal renal function.

METHODS

We first established normal values for anteroposterior, transverse, and longitudinal diameters of the renal pelvis sonographically in 68 normal fetuses at 30-40 weeks' gestation. We also evaluated prospectively the relationship between the severity of pyelectasis (diameter at least two standard deviations above the normal mean) in 36 fetuses at 30-40 weeks' gestation and postnatal renal function. Fetal renal function also was evaluated through measurement of the hourly urine production rate, whereas postnatal renal function was assessed by technetium 99m-diethylenetriamine penta-acetic acid renography and excretory urography.

RESULTS

Fetal pyelectasis was diagnosed when renal pelvic diameters were at least 8 mm (anteroposterior), 11 mm (transverse), and 14 mm (longitudinal), all upper limits of normal diameters of 68 normal fetuses as determined in the first part of the study. Pyelectasis was associated with a normal urine production rate in all fetuses, but in six fetuses it was associated with a normal urine production rate in all fetuses, but in six fetuses it was associated with a progressive deterioration of renal function within the 1st month of life, requiring neonatal surgery. In the other 30 fetuses with pyelectasis, who did not require neonatal surgery, pyelectasis decreased gradually or totally disappeared within 2 years. Renal pelvic anteroposterior, transverse, and longitudinal pelvic diameters were at least 20, 25, and 26 mm, respectively, during late fetal life in those neonates at the time of corrective surgery. The mean anteroposterior diameter in those fetuses who did not require surgery at infancy (11 +/- 6 mm) was significantly less than in those requiring surgery (33 +/- 14 mm, P < .01). Likewise, the transverse diameters were 17 +/- 10 mm and 38 +/- 16 mm (P < .01) and the longitudinal diameters were 20 +/- 10 mm and 48 +/- 22 mm (P < .01).

CONCLUSION

Neonatal surgery is recommended when the anteroposterior, transverse, and longitudinal renal pelvic diameters during the prenatal period are at least 20, 25, and 26 mm, respectively. Surgery is not necessary when the diameters are less than 20 mm.

Monozygotic twins discordant for single umbilical artery and congenital heart disease

We report a case of monozygotic twins. One twin had a single umbilical artery and the other co-twin had congenital heart disease. This case and a review of the literature suggest that local environmental factors are important in the pathogenesis of these malformations although genetic factors cannot be excluded.

[Study of the function of nerve growth factor in the olfactory tract of the mouse]

The aim of this study was to examine the function of nerve growth factor (BGF) in the olfactory tract of mice. Using the mice which had received unilateral olfactory bulbectomy and in which antibodies to NGF had been continuously infused with into the contralateral olfactory blub, three kinds of analysis were performed: histological analysis of the olfactory epithelium by HE staining, immunohistochemical analysis of the olfactory epithelium using polyclonal antibodies to trk which forms the NGF receptor, and olfactory-mediated behavioral analysis with cycloheximide. These animals had been sacrificed at day 1, 3, 7, 14, 21 or 28. Several findings were obtained as a result of the above analysis. Degeneration of the olfactory epithelium and trk expression by the olfactory cells were observed on day 7, and the olfactory epithelium was incompletely regenerated on day 28. However, trk expression by the olfactory cell was still recognized and the olfactory function was not restored by day 28. These examinations suggest that NGF produced in the olfactory bulb was transported retrogradely to olfactory cells through the olfactory nerves, and was associated with sustaining the existence of those cells and with regenerating the olfactory tract after injury.

[Non-small cell lung cancer metastatic to the stomach and the jejunum causing intussusception: a case report]

We report a case of lung cancer metastatic to the stomach and the jejunum. Adenocarcinoma of the lingula (T 4 N 2 M 0) was diagnosed in a 45-year-old man, who then underwent chemoradiotherapy. Bowel obstruction later developed due to jejunal metastasis. Another metastasis was detected in the stomach. Laparotomy revealed jejuno-jejuno-jejunal intussusception caused by the two lesions. The jejunal and gastric lesions were identified as metastatic large cell carcinoma arising from the lung. One month postoperatively, the patient died due to disease. The literature has demonstrated that large cell carcinoma of the lung tends to metastasizes. However, the complex bowel invagination and gastric metastasis seen in our case are rare.

Retrograde transport of nerve growth factor from olfactory bulb to olfactory epithelium

NGF is produced in the olfactory bulb and transported from the bulb to cholinergic neurons in the horizontal limb of the diagonal band. Although the expression of NGF receptors has been reported in olfactory epithelial cells, no correlation between NGF and olfactory epithelial cells has been found. This study aimed to define whether or not retrograde transport of NGF occurs in the olfactory neural system using the method of radioluminography. 125I-labeled NGF injected into the olfactory bulb was taken up and transported to the olfactory epithelium 18 h after injection. This finding suggests that bulbar NGF may act as a neurotrophic factor in olfactory epithelial cells.

Fetal blood flow redistribution in term intrauterine growth retardation (IUGR) and post-natal growth

OBJECTIVE

The purpose of the present study was to evaluate the relationship between intrauterine growth retardation, represented by fetal blood flow redistribution and infantile growth.

METHODS

The blood flow velocity waveform of umbilical and middle cerebral arteries was recorded by Doppler ultrasonography in 77 growth-retarded fetuses. We recorded the pulsatility index (PI) of the umbilical artery and middle cerebral and calculated the PI ratio of the middle cerebral to umbilical artery (C/U ratio). We selected a cutoff value of 1.0 to distinguish between normal and abnormal C/U ratios. To evaluate the development of infants, height, body weight and head circumference were measured serially at 3, 6 and 12 months of age.

RESULTS

Birth weight was significantly lower in newborns who had abnormal C/U ratios (2021+/-295 g vs. 2294+/-236 g). The number of cases admitted to NICU was higher and the duration of admission was longer in abnormal C/U ratio group (15/29 and 33.7+/-13.5 days) than normal C/U ratio group (7/48 and 26.6+/-5.6 days). Body weight was lower in infants of abnormal C/U ratio group at 3 months, but was not different at 6 and 12 months. The height was shorter in abnormal C/U ratio group at birth, there were no significant differences at 3, 6 and 12 months. The number of newborn infants with growth retardation was slightly higher in abnormal C/U ratio group, but the difference was not significant at 6 and 12 months. There was no relationship between C/U and growth variables recorded at birth and follow-up in infants.

CONCLUSION

Intrauterine growth-retardation, represented by abnormal fetal blood redistribution was associated with adverse perinatal outcome, but the influence was not found at the first year of life.

Potent NK1 receptor antagonists: synthesis and antagonistic activity of various heterocycles with an N-[3,5-bis(trifluoromethyl)benzyl]-N-methylcarbamoyl substituent

Various N-[3,5-bis(trifluoromethyl)benzyl]-N-methylcarbamoyl heterocycles (1, 2 and 3) modified at rings A and B in the isoquinolone (1a) and pyrido[3,4-b]pyridine (2a) nuclei were prepared and evaluated for NK1 receptor antagonistic activities. The structure-activity relationship studies on this series, along with conformational analysis, showed that (i) for ring A, 6-membered heterocycles are preferable to 5-membered heterocycles (a ca. 300-fold difference in potency), (ii) the 6-membered ring seems to function as an anchor by fixing the pendant phenyl group in a desirable orientation for receptor binding, and (iii) since compounds with aromatic rings (2) and those with aliphatic rings (3) as ring B both show good potency, this ring does not seem to be essential for receptor recognition. Among the compounds synthesized, the tetrahydropyridine derivatives 3a, 3b and 3f exhibited excellent inhibitory effects both in vitro and in vivo, with potent activity upon oral administration (ED50 = 0.20-0.27 mg/kg) (capsaicin-induced plasma extravasation in guinea pig trachea).

Effect of maternal meal ingestion on fetal renal artery resistance

OBJECTIVE

To examine whether maternal meal ingestion affects the fetal circulation in uncomplicated pregnancies.

METHODS

A simple crossover blinded study was designed for late uncomplicated singleton pregnancies. After overnight fasting, two different maternal meal states were tested. In one state, pregnant women had a standard 600-kcal breakfast at 8 AM (phase A). The other state consisted of maintaining fasting (phase B). Both states were assigned to each woman within 3 days in randomized order. Fetal Doppler studies of the umbilical, middle cerebral, and renal arteries and the descending aorta were performed at 7 AM (the fasting state) and at 10 AM (the fed state or the continuous fasting state).

RESULTS

Twenty women underwent the crossover study. Regardless of the maternal meal state, no significant change was observed in the pulsatility index (PI) of either the umbilical artery (n = 20), the middle cerebral artery (n = 19), or the descending aorta (n = 15). However, the PI of the fetal renal artery decreased significantly after maternal meal ingestion (n = 14) (phase A, 2.36 +/- 0.16 versus 2.09 +/- 0.33; P = .021). There was no such change in the PI after prolonged fasting (phase B, 2.44 +/- 0.32 versus 2.39 +/- 0.44; P = .75).

CONCLUSION

Fetal renal artery resistance decreased after maternal meal ingestion in normally grown fetuses during late pregnancy. This decrease in the resistance may be associated with increased fetal urine production after maternal meals.

Fgfr2 and osteopontin domains in the developing skull vault are mutually exclusive and can be altered by locally applied FGF2

Mutations in the human fibroblast growth factor receptor type 2 (FGFR2) gene cause craniosynostosis, particularly affecting the coronal suture. We show here that, in the fetal mouse skull vault, Fgfr2 transcripts are most abundant at the periphery of the membrane bones; they are mutually exclusive with those of osteopontin (an early marker of osteogenic differentiation) but coincide with sites of rapid cell proliferation. Fibroblast growth factor type 2 (FGF2) protein, which has a high affinity for the FGFR2 splice variant associated with craniosynostosis, is locally abundant; immunohistochemical detection showed it to be present at low levels in Fgfr2 expression domains and at high levels in differentiated areas. Implantation of FGF2-soaked beads onto the fetal coronal suture by ex utero surgery resulted in ectopic osteopontin expression, encircled by Fgfr2 expression, after 48 hours. We suggest that increased FGF/FGFR signalling in the developing skull, whether due to FGFR2 mutation or to ectopic FGF2, shifts the cell proliferation/differentiation balance towards differentiation by enhancing the normal paracrine down-regulation of Fgfr2.

Patient with primary tonsillar and gastric syphilis

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.

The effects of oligohydramnios and cervical cord transection on lung growth in experimental pulmonary hypoplasia in rabbits

OBJECTIVE

Our goal was to examine the effects of oligohydramnios and cervical cord transection on fetal lung development, pulmonary surfactant, and lung mechanics in rabbits.

STUDY DESIGN

The amniotic fluid was shunted into the maternal abdominal cavity in a group of 12 fetal rabbits. In another group (n = 12) high cervical cord transection was performed at day 24 of gestation. Another 12 littermates not operated on served as the control group. Fetuses were delivered on day 30 of gestation by cesarean section and immediately put to death. The body weight and wet lung and liver weights were measured. To determine the extent of fetal lung growth, we measured the size of lung acini, the number of terminal airspaces, and the diameter of alveoli. We also measured the dynamic compliance of the lung, the concentration of phosphatidylcholine, and the lecithin/sphingomyelin ratio in lung lavage fluid at birth.

RESULTS

Amniotic fluid shunting produced a significant reduction in amniotic fluid volume. Amniotic shunt and cervical cord transection significantly decreased wet lung weight and fetal lung/body weight ratio compared with the control. The concentration of phosphatidylcholine and the lecithin/sphingomyelin ratio in lung fluid lavage from fetuses with amniotic shunt were significantly higher than the values for control and cord transection fetuses. Histopathologic examination of the lungs showed significant reductions in the size of acini, the number of terminal airspaces, and the diameter of alveoli in shunted and cord transection groups compared with the control group. The dynamic compliance of transection fetuses was significantly reduced compared with control and shunted fetuses.

CONCLUSION

Our results indicate that oligohydramnios or cervical cord transections cause pulmonary hypoplasia. However, oligohydramnios-induced pulmonary hypoplasia is associated with increased pulmonary surfactant compared with control and cord transection fetuses.

Expression of estrogen and progesterone receptors in endometrium and peritoneal endometriosis: an immunohistochemical and in situ hybridization study

OBJECTIVE

To clarify the role of ovarian steroids in the development and progression of endometriosis, estrogen receptors (ERs) and progesterone receptors (PRs) were localized by immunohistochemistry, and ER messenger RNA (mRNA) was detected by in situ hybridization in the uterine endometrium and in normal and altered pelvic peritoneum.

DESIGN

Retrospective and prospective study.

SETTING

Nagasaki University School of Medicine, Nagasaki, Japan.

PATIENT(S)

A retrospective study of 61 formalin-fixed uterine endometria and normal and altered pelvic peritonea from patients suffering from various gynecologic diseases was conducted. In addition, in 22 fresh frozen tissue specimens, ER mRNA expression was evaluated prospectively.

MAIN OUTCOME MEASURE(S)

In formalin-fixed tissues, ER and PR were localized immunohistochemically. The results of immunohistochemical staining were scored from 0 to 4, depending on the signal intensity and frequency of positive cells. In fresh frozen specimens, ER mRNA expression was assessed by nonradioactive in situ hybridization using thymine-thymine dimerized oligonucleotide probes.

RESULTS

The highest score of ERs and PRs was observed in the epithelial and stromal cells of the normal uterine endometrium at the early proliferative phase of the menstrual cycle. The ER and PR scores declined throughout the secretory phase. In typical endometriotic lesions, the ER and PR scores were constantly high independent of the menstrual cycle. The expression pattern of ER mRNA was mostly in parallel with that of ERs. In typical endometriosis, ERs and PRs were found in both glandular epithelial cells and their surrounding stromal cells. Expression of ER mRNA was found in typical endometriotic peritonea and in pelvic peritoneum with columnar epithelial cells, but not in normal pelvic peritoneum (mesothelium). Estrogen receptors and PRs were negative in mesothelium, but were positive in the nuclei of fibroblasts in the connective tissue.

CONCLUSION(S)

We demonstrated the expression of ERs, ER mRNA, and PRs in the columnar cells in pelvic peritonea and typical endometriosis, but not in normal mesothelium. These results suggest that endometriosis may originate from the columnar cells with ERs and PRs in the pelvic peritoneal lining.

Activity of voriconazole (UK-109,496) against clinical isolates of Aspergillus species and its effectiveness in an experimental model of invasive pulmonary aspergillosis

Voriconazole, a new azole antifungal agent, showed potent activity against clinical isolates of Aspergillus spp. in vitro. For A. fumigatus, the MIC range was < 0.03 to 0.5 microgram/ml and the MIC at which 90% of isolates are inhibited was 0.25 microgram/ml. In an experimental model of invasive pulmonary aspergillosis which mimics infection in humans, oral voriconazole at dosages of 30 mg/kg of body weight per day significantly delayed or prevented mortality.

Fetal redistribution of blood flow and amniotic fluid volume in growth-retarded fetuses

Our purpose was to assess the relationship between the fetal redistribution of blood flow and the amount of amniotic fluid in appropriate-for gestational-age fetuses and growth-retarded fetuses. Blood flow velocity waveforms of the umbilical artery, descending aorta, middle cerebral artery, renal artery and uterine artery were recorded using pulsed Doppler ultrasonography in 100 appropriate-for gestational age fetuses and 39 growth-retarded fetuses. The pulsatility index (PI) values and the amount of amniotic fluid were compared between the two groups. The PI values of the umbilical artery and renal artery were significantly higher in appropriate for gestational-age-fetuses with oligohydraminos than in fetuses with an adequate amount of amniotic fluid. The PI values of the umbilical artery and renal artery were significantly higher and the PI of the middle cerebral artery was significantly lower in growth-retarded fetuses with oligohydramnios than in fetuses with an adequate amount of amniotic fluid. Furthermore, there was a significant negative correlation between the PI value of the renal artery and the vertical diameter of amniotic fluid, and between the PI value of the renal artery and the amniotic fluid index. The PI value of the renal artery was related to the amount of amniotic fluid in growth-retarded fetuses, and the same relationship was demonstrated in appropriate-for gestational age fetuses.

Comparison between the single deepest pocket and amniotic fluid index in predicting fetal distress in small-for-gestational age fetuses

BACKGROUND

The relationship between reduced amniotic fluid volume and increased risk of fetal distress in small-for-gestational age fetuses is not yet clear. Furthermore, the criteria used for the diagnosis of 'oligohydramnios' are different between the single deepest pocket method and amniotic fluid index. We investigated the relationship between the single deepest pocket and amniotic fluid index and their ability in predicting fetal distress in small-for-gestational age fetuses.

METHOD

We examined 69 pregnant women with singleton pregnancy, intact membranes, birth weight below the 50% percentile - 1.5 s.d., in whom delivery occurred within seven days of the last estimation of amniotic fluid volume. Amniotic fluid volume was measured in each woman simultaneously by single deepest pocket and amniotic fluid index. Fetal distress was determined by intrapartum monitoring of fetal heart rate.

RESULTS

Estimates of amniotic fluid volume measured by the two methods showed a significant correlation at 24 to 41 weeks of gestation. A cut-off value for single deepest pocket of 3.0 cm was associated with the highest accuracy in predicting fetal distress in small-for-gestational age fetuses. The rate of cesarean section among patients with single deepest pocket <3.0 cm was higher than that in amniotic fluid index <8.0 cm.

CONCLUSION

Our results demonstrated that a single deepest pocket measurement of <3 cm is the most useful criterion for 'oligohydramnios' in the prediction of fetal distress.

Olfactory evoked potential produced by electrical stimulation of the human olfactory mucosa

Most physiological studies of the human olfactory system have concentrated on the cortical level; the olfactory bulbar level has been studied rarely. We attempted to stimulate the human olfactory mucosa by electrical pulse to detect the bulbar potentials. Electrical stimulation (2 mA, 0.5 ms) of the human olfactory mucosa evoked a change in potential recorded from the frontal sector of the head. A negative peak of the evoked potential that occurred at 19.4 ms (grand means, n = 5) after stimulation was the clearest. The highest amplitude of the potential was recorded from the frontal sector of the head on the stimulated side. Our findings were similar to the experimental results obtained from the olfactory bulbs of animals. This evoked potential was considered to be the human olfactory bulbar potential. When the subjects were stimulated by applying electricity to the olfactory mucosa, no sensation of smell occurred even though evoked potentials were recorded. Evoked potentials were recorded only when the stimulating electrode was located in the olfactory cleft. When the stimulating electrode was outside the olfactory cleft, the stimulation caused pain. The trigeminal nerve seemed to be stimulated by electricity. Olfactory evoked potentials produced by the electrical stimulation of the human olfactory mucosa should aid the research on human olfactory physiology, and may be applicable to clinical tests of olfactory dysfunction.

A case of adrenal insufficiency due to acquired hypothalamic CRH deficiency

A 40-year-old woman with adrenal insufficiency was clinically diagnosed and examined with human corticotropin releasing hormone (CRH). This patient with secondary hypo-adrenalism has shown a normal serum cortisol response to exogenous ACTH administration and has been examined with CRH, lysine-vasopressin (LVP) and insulin tolerance test (ITT), respectively. Success in secreting ACTH in response to both CRH and LVP tests, but not ITT, suggests that this disorder was possibly due to a hypothalamic CRH deficiency rather than pituitary corticotroph dysfunction. A combination of the CRH test and ITT has come to play an increasingly significant role in the diagnosis and differential diagnosis of isolated ACTH deficiency syndrome.

Hyperinsulinemia increases the risk of gestational hypertension

OBJECTIVE

To determine whether hyperinsulinemia is related to gestational hypertension.

METHODS

We measured the arterial blood pressure and the level of immunoreactive insulin (IRI) during a 75 g oral glucose tolerance test in a total of 84 pregnant women. Hyperinsulinemia was defined as a fasting IRI level > or = 9 IU/l, while gestational hypertension was defined as arterial blood pressure > or = 140/90 mmHg.

RESULTS

The incidence of gestational hypertension was higher in the hyperinsulinemic group (n = 29) than in the control group (n = 55) (24.1% vs. 7.3%, respectively P < 0.05). After controlling for maternal age, parity, pre-pregnancy body mass index and the gestational age at the time of oral glucose tolerance test (OGTT), using a multiple regression model, the relative risk of developing gestational hypertension for a fasting insulin level was 1.19 (95% C.I., 1.03-1.38).

CONCLUSION

Pregnant women with hyperinsulinemia are at increased risk of developing gestational hypertension.

Change in fetal urine production rate in growth-restricted fetuses after maternal meal ingestion

OBJECTIVE

To determine if fetal urine production is affected by maternal meal ingestion in growth-restricted fetuses.

METHODS

We studied 25 normal-growth fetuses in uncomplicated pregnancies and 15 growth-restricted fetuses, all after 30 weeks' gestation. Serial fetal bladder volume measurements were obtained at 2-3 minute intervals with ultrasonography 2 hours before and 2 hours after maternal breakfast. The hourly fetal urine production rate in each maternal state was calculated from the bladder volume measurements. The amniotic fluid index (AFI) and the pulsatility index of both umbilical and fetal middle cerebral arteries were also measured.

RESULTS

Two of the 15 growth-restricted fetuses were excluded from analysis, one because it was anomalous and the other because it was not small for gestational age at birth. In the normal-growth fetuses, the hourly fetal urine production rate increased significantly after maternal breakfast (mean +/- standard deviation 30.2 +/- 11.7 versus 41.1 +/- 14.6 mL/hour, P < .001). In contrast, in the growth-restricted fetuses, the rate did not change after maternal breakfast (24.6 +/- 6.2 versus 24.9 +/- 5.7 mL/hour). Although the urine production rate before breakfast did not differ between groups, 2 hours after maternal breakfast it was significantly lower in the growth-restricted fetuses than in the control group (normal-growth) (P < .001). The AFI also was significantly lower in the growth-restricted fetuses than in the control group (15.0 +/- 3.5 versus 18.6 +/- 5.0 cm, P < .04). There were no significant differences in the pulsed Doppler studies.

CONCLUSION

In contrast to normal-growth fetuses, maternal meal ingestion for growth-restricted fetuses does not increase fetal urine production. Decreased fetal urine production in the maternal fed state may lead to decreased amniotic fluid volume in growth-restricted fetuses without obvious hypoxia.