Normal Values in Pregnancy - 22/08/11

Doi : 10.1016/B978-0-443-06930-7.50054-2

Invasive Monitoring

MEASUREVALUE (36–38 WEEKS)UNITSCardiac output6.2 ± 1.0liters/minuteSystemic vascular resistance1,210 ± 266dyne cm second−5Heart rate83 ± 10beats/minutePulmonary vascular resistance78 ± 22dyne cm second−5Colloid oncotic pressure18.0 ± 1.5mm HgMean arterial pressure (MAP)90.3 ± 5.8mm HgPulmonary capillary wedge pressure (PCWP)7.5 ± 1.8mm HgCentral venous pressure (CVP)3.6 ± 2.5mm HgLeft ventricular stroke work index48 ± 6gmm−2Cardiac output is increased in pregnancy but is essentially unchanged over the course of pregnancy.Heart rate gradually rises 5 to 10bpm over the course of pregnancy.References: Clark SL, Cotton DB, Lee W, et al: Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 161:1439, 1989.Spatling L, Fallenstein F, Huch A, et al: The variability of cardiopulmonary adaptation to pregnancy at rest and during exercise. Br J Obstet Gynaecol 99(Suppl 8):1, 1992.

MEASURE	VALUE (36–38 WEEKS)	UNITS
Cardiac output	6.2 ± 1.0	liters/minute
Systemic vascular resistance	1,210 ± 266	dyne cm second⁻⁵
Heart rate	83 ± 10	beats/minute
Pulmonary vascular resistance	78 ± 22	dyne cm second⁻⁵
Colloid oncotic pressure	18.0 ± 1.5	mm Hg
Mean arterial pressure (MAP)	90.3 ± 5.8	mm Hg
Pulmonary capillary wedge pressure (PCWP)	7.5 ± 1.8	mm Hg
Central venous pressure (CVP)	3.6 ± 2.5	mm Hg
Left ventricular stroke work index	48 ± 6	gmm⁻²

Cardiac output is increased in pregnancy but is essentially unchanged over the course of pregnancy.
Heart rate gradually rises 5 to 10bpm over the course of pregnancy.
References: Clark SL, Cotton DB, Lee W, et al: Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 161:1439, 1989.
Spatling L, Fallenstein F, Huch A, et al: The variability of cardiopulmonary adaptation to pregnancy at rest and during exercise. Br J Obstet Gynaecol 99(Suppl 8):1, 1992.

Noninvasive Monitoring

Measure10–18 weeks18–26 weeks26–34 weeks34–42 weeksCardiac output (L/min)7.26 ± 1.567.60 ± 1.637.38 ± 1.636.37 ± 1.48Stroke volume (mL)85 ± 2185 ± 2182 ± 2170 ± 14SVR (dyne cm second−5)966 ± 226901 ± 224932 ± 2401,118 ± 325Heart rate (beats/min)87 ± 1490 ± 1492 ± 1492 ± 7Mean arterial pressure (mm Hg)87 ± 784 ± 784 ± 786 ± 7SVR, systemic vascular resistance.

Measure	10–18 weeks	18–26 weeks	26–34 weeks	34–42 weeks
Cardiac output (L/min)	7.26 ± 1.56	7.60 ± 1.63	7.38 ± 1.63	6.37 ± 1.48
Stroke volume (mL)	85 ± 21	85 ± 21	82 ± 21	70 ± 14
SVR (dyne cm second⁻⁵)	966 ± 226	901 ± 224	932 ± 240	1,118 ± 325
Heart rate (beats/min)	87 ± 14	90 ± 14	92 ± 14	92 ± 7
Mean arterial pressure (mm Hg)	87 ± 7	84 ± 7	84 ± 7	86 ± 7

SVR, systemic vascular resistance.

Third-Trimester Arterial Blood Gas Values

NORMAL ALTITUDEMODERATE ALTITUDE (1,388 M, Provo, UT)Arterial pH7.44 ± 0.047.46 ± 0.02Arterial Po2 (mm Hg)85 ± 586.2 ± 7.3O2 Saturation (%)96 ± 1Arterial Pco2 (mm Hg)29.7 ± 2.826.6 ± 2.7Sodium bicarbonate (mEq/L)22.0 ± 2.118.6 ± 1.9References: Hankins GD, Clark SL, Harvey CJ, et al: Third trimester arterial blood gas and acid base values in normal pregnancy at moderate altitude. Obstet Gynecol 88:347, 1988.Eng M, Butler J, Bonica JJ: Respiratory function in pregnant obese women. Am J Obstet Gynecol 123:241, 1975.

	NORMAL ALTITUDE	MODERATE ALTITUDE (1,388 M, Provo, UT)
Arterial pH	7.44 ± 0.04	7.46 ± 0.02
Arterial Po₂ (mm Hg)	85 ± 5	86.2 ± 7.3
O₂ Saturation (%)		96 ± 1
Arterial Pco₂ (mm Hg)	29.7 ± 2.8	26.6 ± 2.7
Sodium bicarbonate (mEq/L)	22.0 ± 2.1	18.6 ± 1.9

References: Hankins GD, Clark SL, Harvey CJ, et al: Third trimester arterial blood gas and acid base values in normal pregnancy at moderate altitude. Obstet Gynecol 88:347, 1988.
Eng M, Butler J, Bonica JJ: Respiratory function in pregnant obese women. Am J Obstet Gynecol 123:241, 1975.

Pulmonary Function Tests

8–11 WEEKS20–23 WEEKS28–31 WEEKS36–40 WEEKSRespiratory Rate (br/min)15 (14–20)16 (15–18)18 (15–20)17 (16–18)Tidal Volume (mL)640 (550–710)650 (625–725)650 (575–720)700 (660–755)(Median, 25th–75th Percentile)

	8–11 WEEKS	20–23 WEEKS	28–31 WEEKS	36–40 WEEKS
Respiratory Rate (br/min)	15 (14–20)	16 (15–18)	18 (15–20)	17 (16–18)
Tidal Volume (mL)	640 (550–710)	650 (625–725)	650 (575–720)	700 (660–755)

(Median, 25th–75th Percentile)

Mean Values

Vital capacityFirst trimester3.8LitersSecond trimester3.9LitersThird trimester4.1LitersInspiratory capacityFirst trimester2.6LitersSecond trimester2.7LitersThird trimester2.9LitersExpiratory reserve volumeFirst trimester1.2LitersSecond trimester1.2LitersThird trimester1.2LitersResidual volumeFirst trimester1.2LitersSecond trimester1.1LitersThird trimester1.0LitersReferences: Gazioglu K, Kaltreider NL, Rosen M, Yu PN: Pulmonary function during pregnancy in normal women and in patients with cardiopulmonary disease. Thorax 25:445, 1920.Puranik BM, Kaore SB, Kurhade GA, et al: A longitudinal study of pulmonary function tests during pregnancy. Indian J Physiol Pharmacol 38:129, 1994.

Vital capacity
	First trimester	3.8	Liters
	Second trimester	3.9	Liters
	Third trimester	4.1	Liters
Inspiratory capacity
	First trimester	2.6	Liters
	Second trimester	2.7	Liters
	Third trimester	2.9	Liters
Expiratory reserve volume
	First trimester	1.2	Liters
	Second trimester	1.2	Liters
	Third trimester	1.2	Liters
Residual volume
	First trimester	1.2	Liters
	Second trimester	1.1	Liters
	Third trimester	1.0	Liters

References: Gazioglu K, Kaltreider NL, Rosen M, Yu PN: Pulmonary function during pregnancy in normal women and in patients with cardiopulmonary disease. Thorax 25:445, 1920.
Puranik BM, Kaore SB, Kurhade GA, et al: A longitudinal study of pulmonary function tests during pregnancy. Indian J Physiol Pharmacol 38:129, 1994.

Peak Flows (5th% Shown as Lower Limit of Normal) Stable Over Gestation

PEAK FLOW (L/MIN)Standing>320Sitting>310Supine>300

	PEAK FLOW (L/MIN)
Standing	>320
Sitting	>310
Supine	>300

LIVER FUNCTION TESTS

WEEK 12WEEK 32INTRAPARTUMTotal alkaline phosphatase (IU/L)42 (17–88)82 (46–165)97 (48–249)Gamma glutamyl transferase (IU/L)7 (2–18)6 (3–20)9 (5–79)Aspartate transaminase (AST, IU/L)9 (4–18)9 (5–21)11 (5–103)Alanine transaminase (ALT, IU/L)9 (4–30)8 (2–22)12 (5–115)Total bilirubin (IU/L)4 (1–12)4 (2–9)4 (2–10)Medians, Range Sixty-six women with uncomplicated pregnancies followed longitudinally.Reference: van Buul EJA, Steegers EAP, Jongsma HW, et al: Haematological and biochemical profile of uncomplicated pregnancy in nulliparous women; a longitudinal study. Neth J Med 46:73, 1995.

	WEEK 12	WEEK 32	INTRAPARTUM
Total alkaline phosphatase (IU/L)	42 (17–88)	82 (46–165)	97 (48–249)
Gamma glutamyl transferase (IU/L)	7 (2–18)	6 (3–20)	9 (5–79)
Aspartate transaminase (AST, IU/L)	9 (4–18)	9 (5–21)	11 (5–103)
Alanine transaminase (ALT, IU/L)	9 (4–30)	8 (2–22)	12 (5–115)
Total bilirubin (IU/L)	4 (1–12)	4 (2–9)	4 (2–10)

Medians, Range Sixty-six women with uncomplicated pregnancies followed longitudinally.Reference: van Buul EJA, Steegers EAP, Jongsma HW, et al: Haematological and biochemical profile of uncomplicated pregnancy in nulliparous women; a longitudinal study. Neth J Med 46:73, 1995.

ELECTROLYTES, OSMOLALITY, AND RENAL FUNCTION

12 WEEKS20 WEEKS28 WEEKS38 WEEKSTotal osmolality (mosmol/kg)267–279269–285273–283271–289Sodium (mmol/L)133–141136–142135–143135–141Potassium (mmol/L)3.5–4.33.5–4.33.5–4.43.6–4.5Chloride (mmol/L)102–108103–111104–112102–111Creatinine clearance (ml/24 hours)76–18888–16840–19252–208Blood urea nitrogen (BUN)1.7–4.41.9–5.31.9–4.21.8–4.6Serum albumin (g/L)37–4734–4231–4231–39Urine volume (mL/24 hours)750–2,500850–2,400750–2,700550–3,9005th–95th Percentile

	12 WEEKS	20 WEEKS	28 WEEKS	38 WEEKS
Total osmolality (mosmol/kg)	267–279	269–285	273–283	271–289
Sodium (mmol/L)	133–141	136–142	135–143	135–141
Potassium (mmol/L)	3.5–4.3	3.5–4.3	3.5–4.4	3.6–4.5
Chloride (mmol/L)	102–108	103–111	104–112	102–111
Creatinine clearance (ml/24 hours)	76–188	88–168	40–192	52–208
Blood urea nitrogen (BUN)	1.7–4.4	1.9–5.3	1.9–4.2	1.8–4.6
Serum albumin (g/L)	37–47	34–42	31–42	31–39
Urine volume (mL/24 hours)	750–2,500	850–2,400	750–2,700	550–3,900

5th–95th Percentile

24-Hour Urinary Protein (mg/24 Hours)

First trimester80.0 ± 60.6Second trimester116.7 ± 69.3Third trimester115.3 ± 69.2Mean ± SD

First trimester	80.0 ± 60.6
Second trimester	116.7 ± 69.3
Third trimester	115.3 ± 69.2

Mean ± SD

METABOLIC MARKERS AND LIPIDS

Reference: Lain KY, Markovic N, Ness RB, Roberts JM: Effect of smoking on uric acid and other metabolic markers throughout normal pregnancy. J Clin Endocrinol Metab 90:5743, 2005.4–16 WEEKS16–24 WEEKS24–34 WEEKSTERMUric acid (mg/dL)3.21 ± 0.103.48 ± 0.133.49 ± 0.114.72 ± 0.13Creatinine (mg/dL)0.58 ± 0.030.50 ± 0.040.50 ± 0.030.57 ± 0.03Total cholesterol (mg/dL)153.5 ± 3.8194.0 ± 5.2218.3 ± 6.4220.4 ± 8.4Triglycerides70.1 ± 4.5109.6 ± 5.8139.6 ± 6.9159.0 ± 8.1Free fatty acids (mEq/L)0.42 ± 0.030.34 ± 0.020.21 ± 0.020.67 ± 0.04Medians ± SD

	4–16 WEEKS	16–24 WEEKS	24–34 WEEKS	TERM
Uric acid (mg/dL)	3.21 ± 0.10	3.48 ± 0.13	3.49 ± 0.11	4.72 ± 0.13
Creatinine (mg/dL)	0.58 ± 0.03	0.50 ± 0.04	0.50 ± 0.03	0.57 ± 0.03
Total cholesterol (mg/dL)	153.5 ± 3.8	194.0 ± 5.2	218.3 ± 6.4	220.4 ± 8.4
Triglycerides	70.1 ± 4.5	109.6 ± 5.8	139.6 ± 6.9	159.0 ± 8.1
Free fatty acids (mEq/L)	0.42 ± 0.03	0.34 ± 0.02	0.21 ± 0.02	0.67 ± 0.04

Medians ± SD

White Blood Cell Count(10⁹L)

18 Weeks8.8 (5.6–13.8)32 Weeks9.7 (6.0–15.7)39 Weeks9.4 (5.8–15.1)(Mean ± 1.96 × SD)

18 Weeks	8.8 (5.6–13.8)
32 Weeks	9.7 (6.0–15.7)
39 Weeks	9.4 (5.8–15.1)

(Mean ± 1.96 × SD)

RED BLOOD CELL INDICES

Red Cell Indices In Iron-Treated Women (66 mg Elemental Iron as Fumarate)

Red blood cell count (1012/L)First trimester (9–13 wk)>3.45Second trimester (19–22 wk)>3.29Third trimester (31–34 wk)>3.23Term (39–43 wk)>3.54Hemoglobin (g/dL)First trimester (9–13 wk)>11.1Second trimester (19–22 wk)>10.64Third trimester (31–34 wk)>10.47Term (39–43 wk)>11.5Hematocrit (%)First trimester (9–13 wk)>33Second trimester (19–22 wk)>32Third trimester (31–34 wk)>31Term (39–43 wk)>34Mean cell volume (MCV, fl, 5th–95th percentile)First trimester (9–13 wk)88–101Second trimester (19–22 wk)89–104Third trimester (31–34 wk)90–104Term (39–43 wk)90–102Mean corpuscular hemoglobin (MCH, pg)First trimester (9–13 wk)>30.1Second trimester (19–22 wk)>29.9Third trimester (31–34 wk)>30.2Term (39–43 wk)>30.1Mean cell hemoglobin concentration (MCHC, g/dL)First trimester (9–13 wk)>32.6Second trimester (19–22 wk)>31.7Third trimester (31–34 wk)>32.2Term (39–43 wk)>31.9<5th Percentile Shown as Lower Limit of Normal

Red blood cell count (10¹²/L)
	First trimester (9–13 wk)	>3.45
	Second trimester (19–22 wk)	>3.29
	Third trimester (31–34 wk)	>3.23
	Term (39–43 wk)	>3.54
Hemoglobin (g/dL)
	First trimester (9–13 wk)	>11.1
	Second trimester (19–22 wk)	>10.64
	Third trimester (31–34 wk)	>10.47
	Term (39–43 wk)	>11.5
Hematocrit (%)
	First trimester (9–13 wk)	>33
	Second trimester (19–22 wk)	>32
	Third trimester (31–34 wk)	>31
	Term (39–43 wk)	>34
Mean cell volume (MCV, fl, 5th–95th percentile)
	First trimester (9–13 wk)	88–101
	Second trimester (19–22 wk)	89–104
	Third trimester (31–34 wk)	90–104
	Term (39–43 wk)	90–102
Mean corpuscular hemoglobin (MCH, pg)
	First trimester (9–13 wk)	>30.1
	Second trimester (19–22 wk)	>29.9
	Third trimester (31–34 wk)	>30.2
	Term (39–43 wk)	>30.1
Mean cell hemoglobin concentration (MCHC, g/dL)
	First trimester (9–13 wk)	>32.6
	Second trimester (19–22 wk)	>31.7
	Third trimester (31–34 wk)	>32.2
	Term (39–43 wk)	>31.9

<5th Percentile Shown as Lower Limit of Normal

Iron, Folate, and Vitamin B₁₂ Levels

Mean Ferritin (ug/L)First trimester (mean 12.6 wk)46.8 ± 2.5Third trimester (32 wk)20.8 ± 1.3Term (38 wk)21.7 ± 1.6Mean Total Iron Binding Capacity (TIBC, umol/L)First trimester (mean 12.6 wk)59.3 ± 0.6Third trimester (32 wk)73.8 ± 0.9Term (38 wk)77.7 ± 0.9Folate (umol/L)First trimester (mean 12.6 wk)6.7 ± 0.3Third trimester (32 wk)6.4 ± 0.3Term (38 wk)6.9 ± 0.4B12First trimester (mean 12.6 wk)345.6 ± 8.9Third trimester (32 wk)259.3 ± 6.0Term (38 wk)241.8 ± 6.5

Mean Ferritin (ug/L)
	First trimester (mean 12.6 wk)	46.8 ± 2.5
	Third trimester (32 wk)	20.8 ± 1.3
	Term (38 wk)	21.7 ± 1.6
Mean Total Iron Binding Capacity (TIBC, umol/L)
	First trimester (mean 12.6 wk)	59.3 ± 0.6
	Third trimester (32 wk)	73.8 ± 0.9
	Term (38 wk)	77.7 ± 0.9
Folate (umol/L)
	First trimester (mean 12.6 wk)	6.7 ± 0.3
	Third trimester (32 wk)	6.4 ± 0.3
	Term (38 wk)	6.9 ± 0.4
B₁₂
	First trimester (mean 12.6 wk)	345.6 ± 8.9
	Third trimester (32 wk)	259.3 ± 6.0
	Term (38 wk)	241.8 ± 6.5

Platelet Count (10⁹/L)

First trimester (12 wk)240 (170–310)Third trimester (28 wk)250 (150–360)Term (38 wk)240 (140–370)Median (5th–95th percentile)

First trimester (12 wk)	240 (170–310)
Third trimester (28 wk)	250 (150–360)
Term (38 wk)	240 (140–370)

Median (5th–95th percentile)

Fasting Homocysteine With and Without Folic Acid Supplementation (Various Doses) (μmol/L)

8 WEEKS20 WEEKS32 WEEKSUnsupplemented6.48 ± 1.305.22 ± 1.295.16 ± 1.32Supplemented6.32 ± 1.344.18 ± 1.324.42 ± 1.37Means ± 1SD

	8 WEEKS	20 WEEKS	32 WEEKS
Unsupplemented	6.48 ± 1.30	5.22 ± 1.29	5.16 ± 1.32
Supplemented	6.32 ± 1.34	4.18 ± 1.32	4.42 ± 1.37

Means ± 1SD

Coagulation Factors

11–15 WEEKS21–25 WEEKS31–35 WEEKS36–40 WEEKSFactor VII111 (60–206)150 (80–280)162 (84–312)171 (87–336)Factor X103 (62–169)115 (74–177)123 (78–194)127 (72–208)Factor V93 (46–188)82 (66–185)82 (34–195)85 (39–184)Factor II125 (70–224)125 (73–214)115 (74–179)115 (68–194)(% of Standards Shown, Mean and Range)

	11–15 WEEKS	21–25 WEEKS	31–35 WEEKS	36–40 WEEKS
Factor VII	111 (60–206)	150 (80–280)	162 (84–312)	171 (87–336)
Factor X	103 (62–169)	115 (74–177)	123 (78–194)	127 (72–208)
Factor V	93 (46–188)	82 (66–185)	82 (34–195)	85 (39–184)
Factor II	125 (70–224)	125 (73–214)	115 (74–179)	115 (68–194)

(% of Standards Shown, Mean and Range)

COAGULATION PARAMETERS AND TESTING

Coagulation Parameters in Normal Pregnancy and Puerperium (n = 117)

10 WEEKS20 WEEKS30 WEEKS36 WEEKSINR0.97 ± 0.080.91 ± 0.060.88 ± 0.070.87 ± 0.07PTT (sec)27.0 ± 2.726.9 ± 2.727.1 ± 2.927.5 ± 2.8Fibrinogen (mg%)412.5 ± 69.5463.9 ± 83.9538.8 ± 107.3556.9 ± 113.3Antithrombin III101.5 ± 12.7101.4 ± 10.3104.2 ± 12.5102.8 ± 13.5Protein C (%)99.4 ± 21.3107.5 ± 24.999.3 ± 26.094.9 ± 25.5Protein S (%)64.1 ± 15.862.1 ± 14.254.0 ± 13.351.7 ± 17.9PAI (AU/mL)10.3 ± 4.711.3 ± 5.020.5 ± 7.322.4 ± 7.5INR, international normalized ratio; PAI, plasminogen activator inhibitor; PTT, partial thromboplastin time.(Mean ± SD)

	10 WEEKS	20 WEEKS	30 WEEKS	36 WEEKS
INR	0.97 ± 0.08	0.91 ± 0.06	0.88 ± 0.07	0.87 ± 0.07
PTT (sec)	27.0 ± 2.7	26.9 ± 2.7	27.1 ± 2.9	27.5 ± 2.8
Fibrinogen (mg%)	412.5 ± 69.5	463.9 ± 83.9	538.8 ± 107.3	556.9 ± 113.3
Antithrombin III	101.5 ± 12.7	101.4 ± 10.3	104.2 ± 12.5	102.8 ± 13.5
Protein C (%)	99.4 ± 21.3	107.5 ± 24.9	99.3 ± 26.0	94.9 ± 25.5
Protein S (%)	64.1 ± 15.8	62.1 ± 14.2	54.0 ± 13.3	51.7 ± 17.9
PAI (AU/mL)	10.3 ± 4.7	11.3 ± 5.0	20.5 ± 7.3	22.4 ± 7.5

INR, international normalized ratio; PAI, plasminogen activator inhibitor; PTT, partial thromboplastin time.(Mean ± SD)

Calcium Metabolism

13–16 WEEKS21–24 WEEKS29–32 WEEKS>37 WEEKSTotal calcium (mmol/L)2.25–2.352.15–2.302.10–2.252.05–2.25Ionized calcium (mmol/L)1.10–1.201.05–1.201.10–1.151.05–1.15(± 1 SD)

	13–16 WEEKS	21–24 WEEKS	29–32 WEEKS	>37 WEEKS
Total calcium (mmol/L)	2.25–2.35	2.15–2.30	2.10–2.25	2.05–2.25
Ionized calcium (mmol/L)	1.10–1.20	1.05–1.20	1.10–1.15	1.05–1.15

(± 1 SD)

8–11 WEEKS20–23 WEEKS28–31 WEEKS>37 WEEKSCalcitonin (ng/L)73–10179–10887–11383–109Parathyroid hormone (ng/L)7–154.5–125–1510–171,25 Dihydroxy Vitamin D (ng/L)58–7894–12298–13694–150

	8–11 WEEKS	20–23 WEEKS	28–31 WEEKS	>37 WEEKS
Calcitonin (ng/L)	73–101	79–108	87–113	83–109
Parathyroid hormone (ng/L)	7–15	4.5–12	5–15	10–17
1,25 Dihydroxy Vitamin D (ng/L)	58–78	94–122	98–136	94–150

TSH (mIU/L) and Free T₄ (ng/dL) by Race (means, IQ range)¹

BLACKWHITEFirst trimesterTSH0.9 (0.4–1.6)1.3 (0.8–2.0)Free T41.0 (0.9–1.1)1.0 (0.9–1.1)Second trimesterTSH1.0 (0.6–1.5)1.6 (1.0–2.2)Free T40.9 (0.8–1.0)0.9 (0.8–1.0)Third trimesterTSH1.2 (0.9–1.9)1.5 (1.4–2.1)Free T40.8 (0.7–0.9)0.8 (0.7–0.9)DeliveryTSH2.1 (1.3–3.1)2.8 (2.0–4.4)Free T40.8 (0.7–0.9)0.8 (0.7–0.9)Screening and Diagnostic Thresholds across Pregnancy2TSH >2.5 mIU/L – requires further workup for hypothyroidismTotal T4 <100 nmol/L (7.8 μ/dL) – diagnostic of hypothyroidismT4, thyroxine; TSH, thyroid-stimulating hormone.References: 1. Walker JA, Illions EH, Huddleston JF, Smallridge RC: Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol 106:1365, 2005.2. Mandel SJ, Spencer CA, Hollowell JG: Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid 15:44, 2005.

		BLACK	WHITE
First trimester
	TSH	0.9 (0.4–1.6)	1.3 (0.8–2.0)
	Free T₄	1.0 (0.9–1.1)	1.0 (0.9–1.1)
Second trimester
	TSH	1.0 (0.6–1.5)	1.6 (1.0–2.2)
	Free T₄	0.9 (0.8–1.0)	0.9 (0.8–1.0)
Third trimester
	TSH	1.2 (0.9–1.9)	1.5 (1.4–2.1)
	Free T₄	0.8 (0.7–0.9)	0.8 (0.7–0.9)
Delivery
	TSH	2.1 (1.3–3.1)	2.8 (2.0–4.4)
	Free T₄	0.8 (0.7–0.9)	0.8 (0.7–0.9)

Screening and Diagnostic Thresholds across Pregnancy²TSH >2.5 mIU/L – requires further workup for hypothyroidismTotal T₄ <100 nmol/L (7.8 μ/dL) – diagnostic of hypothyroidismT₄, thyroxine; TSH, thyroid-stimulating hormone.References: 1. Walker JA, Illions EH, Huddleston JF, Smallridge RC: Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period. Obstet Gynecol 106:1365, 2005.2. Mandel SJ, Spencer CA, Hollowell JG: Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid 15:44, 2005.

Sequential Measurements of Plasma CRH, ACTH, Cortisol, Aldosterone, and Urinary Free Cortisol during Pregnancy

WEEKS OF GESTATIONCRH (PG/ML)ACTH (PG/ML)CORTISOL (μG/DL)DHEAS (μG/DL)ALDOSTERONE (PG/ML)URINARY FREE CORTISOL (μG/24H)11–15115 ± 568.8 ± 2.810.5 ± 1.4102 ± 14412 ± 63.654.8 ± 7.321–25145 ± 309.8 ± 1.520.0 ± 1.185.1 ± 9.0487 ± 42.884.4 ± 8.431–351,570 ± 34912.1 ± 2.022.0 ± 1.262.6 ± 6.8766 ± 94105 ± 8.836–404,346 ± 75418.6 ± 2.626.0 ± 1.163.8 ± 7.11,150 ± 170111 ± 8.7ACTH, adrenocorticotrophic hormone; CRH, corticotrophin-releasing hormone; DHEAS, dehydroepiandrosterone.

WEEKS OF GESTATION	CRH (PG/ML)	ACTH (PG/ML)	CORTISOL (μG/DL)	DHEAS (μG/DL)	ALDOSTERONE (PG/ML)	URINARY FREE CORTISOL (μG/24H)
11–15	115 ± 56	8.8 ± 2.8	10.5 ± 1.4	102 ± 14	412 ± 63.6	54.8 ± 7.3
21–25	145 ± 30	9.8 ± 1.5	20.0 ± 1.1	85.1 ± 9.0	487 ± 42.8	84.4 ± 8.4
31–35	1,570 ± 349	12.1 ± 2.0	22.0 ± 1.2	62.6 ± 6.8	766 ± 94	105 ± 8.8
36–40	4,346 ± 754	18.6 ± 2.6	26.0 ± 1.1	63.8 ± 7.1	1,150 ± 170	111 ± 8.7

ACTH, adrenocorticotrophic hormone; CRH, corticotrophin-releasing hormone; DHEAS, dehydroepiandrosterone.

Umbilical Cord Blood at Delivery

ARTERYVEINpH7.06–7.367.14–7.45Pco2 (mm Hg)27.8–68.324.0–56.3Po2 (mm Hg)9.8–41.212.3–45.0Base deficit (mmol/L)0.5–15.30.7–12.6

	ARTERY	VEIN
pH	7.06–7.36	7.14–7.45
Pco₂ (mm Hg)	27.8–68.3	24.0–56.3
Po₂ (mm Hg)	9.8–41.2	12.3–45.0
Base deficit (mmol/L)	0.5–15.3	0.7–12.6

Reference: Mercelina-Roumans P, Breukers R, Ubachs, J, Van Wersch J: Hematological variables in cord blood of neonates of smoking and non-smoking mothers. J Clin Epidemiol 49:449, 1996.White blood cell count (109/L)11.1–16.2Red cell count (1012/L)4.13–4.62Hemoglobin (g/dL)15.3–17.2Hematocrit (%)45.2–50.9MCV (fl)107.4–113.3Platelet count (109/L)237–321Reticulocyte count (109/L)145.8–192.625th–75th Percentile

White blood cell count (10⁹/L)	11.1–16.2
Red cell count (10¹²/L)	4.13–4.62
Hemoglobin (g/dL)	15.3–17.2
Hematocrit (%)	45.2–50.9
MCV (fl)	107.4–113.3
Platelet count (10⁹/L)	237–321
Reticulocyte count (10⁹/L)	145.8–192.6

25th–75th Percentile

Invasive Cardiac Monitoring : Noninvasive Cardiac Monitoring : Arterial Blood Gas Values : Pulmonary Function Tests : Liver Function Tests : Electrolytes, Osmolality, and Renal Function : 24-hour Urine Protein : Metabolic Markers and Lipids : White Blood Cells : Red Blood Cell Indices : Iron, Folate, and Vitamin B₁₂ Levels : Platelet Count : Fasting Homocysteine With and Without Folate Supplementation : Coagulation Factor Levels : Coagulation Parameters : Calcium Metabolism : Thyroid Function Tests : Adrenal Function Tests : Umbilical Cord Blood Gas Values and Hematologic Parameters :

© 2007 Elsevier Inc. Tous droits réservés.© 1996 Publié par Elsevier Masson SAS. Tous droits réservés.© 1992 Publié par Elsevier Masson SAS. Tous droits réservés.© 1992 Publié par Elsevier Masson SAS. Tous droits réservés.© 2005 Publié par Elsevier Masson SAS. Tous droits réservés.© 1995 Publié par Elsevier Masson SAS. Tous droits réservés.© 1994 Publié par Elsevier Masson SAS. Tous droits réservés.© 1994 Publié par Elsevier Masson SAS. Tous droits réservés.© 2005 Publié par Elsevier Masson SAS. Tous droits réservés.© 1991 Publié par Elsevier Masson SAS. Tous droits réservés.© 1995 Publié par Elsevier Masson SAS. Tous droits réservés.© 2002 Publié par Elsevier Masson SAS. Tous droits réservés.© 1984 Publié par Elsevier Masson SAS. Tous droits réservés.© 1997 Publié par Elsevier Masson SAS. Tous droits réservés.© 1979 Publié par Elsevier Masson SAS. Tous droits réservés.© 1991 Publié par Elsevier Masson SAS. Tous droits réservés.© 1994 Publié par Elsevier Masson SAS. Tous droits réservés.© 1983 Publié par Elsevier Masson SAS. Tous droits réservés.© 1996 Publié par Elsevier Masson SAS. Tous droits réservés.

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Normal Values in Pregnancy - 22/08/11

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