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Normal Values in Pregnancy

1305

Cardiac output is increased in pregnancy but is essentially unchanged over the course of pregnancy.Heart rate gradually rises 5 to 10 bpm 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.

Invasive Monitoring

MEASURE VALUE (3638 WEEKS) UNITS

Cardiac output 6.2 1.0 liters/minuteSystemic vascular resistance 1,210 266 dyne cm second5

Heart rate 83 10 beats/minutePulmonary vascular resistance 78 22 dyne cm second5

Colloid oncotic pressure 18.0 1.5 mm Hg

Mean arterial pressure (MAP) 90.3 5.8 mm HgPulmonary capillary wedge pressure (PCWP) 7.5 1.8 mm HgCentral venous pressure (CVP) 3.6 2.5 mm HgLeft ventricular stroke work index 48 6 g mm2

SVR, systemic vascular resistance.Reference: Van Oppen CA, Van Der Tweel I, Alsbach JGP, et al: A longitudinal study of maternal hemodynamics during normal pregnancy.

Obstet Gynecol 88:40, 1996.

Noninvasive Monitoring

MEASURE 1018 WEEKS 1826 WEEKS 2634 WEEKS 3442 WEEKS

Cardiac output (L/min) 7.26 1.56 7.60 1.63 7.38 1.63 6.37 1.48Stroke volume (mL) 85 21 85 21 82 21 70 14SVR (dyne cm second5) 966 226 901 224 932 240 1,118 325Heart rate (beats/min) 87 14 90 14 92 14 92 7Mean arterial pressure (mm Hg) 87 7 84 7 84 7 86 7

Invasive Cardiac MonitoringNoninvasive Cardiac Monitoring

Arterial Blood Gas Values

Pulmonary Function TestsLiver Function Tests

Electrolytes, Osmolality, and Renal

Function

24-hour Urine Protein

Metabolic Markers and LipidsWhite Blood Cells

Red Blood Cell Indices

Iron, Folate, and Vitamin B12 LevelsPlatelet Count

Fasting Homocysteine With and

Without Folate Supplementation

Coagulation Factor Levels

Coagulation ParametersCalcium Metabolism

Thyroid Function Tests

Adrenal Function TestsUmbilical Cord Blood Gas Values and

Hematologic Parameters


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1306 Normal Values in Pregnancy

(Median, 25th75th Percentile)Adapted from Spatling L, Fallenstein F, Huch A, et al: The variability of cardiopulmonary adaptation to pregnancy at rest and during exercise.

Br J Obstet Gynaecol 99:1, 1992.

Pulmonary Function Tests

811 WEEKS 2023 WEEKS 2831 WEEKS 3640 WEEKS

Respiratory Rate (br/min) 15 (1420) 16 (1518) 18 (1520) 17 (1618)Tidal Volume (mL) 640 (550710) 650 (625725) 650 (575720) 700 (660755)

Vital capacityFirst trimester 3.8 LitersSecond trimester 3.9 LitersThird trimester 4.1 Liters

Inspiratory capacityFirst trimester 2.6 LitersSecond trimester 2.7 LitersThird trimester 2.9 Liters

Expiratory reserve volume

First trimester 1.2 LitersSecond trimester 1.2 LitersThird trimester 1.2 Liters

Residual volumeFirst trimester 1.2 LitersSecond trimester 1.1 LitersThird trimester 1.0 Liters

References: Gazioglu K, Kaltreider NL, Rosen M, Yu PN: Pulmonaryfunction during pregnancy in normal women and in patients withcardiopulmonary disease. Thorax 25:445, 1920.

Puranik BM, Kaore SB, Kurhade GA, et al: A longitudinal studyof pulmonary function tests during pregnancy. Indian J PhysiolPharmacol 38:129, 1994.

Mean Values

PEAK FLOW (L/MIN)

Standing >320Sitting >310Supine >300

Adapted from Harirah HM, Donia SE, Nasrallah FK, et al: Effectof gestational age and position on peak expiratory flow rate: alongitudinal study. Obstet Gynecol 105:372, 2005.

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

Over Gestation

Third-Trimester Arterial Blood Gas Values

MODERATE ALTITUDENORMAL ALTITUDE (1,388 M, PROVO, UT)

Arterial pH 7.44 0.04 7.46 0.02Arterial Po2 (mm Hg) 85 5 86.2 7.3O2 Saturation (%) 96 1Arterial 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 acidbase 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 ObstetGynecol 123:241, 1975.

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 Med46:73, 1995.

WEEK 12 WEEK 32 INTRAPARTUM

Total alkaline phosphatase (IU/L) 42 (1788) 82 (46165) 97 (48249)Gamma glutamyl transferase (IU/L) 7 (218) 6 (320) 9 (579)Aspartate transaminase (AST, IU/L) 9 (418) 9 (521) 11 (5103)Alanine transaminase (ALT, IU/L) 9 (430) 8 (222) 12 (5115)Total bilirubin (IU/L) 4 (112) 4 (29) 4 (210)

LIVER FUNCTION TESTS


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Normal Values in Pregnancy 1307

Mean SDReference: Higby K, Suiter J, Phelps JY, et al: Normal values of

urinary albumin and total protein excretion during pregnancy. Am JObstet Gynecol 171:984, 1994.

24-Hour Urinary Protein (mg/24 Hours)

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

18 Weeks 8.8 (5.613.8)32 Weeks 9.7 (6.015.7)39 Weeks 9.4 (5.815.1)

(Mean 1.96 SD)Reference: Nils Milman, unpublished data, personal communication.

White Blood Cell Count (109/L)

5th95th PercentileAdapted from 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.


Total osmolality (mosmol/kg) 267279 269285 273283 271289Sodium (mmol/L) 133141 136142 135143 135141Potassium (mmol/L) 3.54.3 3.54.3 3.54.4 3.64.5Chloride (mmol/L) 102108 103111 104112 102111Creatinine clearance (ml/24 hours) 76188 88168 40192 52208

Blood urea nitrogen (BUN) 1.74.4 1.95.3 1.94.2 1.84.6Serum albumin (g/L) 3747 3442 3142 3139Urine volume (mL/24 hours) 7502,500 8502,400 7502,700 5503,900

ELECTROLYTES, OSMOLALITY, AND RENAL FUNCTION

Medians SDReference: 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.

416 WEEKS 1624 WEEKS 2434 WEEKS TERM

Uric acid (mg/dL) 3.21 0.10 3.48 0.13 3.49 0.11 4.72 0.13Creatinine (mg/dL) 0.58 0.03 0.50 0.04 0.50 0.03 0.57 0.03Total cholesterol (mg/dL) 153.5 3.8 194.0 5.2 218.3 6.4 220.4 8.4Triglycerides 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

METABOLIC MARKERS AND LIPIDS


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Means 1SDReference: Murphy MM, Scott JM, McPartlin JM, Fernandez-

Ballart JD: The pregnancy-related decrease in fasting plasmahomocysteine is not explained by folic acid supplementation,hemodilution, or a decrease in albumin in a longitudinal study. Am JClin Nutr 76:614, 2002.

Fasting Homocysteine With and Without Folic Acid

Supplementation (Various Doses) (mmol/L)

8 WEEKS 20 WEEKS 32 WEEKS

Unsupplemented 6.48 1.30 5.22 1.29 5.16 1.32Supplemented 6.32 1.34 4.18 1.32 4.42 1.37

(% of Standards Shown, Mean and Range)Reference: Stirling Y, Woolf L, North WRS, et al: Haemostasis in normal pregnancy. Thromb

Haemost 52:176, 1984.

Coagulation Factors


Factor VII 111 (60206) 150 (80280) 162 (84312) 171 (87336)Factor X 103 (62169) 115 (74177) 123 (78194) 127 (72208)Factor V 93 (46188) 82 (66185) 82 (34195) 85 (39184)Factor II 125 (70224) 125 (73214) 115 (74179) 115 (68194)

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 1.6

Mean 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 0.9

Folate (umol/L)First trimester (mean 12.6 wk) 6.7 0.3Third trimester (32 wk) 6.4 0.3Term (38 wk) 6.9 0.4

B12First trimester (mean 12.6 wk) 345.6 8.9Third trimester (32 wk) 259.3 6.0Term (38 wk) 241.8 6.5

Iron, Folate, and Vitamin B12 Levels

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

Red blood cell count (1012/L)First trimester (913 wk) >3.45Second trimester (1922 wk) >3.29Third trimester (3134 wk) >3.23Term (3943 wk) >3.54

Hemoglobin (g/dL)First trimester (913 wk) >11.1Second trimester (1922 wk) >10.64Third trimester (3134 wk) >10.47Term (3943 wk) >11.5

Hematocrit (%)First trimester (913 wk) >33Second trimester (1922 wk) >32Third trimester (3134 wk) >31Term (3943 wk) >34

Mean cell volume (MCV, fl, 5th95th percentile)First trimester (913 wk) 88101Second trimester (1922 wk) 89104Third trimester (3134 wk) 90104Term (3943 wk) 90102

Mean corpuscular hemoglobin (MCH, pg)First trimester (913 wk) >30.1Second trimester (1922 wk) >29.9Third trimester (3134 wk) >30.2Term (3943 wk) >30.1

Mean cell hemoglobin concentration (MCHC, g/dL)First trimester (913 wk) >32.6Second trimester (1922 wk) >31.7Third trimester (3134 wk) >32.2Term (3943 wk) >31.9


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Normal Values in Pregnancy 1309

( 1 SD)Adapted from Pitkin RM, Reynolds WA, Williams GA, Hargis GK: Calcium metabolism in normal pregnancy: a longitudinal study. Am J

Obstet Gynecol 133:781, 1979.

Calcium Metabolism

1316 WEEKS 2124 WEEKS 2932 WEEKS >37 WEEKS

Total calcium (mmol/L) 2.252.35 2.152.30 2.102.25 2.052.25Ionized calcium (mmol/L) 1.101.20 1.051.20 1.101.15 1.051.15

Adapted from Seki K, Makimura N, Mitsui C, et al: Calcium-regulating hormones and osteocalcin levels during pregnancy: a longitudinal study.Am J Obstet Gynecol 164:1248, 1991.

811 WEEKS 2023 WEEKS 2831 WEEKS >37 WEEKS

Calcitonin (ng/L) 73101 79108 87113 83109Parathyroid hormone (ng/L) 715 4.512 515 10171,25 Dihydroxy Vitamin D (ng/L) 5878 94122 98136 94150


INR 0.97 0.08 0.91 0.06 0.88 0.07 0.87 0.07PTT (sec) 27.0 2.7 26.9 2.7 27.1 2.9 27.5 2.8Fibrinogen (mg%) 412.5 69.5 463.9 83.9 538.8 107.3 556.9 113.3Antithrombin III 101.5 12.7 101.4 10.3 104.2 12.5 102.8 13.5Protein C (%) 99.4 21.3 107.5 24.9 99.3 26.0 94.9 25.5Protein S (%) 64.1 15.8 62.1 14.2 54.0 13.3 51.7 17.9PAI (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)Reference: Cerneca F, Ricci G, Someone R, et al: Coagulation and fibrinolysis changes in normal pregnancy. Increased levels of procoagulants

and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis. Eur J Obstet GynecolReprod Biol 73:31, 1997.

COAGULATION PARAMETERS AND TESTING

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


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Screening and Diagnostic Thresholds across Pregnancy2

TSH >2.5 mIU/L requires further workup for hypothyroidismTotal T4

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