lab values preg women

587

APPENDIX B

Laboratory Values in Normal PregnancyF. Gary CunninghamUniversity of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, USA

There are a number of profound physiological changes that result during

normal pregnancy. Some of these can induce significant alterations in

laboratory values that in a non-pregnant woman would be considered

distinctly abnormal. Common examples are the lower hematocrit and

hemoglobin concentrations that reach a nadir at the end of the second

trimester. Another is that a seemingly normal serum creatinine value of

1.1 mg/dL signifies that almost half of the nephron mass is dysfunctional.

And there are myriad other examples.

Even though these common pregnancy-induced laboratory aberrations

are well recognized, very few laboratories routinely provide normal values

for pregnant women. Indeed, many laboratories do not even report normal

values for ‘females’, much less for pregnant women. Most reports of

pregnancy-induced variations in laboratory values are studies of a limited

number of analytes, while others are found within reference books that are

not easily accessible. Presented in the following tables are normal reference

ranges for some common laboratory test values that were determined

across pregnancy. For comparison, normal values for non-regnant women

are listed when available. These values have been summarized from the

Appendix of normal laboratory values in the 23rd edition of Williams

Obstetrics which was published in Obstetrics & Gynecology.

Table B-1 Hematology, 594

Table B-2 Coagulation studies, 595

Table B-3 Blood chemistry, 596

Table B-4 Endocrine and metabolic values, 597

Table B-5 Vitamins and minerals, 598

Table B-6 Autoimmune and inflammatory mediators, 598

Table B-7 Sex hormones, 599

Table B-8 Lipids, 599

Table B-9 Cardiac peptides and enzymes, 600

Table B-10 Acid–base and blood gases, 600

Table B-11 Renal function, 601

Protocols for High-Risk Pregnancies: An Evidence-Based Approach, Fifth EditionEdited by John T. Queenan, John C. Hobbins and Catherine Y. Spong© 2010 Blackwell Science Ltd. ISBN: 978-1-405-19650-5

588 Appendix B

Table B-1 Hematology

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Erythropoietinb (U/L) 4–27 12–25 8–67 14–222

Ferritinb (ng/mL) 10–150d 6–130 2–230 0–116

Folate, red blood cell (ng/mL)

150–450 137–589 94–828 109–663

Folate, serum (ng/mL) 5.4–18.0 2.6–15.0 0.8–24.0 1.4–20.7

Hemoglobinb (g/dL) 12–15.8d 11.6–13.9 9.7–14.8 9.5–15.0

Hematocritb (%) 35.4–44.4 31.0–41.0 30.0–39.0 28.0–40.0

Iron, total binding capacity (TIBC)b (�g/dL)

251–406 278–403 Not reported 359–609

Iron, serumb (�g/dL) 41–141 72–143 44–178 30–193

Mean corpuscular

hemoglobin (MCH) (pg/cell)

27–32 30–32 30–33 29–32

Mean corpuscular

volume (MCV) (�m3) 79–93 81–96 82–97 81–99

Platelet (� 109/L) 165–415 174–391 155–409 146–429

Mean platelet

volume (MPV) (�m3)

6.4–11.0 7.7–10.3 7.8–10.2 8.2–10.4

Red blood cell count

(RBC) (� 106/mm3)

4.00–5.20d 3.42–4.55 2.81–4.49 2.71–4.43

Red cell distribution

width (RDW) (%)�14.5 12.5–14.1 13.4–13.6 12.7–15.3

White blood cell count

(WBC) (� 103/mm3)

3.5–9.1 5.7–13.6 5.6–14.8 5.9–16.9

Neutrophils (� 103/mm3) 1.4–4.6 3.6–10.1 3.8–12.3 3.9–13.1

Lymphocytes (� 103/mm3) 0.7–4.6 1.1–3.6 0.9–3.9 1.0–3.6

Monocytes (� 103/mm3) 0.1–0.7 0.1–1.1 0.1–1.1 0.1–1.4

Eosinophils (� 103/mm3) 0–0.6 0–0.6 0–0.6 0–0.6

Basophils (� 103/mm3) 0–0.2 0–0.1 0–0.1 0–0.1

Transferrin (mg/dL) 200–400 254–344 220–441 288–530

Transferrin, saturation

without iron (%)

22–46b Not reported 10–44 5–37

Transferrin, saturation with iron (%)

22–46b Not reported 18–92 9–98

aUnless specified, normal reference values are from the 17th edition of Harrison’s Principles of

Internal Medicine (2008). bRange includes references with and without iron supplementation. c Reference value from Laboratory Reference Handbook, Pathology Department, Parkland

Hospital, 2005.d Normal reference range is specific range for females.e Reference values are from the 15th edition of Harrison’s Principles of Internal Medicine (2001).

Laboratory Values in Normal Pregnancy 589

Table B-2 Coagulation studies

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Antithrombin III,

functional (%)

70–130 89–114 88–112 82–116

D-Dimer (�g/mL) 0.22–0.74 0.05–0.95 0.32–1.29 0.13–1.7

Factor V (%) 50–150 75–95 72–96 60–88

Factor VII (%) 50–150 100–146 95–153 149–2110

Factor VIII (%) 50–150 90–210 97–312 143–353

Factor IX (%) 50–150 103–172 154–217 164–235

Factor XI (%) 50–150 80–127 82–144 65–123

Factor XII (%) 50–150 78–124 90–151 129–194

Fibrinogen (mg/dL) 233–496 244–510 291–538 373–619

Homocysteine (�mol/L) 4.4–10.8 3.34–11 2.0–26.9 3.2–21.4

INR 0.9–1.04 0.89–1.05 0.85–0.97 0.80–0.94

Partial thromboplastin

time, activated (aPTT) (sec)

26.3–39.4 24.3–38.9 24.2–38.1 24.7–35.0

Prothrombin time (PT) (sec) 12.7–15.4 9.7–13.5 9.5–13.4 9.6–12.9

Protein C, functional (%) 70–130 78–121 83–133 67–135

Protein S, total (%) 70–140 39–105 27–101 33–101

Protein S, free (%) 70–140 34–133 19–113 20–65

Protein S, functional

activity (%)

65–140 57–95 42–68 16–42

von Willebrand factor (%) 75–125 Not reported Not reported 121–260

a Unless specified, normal reference values are from the 17th edition of Harrison’s Principles of

Internal Medicine (2008).

b Range includes references with and without iron supplementation. c Reference value from Laboratory Reference Handbook, Pathology Department, Parkland


590 Appendix B

Table B-3 Blood chemistry

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Alanine transaminase (ALT) (U/L) 7–41 3–30 2–33 2–25

Albumin (g/dL) 4.1–5.3d 3.1–5.1 2.6–4.5 2.3–4.2

Alkaline phosphatase (U/L) 33–96 17–88 25–126 38–229

Alpha-1 antitrypsin (mg/dL) 100–200 225–323 273–391 327–487

Amylase (U/L) 20–96 24–83 16–73 15–81

Anion gap (mmol/L) 7–16 13–17 12–16 12–16

Aspartate transaminase

(AST) (U/L)

12–38 3–23 3–33 4–32

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

Bilirubin, total (mg/dL) 0.3–1.3 0.1–0.4 0.1–0.8 0.1–1.1

Bilirubin, unconjugated (mg/dL) 0.2–0.9 0.1–0.5 0.1–0.4 0.1–0.5

Bilirubin, conjugated (mg/dL) 0.1–0.4 0–0.1 0–0.1 0–0.1

Bile acids (�mol/L) 0.3–4.8 0–4.9 0–9.1 0–11.3

Calcium, ionized (mg/dL) 4.5–5.3 4.5–5.1 4.4–5.0 4.4–5.3

Calcium, total (mg/dL) 8.7–10.2 8.8–10.6 8.2–9.0 8.2–9.7

Ceruloplasmin (mg/dL) 25–63 30–49 40–53 43–78

Chloride (mEq/L) 102–109 101–105 97–109 97–109

Creatinine (mg/dL) 0.5–0.9d 0.4–0.7 0.4–0.8 0.4–0.9

Gamma-glutamyl

transpeptidase (GGT) (U/L)

9–58 2–23 4–22 3–26

Lactate dehydrogenase (U/L) 115–221 78–433 80–447 82–524

Lipase (U/L) 3–43 21–76 26–100 41–112

Magnesium (mg/dL) 1.5–2.3 1.6–2.2 1.5–2.2 1.1–2.2

Osmolality (mOsm/kg H2O) 275–295 275–280 276–289 278–280

Phosphate (mg/dL) 2.5–4.3 3.1–4.6 2.5–4.6 2.8–4.6

Potassium (mEq/L) 3.5–5.0 3.6–5.0 3.3–5.0 3.3–5.1

Prealbumin (mg/dL) 17–34 15–27 20–27 14–23

Protein, total (g/dL) 6.7–8.6 6.2–7.6 5.7–6.9 5.6–6.7

Sodium (mEq/L) 136–146 133–148 129–148 130–148

Urea nitrogen (mg/dL) 7–20 7–12 3–13 3–11

Uric acid (mg/dL) 2.5–5.6d 2.0–4.2 2.4–4.9 3.1–6.3






Table B-4 Endocrine and metabolic values

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Aldosterone (ng/dL) 2–9 6–104 9–104 15–101

Angiotensin converting

enzyme (ACE) (U/L)

9–67 1–38 1–36 1–39

Cortisol (�g/dL) 0–25 7–19 10–42 12–50

Hemoglobin A1C (%) 4–6 4–6 4–6 4–7

Parathyroid hormone (pg/mL) 8–51 10–15 18–25 9–26

Parathyroid hormone-related

protein (pmol/L)

�1.3e 0.7–0.9 1.8–2.2 2.5–2.8

Renin, plasma

activity (ng/mL/h)

0.3–9.0e Not reported 7.5–54.0 5.9–58.8

Thyroid stimulating

hormone (TSH) (�IU/mL)

0.34–4.25 0.60–3.40 0.37–3.60 0.38–4.04

Thyroxine-binding

globulin (mg/dL)

1.3–3.0 1.8–3.2 2.8–4.0 2.6–4.2

Thyroxine, free (fT4) (ng/dL) 0.8–1.7 0.8–1.2 0.6–1.0 0.5–0.8

Thyroxine, total (T4) (�g/dL) 5.4–11.7 6.5–10.1 7.5–10.3 6.3–9.7

Triiodothyronine, free

(fT3) (pg/mL)

2.4–4.2 4.1–4.4 4.0–4.2 Not reported

Triiodothyronine,

total (T3) (ng/dL)

77–135 97–149 117–169 123–162





592 Appendix B

Table B-5 Vitamins and minerals

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Copper (�g/dL) 70–140 112–199 165–221 130–240

Selenium (�g/L) 63–160 116–146 75–145 71–133

Vitamin A (retinol) (�g/dL) 20–100 32–47 35–44 29–42

Vitamin B12 (pg/mL) 279–966 118–438 130–656 99–526

Vitamin C (ascorbic acid)

(mg/dL)

0.4–1.0 Not Reported Not Reported 0.9–1.3

Vitamin D, 1,25-dihydroxy

(pg/mL)

25–45 20–65 72–160 60–119

Vitamin D, 24,25-dihydroxy

(ng/mL)

0.5–5.0 1.2–1.8 1.1–1.5 0.7–0.9

Vitamin D, 25-hydroxy (ng/mL) 14–80 18–27 10–22 10–18

Vitamin E (�-tocopherol)

(�g/mL)

5–18 7–13 10–16 13–23

Zinc (�g/dL) 75–120 57–88 51–80 50–77





Table B-6 Autoimmune and inflammatory mediators

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

C3 complement (mg/dL) 83–177 62–98 73–103 77–111

C4 complement (mg/dL) 16–47 18–36 18–34 22–32

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

Erythrocyte sedimentation

rate (ESR) (mm/h)

0–20d 4–57 7–47 13–70

IgA (mg/dL) 70–350 95–243 99–237 112–250

IgG (mg/dL) 700–1700 981–1267 813–1131 678–990

IgM (mg/dL) 50–300 78–232 74–218 85–269






Table B-7 Sex hormones

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Dehydroepiandrosterone

sulfate (DHEAS) (�mol/L)

1.3–6.8e 2.0–16.5 0.9–7.8 0.8–6.5

Estradiol (pg/mL) �20–443d 188–2497 1278–7192 6137–3460

Progesterone (ng/mL) �1–20d 8–48 99–342

Prolactin (ng/mL) 0–20 36–213 110–330 137–372

Sex hormone binding

globulin (nmol/L)

18–114d 39–131 214–717 216–724

Testosterone (ng/dL) 6–86d 25.7–211.4 34.3–242.9 62.9–308.6

17-Hydroxyprogesterone (nmol/L) 0.6–10.6d,e 5.2–28.5 5.2–28.5 15.5–84





Table B-8 Lipids

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Cholesterol, total (mg/dL) �200 141–210 176–299 219–349

HDL-Cholesterol (mg/dL) 40–60 40–78 52–87 48–87

LDL-Cholesterol (mg/dL) �100 60–153 77–184 101–224

VLDL-Cholesterol (mg/dL) 6–40e 10–18 13–23 21–36

Triglycerides (mg/dL) �150 40–159 75–382 131–453

Apolipoprotein A-I (mg/dL) 119–240 111–150 142–253 145–262

Apolipoprotein B (mg/dL) 52–163 58–81 66–188 85–238





594 Appendix B

Table B-9 Cardiac peptides and enzymes

Non-pregnant

adulta

First trimester Second

trimester

Third

trimester

Atrial natrieuretic

peptide (ANP) (pg/mL)

Not reported Not reported 28.1–70.1 Not reported

B-type natrieuretic

peptide (BNP) (pg/mL)

�167 (age and

gender specific)

Not reported 13.5–29.5 Not reported

Creatine kinase (U/L) 39–238d 27–83 25–75 13–101

Creatine kinase-MB (U/L) �6 Not reported Not reported 1.8–2.4

Troponin I (ng/mL) 0–0.08 Not reported Not reported 0–0.064

(intrapartum)





Table B-10 Acid–base and blood gases

Non-pregnant

adulta

First trimester Second trimester Third trimester

Bicarbonate (HCO3–)

(mEq/L)

22–26 Not reported Not reported 16–22

PCO2 (mmHg) 38–42 Not reported Not reported 25–33

PO2 (mmHg) 90–100 93–100 90–98 92–107

pH 7.38–7.42

(arterial)

7.36–7.52

(venous)

7.40–7.52 (venous) 7.41–7.53 (venous)

7.39–7.45 (arterial)






Table B-11 Renal function

Non-pregnant

adulta

First

trimester

Second

trimester

Third

trimester

Effective renal plasma flow (mL/min) 492–696d, e 696–985 612–1170 595–945

Glomerular filtration

rate (GFR) (mL/min)

106–132d 131–166 135–170 117–182

Filtration fraction (%) 16.9–24.7 14.7–21.6 14.3–21.9 17.1–25.1

Osmolarity, urine (mOsm/kg) 500–800 326–975 278–1066 238–1034

24-h albumin excretion (mg/24 h) �30 5–15 4–18 3–22

24-h calcium excretion (mmol/24 h) �7.5e 1.6–5.2 0.3–6.9 0.8–4.2

24-h creatinine clearance (mL/min) 91–130 69–140 55–136 50–166

24-h creatinine excretion (mmol/24 h) 8.8–14e 10.6–11.6 10.3–11.5 10.2–11.4

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

24-h protein excretion (mg/24 h) �150 19–141 47–186 46–185

24-h sodium excretion (mmol/24 h) 100–260e 53–215 34–213 37–149





Suggested reading

Hytten FE, Lind T. Diagnostic Indices in Pregnancy. Summit, NJ: Ciba-Geigy Corporation,

1975.

Larsson A, Palm M, Hansson L-O, et al. Reference values for clinical chemistry tests

during normal pregnancy. Br J Obstet Gynaecol 2008;115:874.

Lockitch G. Handbook of Diagnostic Biochemistry and Hematology in Normal Pregnancy. Boca

Raton, FL: CRC Press, 1993.

lab values preg women

Education