PDK4 and fetal growth restriction: Notably, our results are consistent with multiple studies in a sheep model of IUGR, which indicated higher expression of PDK4 in both hepatic and skeletal tissue, as well as markedly increased lactate production (Brown et al., 2015; Pendleton et al., 2019), suggesting that pyruvate is prevented from entering the citric acid cycle and instead is converted to oxaloacetate and, subsequently, promotes gluconeogenesis.