Physiological and metabolic adaptations in pregnancy: importance of trimester-specific reference intervals to investigate maternal health and complications

Abstract

Diagnosis, prognostication, and monitoring of maternal health throughout pregnancy relies on laboratory testing, including but not limited to key markers of thyroid, hepatic, cardiac, hematology, and renal function. Dynamic physiological processes during gestation significantly influence the maternal biochemistry that supports both the mother and fetus. Resultant changes in blood biochemistry alter the expected values of common laboratory tests. However, the importance of pregnancy-specific reference intervals for laboratory test result interpretation and appropriate monitoring of maternal health and complications is underappreciated. Most clinical laboratories continue to use non-pregnant adult reference intervals for laboratory test interpretation in pregnancy. The current review summarizes and critically evaluates the available literature regarding physiological and metabolic adaptations in pregnancy and their influence on common biomarkers of health and disease. The main laboratory parameters discussed include thyroid, hepatic, metabolic, renal, hematology, inflammatory, and cardiac markers. Considering the available data, further studies are urgently needed to establish trimester-specific reference intervals in healthy pregnant women on updated analytical platforms. Without such data, the standard of clinical laboratory service in pregnancy remains compromised and affects the quality of maternal-fetal healthcare.

Keywords:

• Pregnancy
• physiology
• laboratory testing
• reference intervals
• maternal complications

Acknowledgements

We would like to thank Dr. Lei Fu (Sunnybrook Health Sciences Centre, Toronto, CA) and Dr. Vilte Barakauskas (BC Women’s and Children’s Hospital, Vancouver, CA) for their critical review of the manuscript. All figures were made using Biorender Software.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

MKB was supported by a Canadian Institutes for Health Research (CIHR) Doctoral Award).