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Aim To assess the glycaemic profile and glycaemic variation in the second and third trimesters of normal pregnancies. Methodology Healthy pregnant women aged 19–35 years between 24 and 36 weeks of gestation were recruited for ambulatory glucose profile monitoring. A total of 18 women in the second trimester, 15 women in the third trimester and 9 healthy non-pregnant women were recruited providing, respectively, 205 days (19,680 data points), 147 days (14,112 data points) and 100 days (9,600 data points) for analysis. Results Mean blood glucose level was 20.2% lower in the second trimester and 10.6% lower in the third trimester than non-pregnant women (p Conclusion There is tight blood sugar control along with lower mean blood glucose in healthy pregnant women compared to non-pregnant women. Despite this tight glycaemic control, glycaemic variability is higher during pregnancy.

Interpretation of laboratory investigations relies on reference intervals. Physiological changes in pregnancy may result in significant changes in normal values for many biochemical assays, and as such results may be misinterpreted as abnormal or mask a pathological state.The aims of this review are as follows:1. To review the major physiological changes in biochemical tests in normal pregnancy.2. To outline where these physiological changes are important in interpreting laboratory investigations in pregnancy.3. To document the most common causes of abnormalities in biochemical tests in pregnancy, as well as important pregnancy-specific causes.

Many women experience dyspnoea, orthopnoea, and peripheral oedema during pregnancy, and diagnosing cardiac problem is confounded by these signs and symptoms of normal pregnancy. Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown aetiology that occurs between the last month of pregnancy and the first 5 months postpartum in previously healthy woman. Multiparity, twins, advanced maternal age, preeclampsia, gestational hypertension, and black race are known risk factors. The course of PPCM can range from readily treatable to acutely fatal. We present a lady with dyspnoea in the peripartum period admitted in cardiac arrest as a result of PPCM.

Previous reports have suggested that delivery is associated with the induction of inflammatory cytokines. The present study was designed to investigate whether increased cytokine production was present on postpartum day 3 after a normal pregnancy and whether any changes were associated with the mode of delivery. In total, 33 pregnant women were enrolled; 18 delivered vaginally and 15 underwent an elective caesarean section (C-section). The levels of 17 cytokines and growth hormones were measured at the beginning of delivery or before anaesthesia and on postpartum day 3. While interleukin (IL)-6 and IL-8 levels decreased significantly postpartum, other cytokine concentrations were comparable before and after delivery. Only IL-7 levels were significantly increased in the C-section patients compared with the vaginal birth patients postpartum. In conclusion, there was no risk of a prolonged maternal inflammatory reaction after an uncomplicated vaginal birth or elective C-section, so it is probably not necessary to consider this as an issue when making a decision on the mode of delivery following uncomplicated pregnancy.

Within the acupuncture literature there is debate on the safety of using specific acupuncture points during pregnancy. Termed ‘forbidden’ or contraindicated, they refer to acupuncture points that can be used to induce labour but may also include points with no known inducing or labour-enhancing effects. Recommendations range from avoiding these acupuncture points at any time in pregnancy to statements that despite the warnings in the literature, these points are not contraindicated during a normal pregnancy. This discussion paper examines the historical use of contraindicated points, the physiology of the pregnant body and the effect of these points during research trials. It is hoped that this will encourage further discussion and provide a background for practitioners to make informed choices about how they use these points in clinical practice.

Using the saccharin method, we performed tests of mucociliary function four times during pregnancy and once one month after delivery in 27 women. As the transport distance for saccharin varied from 37 to 65 mm, we used the transport speed for evaluation. Pregnancy rhinitis affects at least 20% of pregnancies. The mucociliary transport speed was higher in the group of women with pregnancy rhinitis, and was reduced during pregnancy in the group of women without that condition. We found no significant correlation between mucociliary transport speed and objectively registered nasal peak expiratory flow index. The pathophysiology of pregnancy rhinitis is not known, but is possibly multifactorial. The changes occurring in the nasal mucociliary transport system during normal pregnancy and in pregnancy rhinitis need further studies.

This study was performed to define physiologic changes in lower extremity venous hemodynamics during and after normal, healthy pregnancy. Lower extremity venous physiology was evaluated by using air plethysmography in 24 healthy primigravid females (48 extremities) with no known venous disease. All patients were studied during their first, second, and third trimester, and at 6 weeks, 3 months, and 6 months postpartum. Data were evaluated for changes over time and for differences between the right and left lower extremity by use of repeated measures analysis of variance. None of the patients developed overt signs of venous reflux during pregnancy although there was an increase in venous filling index in advanced stages of pregnancy. All values remained within normal range (1.0-1.7 mL/sec, p = 0.52). There was a statistically significant decrease in residual volume fraction that reached a nadir during the third trimester and returned to below-baseline values immediately postpartum (p = 0.02). An increase in venous outflow fraction was demonstrated as pregnancy progressed (p = 0.05). This trend peaked during the third trimester. Calf muscle pump function did not change appreciably during the study period (p = 0.61). There was no difference between right and left lower extremities with regard to venous filling index (p = 0.25), residual volume fraction (p = 0.33), venous outflow fraction (p = 0.17), or calf muscle pump function (p = 0.33). Some alterations in venous hemodynamics are associated with pregnancy. Venous outflow fraction overall is increased coincident with a decrease in residual volume fraction. The significant decrease in residual volume fraction and augmentation in venous filling index may be related to venous dilation and an increase in venous capacitance secondary to hormonally influenced smooth muscle relaxation.

We have previously shown that elevation of anticardiolipin antibodies (aCL) at the first prenatal visit is associated with increased fetal loss in normal pregnancy. The variation in aCL levels during normal pregnancy has not been established. To examine this question we measured IgG, IgM and IgA aCL levels five times during pregnancy at weeks 5-15, 16-25, 26-35, 36-37 and at delivery. Data were analyzed to determine: (a) the within and between subject variability of aCL during pregnancy; (2) the temporal trend of aCL; and (3) the relation of serial measures of aCL with maternal complications of pregnancy.We divided our cohort of 354 subjects into two groups. Group A included those subjects with consistently normal levels of aCL and group B those subjects with at least one elevated level of aCL. In group A the within subject variability was relatively low (28-34%). In group B we found wide fluctuations in aCL levels and a within subject variability of 88-91 %. Subjects in group B had no increase in maternal complications of pregnancy.The present data suggest that aCL may fluctuate significantly during normal pregnancy and there is little clinical value in measuring aCL on a serial basis during pregnancy.

Normal pregnancy is associated with an increase in uteroplacental blood flow in part due to growth and remodeling of the maternal uterine vasculature. In this study, we characterized the effect of diabetic pregnancy on vascular growth of the maternal uterine vasculature and on the passive mechanical properties of the uterine resistance arteries. Diabetes was induced in pregnant rats by injection of streptozotocin and confirmed by development of hyperglycemia. Fetuses of diabetic rats were significantly smaller and placentas larger compared to controls. Pregnancy-induced axial elongation of the mesometrial uterine vasculature was not altered by diabetes. Vascular wall thickness was unchanged between groups. Wall distensibility was increased and the rate constant of an exponential function fitted to stress–strain curve was significantly reduced demonstrating decreased wall stiffness in diabetic uterine radial arteries compared to controls. We conclude that experimental diabetes in rat pregnancy does not compromise the growth of maternal uterine vasculature but alters passive mechanical properties of the uterine radial arteries.

McArdle disease is a rare, mostly autosomal recessive disorder of deficient myophosphorylation of glycogen in skeletal muscles. Recent knowledge regarding this condition means that women of childbearing age with McArdle disease can expect to labour normally without ill effect. We report a case of a 30-year-old woman in her first pregnancy who had an episode of exercise-induced myoglobinuria with a significant rise in serum creatine kinase (CK) levels in early pregnancy who then laboured normally but did require a caesarean section for a malposition of the fetal head.

Overview The purpose of this study was to evaluate the role of Tumor Necrosis Factor-α (TNF-α) in insulin resistance (IR) during normal pregnancy. Approach This cross sectional study was carried out on 86 healthy pregnant women including 26, 23 and 37 individuals in the 1st, 2nd and 3rd trimesters, respectively, and in 21 healthy non pregnant women. Serum TNF-α concentration was measured by Enzyme Linked Immunosorbent Assay (ELISA) method. Results There were significant differences between serum TNF-α and IL-6 levels in pregnant women as compared with maternal healthy controls. There was significant correlation between gestational age and Body Mass Index (BMI) (r = 0.28, P = 0.01). There was no significant correlation between gestational age and insulin resistance (IR). We also did not find correlations between IR and TNF-α and IR and IL-6 in pregnant women. Conclusion In conclusion, our findings suggest that TNF-α and IL-6 are not greatly contributed to pregnancy induced insulin resistance in normal pregnancy.

Circulating immune complexes were detected in 20% of serum samples from pregnant patients by the liquid-phase C1q-binding assay. Two other immune complex assays yielded negative results with the same samples. A careful case study was also carried out in which serum samples from before, during and after a normal pregnancy were analysed. The results are discussed in relation to the contradictory data previously published in this field.

Social, cognitive, and psychologic aspects of normal pregnancy are discussed verbally and in a model format. The major anxieties arising from pregnancy, typical activities, and maternal-fetal attachment typical of each trimester are discussed. Ways in which sonographers can support pregnant patients during an ultrasound examination and further questions related to the development of optimum interaction strategies are explored.

During normal pregnancy in the mouse, maternal serum levels of the analogues to human schwangerschaftsprotein-1 and α-fetoprotein correlate significantly with the growth of the placenta and fetus respectively. This relationship has been utilized in the analysis of the effect of sodium selenite on placental and fetal growth in mice. Moderate doses of sodium selenite did not affect the growth of the placenta and fetus significantly, whereas high doses of selenite resulted in a large percentage of abortions. The protein markers were found to be useful in the prediction of placental and fetal growth, and they are suggested to be of general use in the study of the impact of teratogenic substances, since they reflect the status of the fetoplacental mass during gestation.

A versatile radioimmunoassay for serum oestriol in pregnancy has been developed which requires 10 μ| of serum (for total) or 50 μ| (for unconjugated). Selection of the optimum conditions for the hydrolysis of serum oestriol conjugates, the isolation of free oestriol, the displacement of tritiated oestriol by cold oestriol and the separation of the free and bound fractions is described. Total oestriol levels doubled between weeks 34 and 38 of normal pregnancy, very little change occurring in the mean level after the 38th week of gestation. In a random series of pregnancy sera there was a significant correlation between total and unconjugated oestriol.

SummaryGrowth of the mammary gland of the rat during normal pseudopregnancy was only 18% of the growth found at day 18 of normal pregnancy as measured by DNA. This suggests that the corpora lutea of pseudopregnancy function at approximately one-fifth the level of those in pregnancy. Hysterectomy, which resulted in a 6-day extension of pseudopregnancy, was without effect in the enhancement of mammary gland growth over normal pseudopregnancy. However, the ratio of RNA to DNA in the mammary glands of these animals was raised significantly. The production of deciduomata concomitant with pseudopregnancy resulted in a 9-day extension of pseudopregnancy and a slight increase in mammary gland growth over that of normal pseudopregnancy. It was only 30% of that at day 18 of pregnancy and 76% of that at day 12 of pregnancy when DNA was standardized to body weight.

Conclusions1. Inasmuch as pseudopregnant rats gain at nearly the same rate as those going through normal pregnancy it would appear that the fetus and its membranes are responsible only in part, if at all, for the increased growth rate of pregnant rats. 2. Progesterone apparently does not stimulate appetite. If the ovary is indirectly involved it may be by depressed estrogen secretion following mating inasmuch as appetite is increased following castration. This increase, however, is not observed until the sixth day as compared to the second day in pregnancy.

Summary1. Blood levels of 17-OHCS were studied at intervals during parturition in normal pregnancy. 2. Early in labor, a rise in levels above those found in late pregnancy was noted, with further rise between first and second stages. These high levels were maintained until after the end of 3rd stage. In most cases studied, levels were still well above normal on 4th or 6th postpartum day. 3. There seems to be a relation between length of labor and rise in plasma 17-OHCS. Labors of longer than 6 hours deviation were accompanied by high levels of these hormones. 4. Maximum values observed in labor approached those noted after exogenous ACTH stimulation during late pregnancy, indicating nearly maximal output of these hormones by the adrenal cortex. 5. The mechanisms by which labor stimulated the maternal pituitary gland have been discussed.

SummaryBilateral resection of the pelvic nerve (PN) in female rats had no effect on the estrous cycle, but prevented pregnancy when performed prior to mating. Pelvic neurectomy performed 30 min postmating did not affect the interim pregnancy, but blocked parturition. Twice daily sc injections of 7.0 to 28 IU of prolactin (NIH-S-8) into PN females beginning on the a.m. after mating (day 1) maintained normal pregnancy until sacrifice at day 16. Lower doses of 1.4 and 3.5 IU of prolactin twice daily were partially effective; whereas a single injection of 280 IU on day 1 was ineffective. Injections of 7.0 IU of prolactin on days 1-3 maintained pregnancy in 60% of the PN females. Following parturition, lactating females suckling six young were bilaterally pelvic neurectomized and mated to a fertile male. Pregnancy occurred and was maintained in 7 of 10 females, sacrificed at day 16 postpartum. Removal of the entire litter at day 1, 3, or 6 postpartum, resulted in maintenance of pregnancy in two of eight, three...

SummaryThe average blood lactic acid in 7 cases of preeclampsia was 12.9 mg % (8.0-18.6) as compared with 11.0 mg % (9.1-12.3) in 8 cases of normal pregnancy. The average blood acetone bodies in the pre-eclamptic cases was 0.8 mg % (

Some 10 years ago, the senior author began a study of certain phases of the metabolism in normal pregnancy as a basis for a later comprehensive investigation of the toxaemias incident to this condition. Many of the measurements could demonstrate their real significance only if presented as relative values or changes, using convenient and easily ascertained biometric magnitudes as bases of reference. A case in point is the so-called basal metabolic rate, all of the usual prediction criteria involving some expression of the body weight in the formula used. A review of the literature disclosed a paucity of dependable recent observations of weight changes, and the few older records were incomplete. Single measurements on isolated cases are of little worth. Only continuous studies, both ante- and post-partum, on the same individual, are significant. This involved the continued cooperation on the part of the individual patient. In the present study the work has been carried out on this basis.For the purposes of...

SummaryFertility of vaginal inseminations in rabbits treated with melengestrol acetate (MGA) was significantly improved when phenobarbital was administered at MGA withdrawal. Oxytocin administration after vaginal insemination in MGA-treated rabbits resulted in partial restoration of normal fertility. Ova transferred from superovulated donors to synchronous MGA-treated recipients failed to survive, but ova transferred to MGA-treated recipients in which pseudopregnancy was one day advanced in relation to the donors resulted in normal pregnancy.

SummaryPregnant rats were hypophysectomized and pituitary autografted on day 2, the day after sperm were observed in the vaginal lavage. Estradiol-17β (E-17-β) was injected (0.1 μg/day) on days 8 through 16 to induce implantation and maintain pregnancy. This protocol resulted in a 4 day delay of implantation, and day 8 becomes equivalent to day 4 of normal pregnancy. A single dose of LHAS (equivalent to 1.4 times the dose necessary to cause abortion on day 8 in the normal pregnant rat) failed to prevent implantation when administered on day 7 or cause fetal resorption when administered on days 11, 12, 13, 14 or 15 (equivalent to days 4, and 7 through 11). LHAS given on the two successive days 13 and 14 (days 9 and 10 equivalent) was also without effect. These results suggest that LHAS causes abortion in the rat by acting on pituitary LH-like material and not on the ovary, developing fetus or placenta.

SummaryThe oral effectiveness of 4 progesterone-like compounds to stimulate mammary gland growth (DNA) of ovariectomized rats is reported. Norlutin and Norlutate plus E.B. were ineffective in stimulating increasing DNA in comparison with E.B. alone. Lutoral and Provera plus E.B. at the 1 mg level or above stimulated comparable mammary gland growth to that observed at end of pregnancy or after 1 μg E.B. + 3 mg P. The injection of 1 or 2 μg E.B. plus 3 or 6 mg Norlutin Enanthate was also effective in stimulating DNA values comparable to normal pregnancy. The losses in body weight of most groups during the 19-day feeding period were apparently due to the unpalatable nature of feed containing these compounds.

Although there have been numerous reports of the findings of tremendous amounts of the anterior-pituitary-like hormone (A.P.L.) in the blood and urine of cases of hydatidiform mole and chorioepithelioma, we have found no mention of determinations of oestrin in these patients, and it has even been assumed1 that the oestrin is also very high. This assumption is presumably based upon the fact that in pregnancy both of these hormones are easily demonstrable.In the course of our quantitative studies of A.P.L. and oestrin in pregnancy, we have had access to the blood and urine of 4 cases of chorioepithelioma, 3 of them males. The same methods of analysis as those previously described2 have been used. The results in Table I demonstrate that although the blood and urine of these patients contain a higher concentration of A.P.L. than is ever found in normal pregnancy, the oestrin content is very low, in fact not demonstrable without concentration of the specimens by extraction. In cases 3 and 4, 700 cc. of urine w...

In normal whole blood the urea nitrogen usually accounts for about 50% of the total non-protein nitrogen, although the variations found in this ratio (35-55)1 scarcely justify the practice occasionally seen in hospital laboratories by which the concentration of urea nitrogen is calculated from the non-protein nitrogen or vice versa.The fact seems well established that in the blood of patients with nitrogen retention of considerable magnitude the relative concentration of urea nitrogen may be increased as high as 75% of the non-protein nitrogen.2 On the other hand, the finding of a lowered ratio to non-protein nitrogen which has been noted by certain investigators to occur in the blood of pregnant women has not received universal confirmation, for while certain observations would indicate that this lowered ratio is found in the blood in normal pregnancy,3 others have found this relative decrease in the urea fraction only in abnormal cases.4 The records of still other observations would indicate that the ra...

A slight amount of edema occurs in many women during normal pregnancy. A marked edema or even an anasarca may occur in pre-eclampsia and eclampsia. No adequate explanation has been given for the cause of the edema in normal or toxemic pregnancy.In the edema of certain types of nephritis, malnutrition, and in some cases of cardiac disease, the cause is found in an abnormally low serum protein concentration. Various studies indicate that edema is likely to occur if the concentration of the serum protein is less than 5.5 gm. % or if the albumin concentration is less than 2.5 gm. %. Dieckmann and Wegner,1 as well as other investigators, have demonstrated that the concentration of the serum protein in normal pregnancy is at the lower limits of normal. Their average figures obtained from the same women during pregnancy and the puerperium are given in Table I.The studies of Schade,2 Govaerts,3 and Verney4 would seem to indicate that the oncotic or colloid osmotic pressure of 1 gm. of albumin is 7.54 cm. of water...

Harding and Fort1 first noted the presence of a considerable amount of histamine in the placenta. This has been confirmed several times since. As an accumulation of histamine could be dangerous for normal pregnancy it seemed consistent to investigate whether histaminase is present in the placenta. Danforth and Corham2 found histaminase to be present in the human placenta though in extremely variable amounts. Danforth3 demonstrated that the amount of histaminase to be found in the placenta “shows some correlation with the efficiency of uterus contractions of women during labor.”During researches—Daels and Donatelli4-6—on the motility of the cat's uterus (about 150 animals) we had the opportunity to examine the motility of the uterus of 7 pregnant cats. These observations seem to us to be in correlation with the problem mentioned above and this is why we want to publish them. The cats in our experiments were narcotized with chloralosane; the distal end of one uterus horn was fixed by a thread which was conn...

Schockaert and Lainbillon1 have demonstrated that women in the latter half of a normal pregnancy are relatively insensitive to the pressor action of the postpituitary hormone, and that the blood serum of such women, when mixed with postpituitary hormone has an inhibitory action on the pressor coniponent as compared to the serum of non-pregnant ivonien. These findings have been applied to the study of human eclampsia.2 This reports an attempt to determine whether such a phenomenon may be demonstrated in the rabbit.We have found no reports of blood pressure records throughout pregnancy except for the human being, and it was necessary therefore to determine whether iioriiial pregnancy in the rabbit produced any significant alteration of blood pressure. At various intervals through-out pregnancy, a standard dose of pitressin was administered intra-venously to the unanesthetized animal to obtain the pressor response.The method of Grant and Rothschild3 was used for measuring the blood pressure on the central ar...

SummaryThe induction of deciduomata resulted in prolongation of pseudopregnancy to the period of normal pregnancy in the rat. This prolongation occurred in the absence of fetal tissue and was associated with the presence of metrial glands, maintenance of corpora lutea, and inhibition of follicular development.