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Review

Pregnancy and Laboratory Studies


A Reference Table for Clinicians
Mina Abbassi-Ghanavati, MD, Laura G. Greer, MD, and F. Gary Cunningham, MD

OBJECTIVE: To establish normal reference ranges during


pregnancy for common laboratory analytes.
DATA SOURCES: We conducted a comprehensive elec-
P regnancy induces a number of physiological alter-
ations in most, if not all, organ systems. In some
cases, these changes are profound. Along with these
tronic database review using PUBMED and MEDLINE physiologic adaptations, there are considerable changes
databases. We also reviewed textbooks of maternal lab- in laboratory test values. For example, every obstetri-
oratory studies during uncomplicated pregnancy. cian is familiar with the lower hematocrit value and
METHODS OF STUDY SELECTION: We searched the hemoglobin concentration with normal pregnancy.
databases for studies investigating various laboratory ana- Similarly, a seemingly normal serum creatinine
lytes at various times during pregnancy. All abstracts were value of 1.1 mg/dL is immediately recognized as
examined by two investigators and, if they were found abnormal in the pregnant woman. Yet another im-
relevant, the full text of the article was reviewed. Articles portant example is the woman with an acute asthmatic
were included if the analyte studied was measured in exacerbation in the third trimester whose arterial PCO2
pregnant women without major medical problems or con- is a “normal” 37 mm Hg; for her, this is a harbinger of
founding conditions and if the laboratory marker was mea-
impending disaster.
sured and reported for a specified gestational age.
Although the phenomenon of changes in normal
TABULATION, INTEGRATION, AND RESULTS: For each laboratory values induced by pregnancy is well rec-
laboratory marker, data were extracted from as many
ognized, very few laboratories provide reference
references as possible, and these data were combined to
ranges for pregnant women. In fact, many laborato-
establish normal reference ranges in pregnancy. When
possible, the 2.5 and 97.5 percentiles were reported as the ries do not even report normal values for “females,”
normal range. In some of the reference articles, however, much less pregnant women. Obstetricians, family med-
the reported range was based on the minimum and maxi- icine physicians, nurse practitioners, and midwives are
mum value of the laboratory constituent. In those cases, the trained to be familiar with common tests known to be
minimum to maximum range was used and combined with considerably altered by pregnancy. On the other hand,
the 2.5 and 97.5 percentile range. We found that there is a physicians who provide primary care, such as emer-
substantial difference in normal values in some laboratory gency room physicians, or those who serve as consult-
markers in the pregnant state when compared with the ants, such as internists and surgeons, are less likely to be
nonpregnant state. facile with many of these perturbations.
CONCLUSION: It is important to consider normal refer- There are a few sources that provide reference
ence ranges specific to pregnancy when interpreting ranges or laboratory values for use in pregnancy.
some laboratory results that may be altered by the Some of those available are more detailed than oth-
normal changes of pregnancy. ers. For example, some include reference ranges
(Obstet Gynecol 2009;114:1326–31)
across pregnancy, with results that vary with gesta-
tional age. An obvious example again is the hemoglo-
From the University of Texas Southwestern Medical Center, Dallas, Texas. bin concentration, which is highest in the first and last
Corresponding author: Mina Abbassi-Ghanavati, MD, University of Texas trimesters and lowest in midpregnancy. We cite the
Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX efforts of Hytten,1 who recognized the need for nor-
75390; e-mail: Mina.Abbassi-Ghanavati@UTSouthwestern.edu.
mal values in pregnancy. More recently, both Lars-
Financial Disclosure
The authors did not report any potential conflicts of interest.
son2 and Lockitch3 prospectively collected blood sam-
ples across normal pregnancies to provide reference
© 2009 by The American College of Obstetricians and Gynecologists. Published
by Lippincott Williams & Wilkins. ranges for some analytes during pregnancy. Thus, our
ISSN: 0029-7844/09 goal was to analyze these and other publications to

1326 VOL. 114, NO. 6, DECEMBER 2009 OBSTETRICS & GYNECOLOGY


provide a quickly accessible table of normal reference group of healthy women who were chosen to serve as
ranges for the most common, and some not so controls to compare laboratory determinations in a
common, laboratory values across pregnancy. cohort with a pregnancy complication. By way of
example, many studies were in women whose preg-
SOURCES nancies were complicated by either preeclampsia or
We conducted a comprehensive electronic database diabetes. In these cases, the only data reported in the
review, using PUBMED and MEDLINE to search for table are from the control group. All of the reference
studies published from 1975 to 2008 in English, ranges for laboratory analytes in normal pregnancy
investigating various laboratory analytes at some time are shown in Table 1. Normal reference ranges for
during pregnancy. Some examples of MeSH terms nonpregnant adults listed in the first column are from
used for this literature search include pregnancy, the 17th edition of Harrison’s Principles of Internal
hematological indices, coagulation factors, electro- Medicine,4 unless otherwise specified in Table 1.
lytes, thyroid function tests, endocrine hormones, The table contains the majority of normal labo-
hepatic and renal function tests, metabolic markers, ratory values by trimester that are needed by most
blood gas values, and a host of urinary analytes. clinicians and clinical investigators caring for preg-
Articles were included if the analyte studied was nant women. For comparison, values are also given
measured in pregnant women without major medical for healthy, nonpregnant adults. As anticipated, there
problems or confounding conditions and if the labo- is considerable variation in some reference ranges
ratory marker was measured and reported for a when these are compared with values in healthy, preg-
specified gestational age. nant women. Some values, but certainly not the major-
All the available abstracts were reviewed by at ity, remain stable across pregnancy, whereas others vary
least two investigators, and, if they were found to be by trimester. This fact must be taken into consideration
relevant, the full text of the article was reviewed. when applicable. For example, both the upper limit of
normal for white blood cell count and alkaline phospha-
STUDY SELECTION tase levels rise throughout pregnancy. Similarly, the
Laboratory values were included if the studied ana- upper limit of normal for D-dimer nearly doubles from
lyte was measured in pregnant women who had no the first to the third trimester. Increases also are seen in
major medical problems or any confounding condi- numerous coagulation factors, including fibrinogen and
tions that would have interfered with a normal distri- factors VIII, IX, and XI. Similarly, there are substantial
bution. In addition, the gestational age, at least by serum elevations in total cholesterol, low-density li-
trimester, had to be stated in the study methods. Values poprotein, high-density lipoprotein, and triglycerides.
that were collected in laboring or postpartum women
were not used. The reference books by Hytten1 and CONCLUSION
Lockitch3 also were accessed when appropriate. Where It is important to consider normal reference ranges
necessary, reported values were converted to conven- specific to pregnancy when interpreting some labora-
tional units. Reference ranges for healthy, nonpregnant tory results that may be altered by the normal changes
adults generally were obtained from Harrison’s Principles of pregnancy. As expected, many common hormones
of Internal Medicine, 17th edition.4 Other sources for have dramatic shifts in normal values during preg-
normal values are specified in the table. nancy. Estradiol, progesterone, testosterone, and pro-
For each laboratory analyte reported, data were lactin all rise markedly, as does sex-hormone-binding
extracted from as many studies as possible. These globulin. Unless these normal, gestation-related alter-
ranges then were combined to establish a normal ations are taken into account when evaluating labo-
reference range for each trimester. In some studies, ratory values in a pregnant woman, physiologic ad-
ranges were reported based on minimal and maximal aptations of pregnancy can be misinterpreted as
values, but, when possible, the 2.5 and 97.5 percen- pathologic or, alternatively, pathologic findings may
tiles were used to describe the normal range. In those not be recognized.
cases, the minimum-to-maximum range was com- One limitation of this table is that the published
bined with the 2.5 and 97.5 percentile range. values frequently were taken from more than one
study and therefore were analyzed in different labo-
RESULTS ratories. Additionally, the analytes may have been
Approximately 70 references met the criteria for analyzed using different assays. For this reason, the
inclusion. In most of these studies, normal values data presented in the table are subject to the inherent
reported during pregnancy were derived from a limitations of abridged data. In addition, there exists

VOL. 114, NO. 6, DECEMBER 2009 Abbassi-Ghanavati et al Laboratory Values in Pregnancy 1327
Table 1. Normal Reference Ranges in Pregnant Women
Nonpregnant First Second Third
AdultA Trimester Trimester Trimester ReferencesB

HEMATOLOGY
ErythropoietinC (U/L) 4–27 12–25 8–67 14–222 7, 10, 47
FerritinC (ng/mL) 10–150D 6–130 2–230 0–116 7, 10, 39, 42, 45, 47, 62, 70
Folate, red blood cell (ng/mL) 150–450 137–589 94–828 109–663 45, 46, 72
Folate, serum (ng/mL) 5.4–18.0 2.6–15.0 0.8–24.0 1.4–20.7 7, 43, 45, 46, 53, 58, 72
HemoglobinC (g/dL) 12–15.8D 11.6–13.9 9.7–14.8 9.5–15.0 10, 45, 47, 58, 62
HematocritC (%) 35.4–44.4 31.0–41.0 30.0–39.0 28.0–40.0 6, 7, 10, 42, 45, 58, 66
Iron, total binding capacityC (␮g/dL) 251–406 278–403 Not reported 359–609 62
Iron, serumC (␮g/dL) 41–141 72–143 44–178 30–193 10, 62
Mean corpuscular hemoglobin (pg/cell) 27–32 30–32 30–33 29–32 42
Mean corpuscular volume (␮m3) 79–93 81–96 82–97 81–99 6, 42, 45, 58
Platelet (⫻109/L) 165–415 174–391 155–409 146–429 4, 6, 16, 42, 45
Mean platelet volume (␮m3) 6.4–11.0 7.7–10.3 7.8–10.2 8.2–10.4 42
Red blood cell count (⫻106/mm3) 4.00–5.20D 3.42–4.55 2.81–4.49 2.71–4.43 6, 42, 45, 58
Red cell distribution width (%) ⬍14.5 12.5–14.1 13.4–13.6 12.7–15.3 42
White blood cell count (⫻103/mm3) 3.5–9.1 5.7–13.6 5.6–14.8 5.9–16.9 6, 9, 42, 45, 58
Neutrophils (⫻103/mm3) 1.4–4.6 3.6–10.1 3.8–12.3 3.9–13.1 4, 6, 9, 42
Lymphocytes (⫻103/mm3) 0.7–4.6 1.1–3.6 0.9–3.9 1.0–3.6 4, 6, 9, 42
Monocytes (⫻103/mm3) 0.1–0.7 0.1–1.1 0.1–1.1 0.1–1.4 6, 9, 42
Eosinophils (⫻103/mm3) 0–0.6 0–0.6 0–0.6 0–0.6 6, 9
Basophils (⫻103/mm3) 0–0.2 0–0.1 0–0.1 0–0.1 6, 9
Transferrin (mg/dL) 200–400 254–344 220–441 288–530 39, 42
Transferrin, saturation without iron (%) 22–46C Not reported 10–44 5–37 47
Transferrin, saturation with iron (%) 22–46C Not reported 18–92 9–98 47
COAGULATION
Antithrombin III, functional (%) 70–130 89–114 88–112 82–116 15, 16
D–dimer (␮g/mL) 0.22–0.74 0.05–0.95 0.32–1.29 0.13–1.7 16, 25, 35, 51
Factor V (%) 50–150 75–95 72–96 60–88 40
Factor VII (%) 50–150 100–146 95–153 149–211 16
Factor VIII (%) 50–150 90–210 97–312 143–353 16, 40
Factor IX (%) 50–150 103–172 154–217 164–235 16
Factor XI (%) 50–150 80–127 82–144 65–123 16
Factor XII (%) 50–150 78–124 90–151 129–194 16
Fibrinogen (mg/dL) 233–496 244–510 291–538 373–619 16, 25, 42, 51
Homocysteine (␮mol/L) 4.4–10.8 3.34–11 2.0–26.9 3.2–21.4 43, 45, 46, 53, 72
International Normalized Ratio 0.9–1.04G 0.89–1.05 0.85–0.97 0.80–0.94 15
Partial thromboplastin time, activated 26.3–39.4 24.3–38.9 24.2–38.1 24.7–35.0 15, 16, 42
(sec)
Prothrombin time (sec) 12.7–15.4 9.7–13.5 9.5–13.4 9.6–12.9 16, 42
Protein C, functional (%) 70–130 78–121 83–133 67–135 15, 24, 40
Protein S, total (%) 70–140 39–105 27–101 33–101 16, 24, 40
Protein S, free (%) 70–140 34–133 19–113 20–65 24, 40
Protein S, functional activity (%) 65–140 57–95 42–68 16–42 40
Tissue plasminogen activator (ng/mL) 1.6–13I 1.8–6.0 2.4–6.6 3.3–9.2 15, 16
Tissue plasminogen activator 4–43 16–33 36–55 67–92 16
inhibitor-1 (ng/mL)
von Willebrand factor (%) 75–125 Not reported Not reported 121–260 73
BLOOD CHEMICAL
CONSTITUENTS
Alanine transaminase (U/L) 7–41 3–30 2–33 2–25 5, 39, 42, 70
Albumin (g/dL) 4.1–5.3D 3.1–5.1 2.6–4.5 2.3–4.2 3, 5, 26, 29, 39, 42, 72
Alkaline phosphatase (U/L) 33–96 17–88 25–126 38–229 3, 5, 39, 42, 70
Alpha-1 antitrypsin (mg/dL) 100–200 225–323 273–391 327–487 42
Amylase (U/L) 20–96 24–83 16–73 15–81 32, 39, 42, 68
Anion gap (mmol/L) 7–16 13–17 12–16 12–16 42
Aspartate transaminase (U/L) 12–38 3–23 3–33 4–32 5, 39, 42, 70
(continued)

1328 Abbassi-Ghanavati et al Laboratory Values in Pregnancy OBSTETRICS & GYNECOLOGY


Table 1. Normal Reference Ranges in Pregnant Women (continued)
Nonpregnant First Second Third
AdultA Trimester Trimester Trimester ReferencesB

Bicarbonate (mmol/L) 22–30 20–24 20–24 20–24 42


Bilirubin, total (mg/dL) 0.3–1.3 0.1–0.4 0.1–0.8 0.1–1.1 5, 39
Bilirubin, unconjugated (mg/dL) 0.2–0.9 0.1–0.5 0.1–0.4 0.1–0.5 5, 42
Bilirubin, conjugated (mg/dL) 0.1–0.4 0–0.1 0–0.1 0–0.1 5
Bile acids (␮mol/L) 0.3–4.8J 0–4.9 0–9.1 0–11.3 5, 14
Calcium, ionized (mg/dL) 4.5–5.3 4.5–5.1 4.4–5.0 4.4–5.3 26, 42, 48, 56
Calcium, total (mg/dL) 8.7–10.2 8.8–10.6 8.2–9.0 8.2–9.7 3, 29, 39, 42, 48, 56, 63
Ceruloplasmin (mg/dL) 25–63 30–49 40–53 43–78 42, 44
Chloride (mEq/L) 102–109 101–105 97–109 97–109 20, 39, 42
Creatinine (mg/dL) 0.5–0.9D 0.4–0.7 0.4–0.8 0.4–0.9 39, 42, 45
Gamma-glutamyl transpeptidase (U/L) 9–58 2–23 4–22 3–26 5, 42, 39, 70
Lactate dehydrogenase (U/L) 115–221 78–433 80–447 82–524 42, 29, 39, 70
Lipase (U/L) 3–43 21–76 26–100 41–112 32
Magnesium (mg/dL) 1.5–2.3 1.6–2.2 1.5–2.2 1.1–2.2 3, 26, 29, 39, 42, 48, 63
Osmolality (mOsm/kg H20) 275–295 275–280 276–289 278–280 17, 63
Phosphate (mg/dL) 2.5–4.3 3.1–4.6 2.5–4.6 2.8–4.6 3, 26, 33, 39, 42
Potassium (mEq/L) 3.5–5.0 3.6–5.0 3.3–5.0 3.3–5.1 20, 26, 29, 39, 42, 63, 66
Prealbumin (mg/dL) 17–34 15–27 20–27 14–23 42
Protein, total (g/dL) 6.7–8.6 6.2–7.6 5.7–6.9 5.6–6.7 26, 29, 42
Sodium (mEq/L) 136–146 133–148 129–148 130–148 17, 26, 29, 39, 42, 63, 66
Urea nitrogen (mg/dL) 7–20 7–12 3–13 3–11 20, 39, 42
Uric acid (mg/dL) 2.5–5.6D 2.0–4.2 2.4–4.9 3.1–6.3 17, 39, 42
METABOLIC AND ENDOCRINE
TESTS
Aldosterone (ng/dL) 2–9 6–104 9–104 15–101 21, 34, 69
Angiotensin converting enzyme (U/L) 9–67 1–38 1–36 1–39 20, 54
Cortisol (␮g/dL) 0–25 7–19 10–42 12–50 42, 69
Hemoglobin A1C (%) 4–6 4–6 4–6 4–7 48, 49, 59
Parathyroid hormone (pg/mL) 8–51 10–15 18–25 9–26 3
Parathyroid hormone-related protein ⬍1.3E 0.7–0.9 1.8–2.2 2.5–2.8 3
(pmol/L)
Renin, plasma activity 0.3–9.0E Not reported 7.5–54.0 5.9–58.8 20, 34
(ng/mL/h)
Thyroid-stimulating hormone 0.34–4.25 0.60–3.40 0.37–3.60 0.38–4.04 39, 42, 57
(␮IU/mL)
Thyroxine-binding globulin (mg/dL) 1.3–3.0 1.8–3.2 2.8–4.0 2.6–4.2 42
Thyroxine, free (ng/dL) 0.8–1.7 0.8–1.2 0.6–1.0 0.5–0.8 42, 57
Thyroxine, total (␮g/dL) 5.4–11.7 6.5–10.1 7.5–10.3 6.3–9.7 29, 42
Triiodothyronine, free (pg/mL) 2.4–4.2 4.1–4.4 4.0–4.2 Not reported 57
Triiodothyronine, total (ng/dL) 77–135 97–149 117–169 123–162 42
VITAMINS AND MINERALS
Copper (␮g/dL) 70–140 112–199 165–221 130–240 2, 30, 42
Selenium (␮g/L) 63–160 116–146 75–145 71–133 2, 42
Vitamin A (retinol) (␮g/dL) 20–100 32–47 35–44 29–42 42
Vitamin B12 (pg/mL) 279–966 118–438 130–656 99–526 45, 72
Vitamin C (ascorbic acid) (mg/dL) 0.4–1.0 Not reported Not reported 0.9–1.3 64
Vitamin D, 1,25-dihydroxy (pg/mL) 25–45 20–65 72–160 60–119 3, 48
Vitamin D, 24,25-dihydroxy (ng/mL) 0.5–5.0E 1.2–1.8 1.1–1.5 0.7–0.9 60
Vitamin D, 25-hydroxy (ng/mL) 14–80 18–27 10–22 10–18 3, 60
Vitamin E (␣-tocopherol) (␮g/mL) 5–18 7–13 10–16 13–23 42
Zinc (␮g/dL) 75–120 57–88 51–80 50–77 2, 42, 58
AUTOIMMUNE AND
INFLAMMATORY
MEDIATORS
C3 complement (mg/dL) 83–177 62–98 73–103 77–111 42
C4 complement (mg/dL) 16–47 18–36 18–34 22–32 42
(continued)

VOL. 114, NO. 6, DECEMBER 2009 Abbassi-Ghanavati et al Laboratory Values in Pregnancy 1329
Table 1. Normal Reference Ranges in Pregnant Women (continued)
Nonpregnant First Second Third
AdultA Trimester Trimester Trimester ReferencesB

C-reactive protein (mg/L) 0.2–3.0 Not reported 0.4–20.3 0.4–8.1 28


Erythrocyte sedimentation rate (mm/h) 0–20D 4–57 7–47 13–70 71
Immunoglobulin A (mg/dL) 70–350 95–243 99–237 112–250 42
Immunoglobulin G (mg/dL) 700–1700 981–1267 813–1131 678–990 42
Immunoglobulin M (mg/dL) 50–300 78–232 74–218 85–269 42
SEX HORMONES
Dehydroepiandrosterone sulfate 1.3–6.8F 2.0–16.5 0.9–7.8 0.8–6.5 52
(␮mol/L)
Estradiol (pg/mL) ⬍20–443D,F 188–2497 1278–7192 6137–3460 13, 52
Progesterone (ng/mL) ⬍1–20D 8–48 99–342 13, 52
Prolactin (ng/mL) 0–20 36–213 110–330 137–372 3, 13, 38, 49
Sex hormone binding globulin (nmol/L) 18–114D 39–131 214–717 216–724 1, 52
Testosterone (ng/dL) 6–86D 26–211 34–243 63–309 52
17-hydroxyprogesterone (nmol/L) 0.6–10.6D,E 5.2–28.5 5.2–28.5 15.5–84 52
LIPIDS
Cholesterol, total (mg/dL) ⬍200 141–210 176–299 219–349 8, 18, 31, 42
High-density lipoprotein cholesterol 40–60 40–78 52–87 48–87 8, 18, 31, 42, 55
(mg/dL)
Low-density lipoprotein cholesterol ⬍100 60–153 77–184 101–224 8, 18, 31, 42, 55
(mg/dL)
Very-low-density lipoprotein cholesterol 6–40E 10–18 13–23 21–36 31
(mg/dL)
Triglycerides (mg/dL) ⬍150 40–159 75–382 131–453 8, 18, 31, 39, 42, 55
Apolipoprotein A-I (mg/dL) 119–240 111–150 142–253 145–262 18, 39, 49
Apolipoprotein B (mg/dL) 52–163 58–81 66–188 85–238 18, 39, 49
CARDIAC
Atrial natriuretic peptide (pg/mL) Not reported Not reported 28.1–70.1 Not reported 11
B-type natriuretic peptide (pg/mL) ⬍167 (age- Not reported 13.5–29.5 Not reported 11
and gender-
specific)
Creatine kinase (U/L) 39–238D 27–83 25–75 13–101 41, 42
Creatine kinase-MB (U/L) ⬍6J Not reported Not reported 1.8–2.4 41
Troponin I (ng/mL) 0–0.08 Not reported Not reported 0–0.064 36, 65
(intrapartum)
BLOOD GAS
pH 7.38–7.42 7.36–7.52 7.40–7.52 7.41–7.53 23, 26
(arterial) (venous) (venous) (venous)
7.39–7.45
(arterial)
PO2 (mmHg) 90–100 93–100 90–98 92–107 23, 67
PCO2 (mmHg) 38–42 Not reported Not reported 25–33 23
Bicarbonate (HCO3⫺) (mEq/L) 22–26 Not reported Not reported 16–22 23
RENAL FUNCTION TESTS
Effective renal plasma flow (mL/min) 492–696D,E 696–985 612–1170 595–945 19, 22
Glomerular filtration rate (GFR) 106–132D 131–166 135–170 117–182 19, 22, 50
(mL/min)
Filtration fraction (%) 16.9–24.7K 14.7–21.6 14.3–21.9 17.1–25.1 19, 22, 50
Osmolarity, urine (mOsm/kg) 500–800 326–975 278–1066 238–1034 61
24-h albumin excretion (mg/24 h) ⬍30 5–15 4–18 3–22 27, 61
24-h calcium excretion (mmol/24 h) ⬍7.5E 1.6–5.2 0.3–6.9 0.8–4.2 66
24-h creatinine clearance 91–130 69–140 55–136 50–166 22, 66
(mL/min)
24-h creatinine excretion 8.8–14E 10.6–11.6 10.3–11.5 10.2–11.4 61
(mmol/24 h)
(continued)

1330 Abbassi-Ghanavati et al Laboratory Values in Pregnancy OBSTETRICS & GYNECOLOGY


Table 1. Normal Reference Ranges in Pregnant Women (continued)
Nonpregnant First Second Third
AdultA Trimester Trimester Trimester ReferencesB

24-h potassium excretion (mmol/24 h) 25–100E 17–33 10–38 11–35 66


24-h protein excretion (mg/24 h) ⬍150 19–141 47–186 46–185 27
24-h sodium excretion (mmol/24 h) 100–260E 53–215 34–213 37–149 17, 66
Cunningham FG, Leveno KJ, Bloom S, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. 23rd ed. New York (NY): McGraw–Hill;
2010.
A
Unless otherwise specified, all normal reference values are from reference 37.
B
The reference list for all references referred to in this table is available in the Appendix online at http://links.lww.com/AOG/A153.
C
Range includes references with and without iron supplementation.
D
Normal reference range is specific range for females.
E
Reference values are from Reference 12.
F
Range is for premenopausal females and varies by menstrual cycle phase.
G
Reference value from Reference 15.
H
Reference values from References 15 and 16.
I
Reference values from Reference 5.
J
Reference values from Reference 41.
K
Reference values from Reference 19.

the possibility that there may be variations between sequelae of hypertension, diabetes, and lipid derange-
racial groups, regions of the world, and timing of ment, pregnant women with significant cardiac dis-
sample collection that cannot be fully examined. ease are becoming more common. Accordingly, ad-
Practitioners using this table should be cognizant of ditional research of normal values of these increasingly
any underlying medical conditions or racial predispo- used laboratory studies is needed. Despite these lim-
sitions that would modify laboratory results in the itations, the table as published should provide a quick
nonpregnant woman because the values generally reference for most values needed to provide care for
found during pregnancy may not be representative of the pregnant woman.
an individual patient’s values.
Finally, there remains a list of laboratory analytes REFERENCES
1. Hytten FE, Lind T. Diagnostic indices in pregnancy. Summit
that have not been evaluated for pregnancy-induced (NJ): CIBA-GEIGY Corporation; 1975.
deviations from normal values. Most notable are the 2. Larsson A, Palm M, Hansson LO, Axelsson O. Reference
values for tests used in cardiac evaluation such as values for clinical chemistry tests during normal pregnancy.
atrial natriuretic peptide, B-type natriuretic peptide, BJOG 2008;115:874 – 81.
troponin, creatine kinase, and creatine kinase-MB. At 3. Lockitch G. Handbook of diagnostic biochemistry and hematol-
ogy in normal pregnancy. Boca Raton (FL): CRC Press; 1993.
a time where increasing numbers of women are
4. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL,
delaying pregnancy until middle-age in a population Jameson JL, et al, editors. Harrison’s principles of internal
with epidemic rates of obesity and its metabolic medicine. 17th ed. New York (NY): McGraw-Hill; 2008.

VOL. 114, NO. 6, DECEMBER 2009 Abbassi-Ghanavati et al Laboratory Values in Pregnancy 1331

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