Reference values for clinical chemistry tests during normal pregnancy

Larsson, Anders; Palm, Maria; Hansson, Lars O.; Axelssön, Ove

doi:10.1111/j.1471-0528.2008.01709.x

Cited by 177 publications

(151 citation statements)

References 18 publications

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“…Furthermore, conditions prone to either electrolyte retention or loss may be exacerbated during pregnancy. To facilitate identification of abnormalities in serum electrolytes, a recent report by Larsson et al details biochemical reference values for normal pregnancy (80).…”

Section: Electrolyte Balancementioning

confidence: 99%

Obstetric Nephrology

Odutayo

Hladunewich

2012

Clinical Journal of the American Society of Nephrology

172

106

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SummaryGlomerular hyperfiltration, altered tubular function, and shifts in electrolyte-fluid balance are among the hallmark renal physiologic changes that characterize a healthy pregnancy. These adjustments are not only critical to maternal and fetal well being, but also provide the clinical context for identifying gestational aberrations in renal function and electrolyte composition. Systemic vasodilation characterizes early gestation and produces increments in renal plasma flow and GFR, the latter of which is maintained into the postpartum period. In addition, renal tubular changes allow for the accumulation of nutrients and electrolytes necessary for fetal growth such that wasting of proteins, glucose, and amino acids in urine is limited in pregnancy and total body stores of electrolytes increase throughout gestation. Substantial insight into the mechanisms underlying these complex adjustments can be gleaned from the available animal and human literature, but our understanding in many areas remains incomplete. This article reviews the available literature on renal adaptation to normal pregnancy, including renal function, tubular function, and electrolyte-fluid balance, along with the clinical ramifications of these adjustments, the limitations of the existing literature, and suggestions for future studies.

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Section: Electrolyte Balancementioning

confidence: 99%

Obstetric Nephrology

Odutayo

Hladunewich

2012

Clinical Journal of the American Society of Nephrology

172

106

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“…39 When feasible, the ionized calcium should be measured; however, when total calcium is measured, values can be corrected for the serum albumin concentration, and compared with published reference values for pregnancy. 40 The incidence of hypercalcemia using prespecified cutoffs, not just the mean [Ca], should ideally be reported.…”

Section: -Hydroxyvitamin D ([25(oh)d]mentioning

confidence: 99%

Vitamin D supplementation during pregnancy: safety considerations in the design and interpretation of clinical trials

Roth

2011

J Perinatol

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Maternal-child health benefits of optimizing vitamin D status during pregnancy may include a reduced risk of pre-eclampsia, improved fetal growth and beneficial effects on infant immune function. These hypotheses require evaluation by randomized controlled antenatal vitamin D supplementation trials using doses that are high enough to elevate serum 25-hydroxyvitamin D concentrations into the range believed to be associated with improved health outcomes. Such doses may be considerably higher than the current recommended dietary allowance (600 IU day -1 ) or standard prenatal supplement dose (400 IU day -1 ), and may even be higher than the tolerable upper intake level (4000 IU day -1 ) advised by the Institute of Medicine (2010). A critical review of the published literature yielded limited data regarding the safety of antenatal vitamin D regimens. There have been no published reports of the teratogenic effects of vitamin D on humans. Some animal studies have suggested the potential for dosedependent fetal toxicities (for example, growth impairment, skeletal malformations and cardiovascular anomalies), but the relevance of these observations to humans is unknown. Antenatal vitamin D supplementation trials should incorporate a range of methods for objectively establishing maternal and fetal safety, and aim to identify the lowest doses of vitamin D required to achieve target outcomes.

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“…Sir, I read with interest the article written by Larsson et al 1 on reference values for clinical chemistry tests during normal pregnancy. Their effort is to be applauded, first, in highlighting the importance of the effect of normal pregnancy on commonly measured biological markers and hence the need for caution not to interpret physiological changes in normal pregnancy as pathological; second, in being able to consolidate and define reference intervals for as many parameters as they have in their article.…”

Section: Reference Values For Clinical Chemistry Tests During Normal mentioning

confidence: 99%

“…

Reference values for clinical chemistry tests during normal pregnancySir, I read with interest the article written by Larsson et al 1 on reference values for clinical chemistry tests during normal pregnancy. Their effort is to be applauded, first, in highlighting the importance of the effect of normal pregnancy on commonly measured biological markers and hence the need for caution not to interpret physiological changes in normal pregnancy as pathological; second, in being able to consolidate and define reference intervals for as many parameters as they have in their article.

I, however, have some concerns with their article; they stated that 'Previous studies of normal variations during pregnancy are incomplete and often limited to the third trimester and focused on a single or a few analytes'; this, however, is not entirely accurate and furthermore the concept they are talking about cannot be claimed by them because it has been out there for years.

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mentioning

confidence: 99%

Reference values for clinical chemistry tests during normal pregnancy

Evbuomwan

2008

BJOG

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Reference values for clinical chemistry tests during normal pregnancySir, I read with interest the article written by Larsson et al. 1 on reference values for clinical chemistry tests during normal pregnancy. Their effort is to be applauded, first, in highlighting the importance of the effect of normal pregnancy on commonly measured biological markers and hence the need for caution not to interpret physiological changes in normal pregnancy as pathological; second, in being able to consolidate and define reference intervals for as many parameters as they have in their article.I, however, have some concerns with their article; they stated that 'Previous studies of normal variations during pregnancy are incomplete and often limited to the third trimester and focused on a single or a few analytes'; this, however, is not entirely accurate and furthermore the concept they are talking about cannot be claimed by them because it has been out there for years. 2 Davison et al. 3 in work spanning well over a decade, has demonstrated unambiguously, changes in osmoregulation function in the three trimesters of normal pregnancy, which we now know are physiological, but would have been interpreted as pathological in the context of nonpregnant reference values.They demonstrated that, plasma osmolality falls by 8-10 mOsm/kg in the first few weeks of pregnancy, a relative hypotonicity that is maintained until parturition. This decrease in osmolality is accompanied by parallel decreases in the main extracellular fluid electrolytes, mainly sodium and its attendant ion chloride, as well as urea. 3 Furthermore, this group demonstrated robustly that the explanation for the observed decreases was not due simply to haemodilution, a commonly held and accepted explanation for most of the observed physiological changes in normal pregnancy, but was due instead to the lowering of the osmotic thresholds for both vasopressin release and thirst to the observed lower osmolality values. 4 This explanation, they argued, was why normally pregnant women were able to continue to concentrate and dilute their urine normally, about their new lower osmolality levels instead of being in a state of continuous diuresis as one would have expected if it was simply due to haemodilution.Finally, I would suggest that the authors now do a thorough search of the literature in order to make their list of reference complete because in its current state, they have failed to acknowledge previous similar and important work that have been undertaken by other groups.

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Reference values for clinical chemistry tests during normal pregnancy

Cited by 177 publications

References 18 publications

Obstetric Nephrology

Obstetric Nephrology

Vitamin D supplementation during pregnancy: safety considerations in the design and interpretation of clinical trials

Reference values for clinical chemistry tests during normal pregnancy

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