Plasma glucose, immunoreaetive insulin, and growth hormone (GH) have been estimated during morning (AM) and afternoon (PM) oral glucose tolerance tests (GTT) in a group of 22 subjects, 13 of whom were young women receiving combined oestrogen-progestogen oral contraceptives. Impaired PM glucose tolerance with associated delay and impairment of insulin secretion has been conf~'med, as has the inverse correlation between obesity and diurnal GTT variation. Diurnal changes in GH are unlikely to be responsible for this circadian GTT rhythm. Patients on oral contraceptives continue to show a normal GTT rhythm, so that a mildly abnormal AM test is likely to be associated with a more severely diabetic PM test. These observations indicate that while obesity and oral contraceptive use may have metabolic features in common, they differ in this respect; they support the view that, if possible, carbohydrate tolerance should be monitored in women taking oral contraceptives in whom a tendency to diabetes is suspected.

Using stable isotope, glucose turnover was measured in six normal pregnant women during the various stages of labor; during the latent (A1) and active (A2) phases of cervical dilatation, during fetal expulsion (B), and during placental expulsion (C). These data were compared to measurements made in five postpartum women. Pancreatic hormones and cortisol were also measured. In four other normal women undergoing spontaneous labor, catecholamines and free fatty acids were measured. Plasma glucose increased throughout labor from 4.0 +/- 0.2 (A1) to 5.5 +/- 0.5 mmol/L (C) (P < 0.01), compared to 4.7 +/- 0.1 in the postpartum women. Glucose utilization and production were increased throughout labor at 33.4 +/- 3.1 and 32.8 +/- 3.1 mumol/kg min, respectively, compared to 8.2 +/- 0.9 in postpartum women. Glucose metabolic clearance was also increased to 7.5 +/- 0.8 mL/kg.min compared to that in nonpregnant women (1.8 +/- 0.3). Plasma insulin remained at 59 +/- 5 pmol/L during stages A1, A2, and B, but increased to 115 +/- 15 pmol/L during stage C. Plasma glucagon was increased throughout labor at 127 +/- 7 pg/mL, compared to 90 +/- 4 pg/mL in control postpartum women. Plasma cortisol increased during labor from 921 +/- 136 to 2018 +/- 160 nmol/L, compared to 645 +/- 355 during the postpartum period. Epinephrine and norepinephrine also increased during labor from 218 +/- 132 pmol/L and 1.09 +/- 0.16 nmol/L to 1119 +/- 158 and 3.61 +/- 1.04, respectively. It is concluded that labor is associated with a marked increase in glucose utilization and production. These findings suggest that muscle contraction (uterus and skeletal) independent of insulin is a major regulator of glucose utilization during labor. Furthermore, the increase in hepatic glucose production could be favored by an increase in glucagon, catecholamines, and cortisol.

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