Metabolism in Pregnancy

Abstract

In the course of an extended investigation on various aspects of the metabolism during pregnancy a series of records were made while the patient was actually in labor and immediately thereafter. It is a well-recognized fact that during pregnancy blood sugars are at a low normal level. In our own series 1 the average level throughout gestation was 83 mg. and the average extreme fluctuation from 81 to 86 mg. In the present instance, a series of 25 patients were examined at some time after labor had begun and blood was taken again 30 minutes after delivery. Certain details may be presented in tabular form.

Even so small a series presents a wide scatter of performance. There were 11 primiparae, and while the time in labor (16 hr. 32 min.) averages well above the mean for the group, the longest labor was the woman terminating her tenth pregnancy. The influence of nourishment was seemingly negligible. In the case receiving food (cocoa, orange juice, muffin) 45 minutes before the blood sample was taken, the blood sugar level was 80 mg., and in only 5 cases was the elapsed time less than 6 hours with an average level of 82 mg. In the analysis of the elapsed time from blood taking to delivery, that with the longest was 87 mg. and the shortest 85. The blood sugar data follow:

Only one case in the entire series failed to show an appreciable rise. This was a primipara 9 hours and 20 minutes in labor with blood taken 3 hours and 20 minutes before actual delivery. Food had not been taken for 17 hours before the veinpuncture. The levels both a.p. and p.p. were 86 mg.

Summary. 1. The low blood sugar levels characteristic of pregnancy obtain actually during labor and apparently to within a few minutes of delivery. 2. There is a marked rise in blood sugar on emptying the uterus, the average increase being slightly more than 30%, and in individual cases reaching low hyperglycaemic levels. 3. The time factor as such seemingly plays no part. In the case with blood taken 15 minutes before delivery, the level was 85 mg.; 45 minutes later it was 108 mg., an increase of 27%.