FASTING BLOOD GLUCOSE AND URINARY KETONE IN THE THREE TRIMESTERS OF NORMAL PREGNANCY
Background: Normal pregnancy is a physiological condition in which there is a balanced feto-maternal homeostasis with overall aim of achieving a successful period of gestation. Increase in blood glucose with increasing trimester of pregnancy and use of fatty acid as an alternative source of energy is well documented. However, the progressive increase in blood glucose as pregnancy advances has not been related to urinary ketone. This study was designed to examine the blood glucose and urine of apparently healthy non-pregnant and pregnant women in the three trimesters of pregnancy. Methods: This cross-sectional study involved 200 volunteers (50 non-pregnant women and 50 pregnant women in each of the three trimesters of pregnancy. Blood samples were collected from the thumb by a lancet prick and examined using a glucometer. Urine samples were collected from each subject into a sterile universal bottle and analysed for Ketone among other parameters such as Blood, Protein, Nitrite, Glucose, Urobilinogen, Ascorbic acid, and pH. Results: Fasting blood glucose increased as pregnancy advanced; 97.27Â±3.06 (third trimester) >92.03Â±3.01 (second trimester) >86.10Â±2.83 (first trimester). The fasting blood sugar for the non-pregnant control subjects (84.07Â±1.36) was significantly lower (p<0.05) than that of the pregnant women. The 24% of the subjects in the third trimester had ketonuria, none of the other group of subjects had ketone in their urine. Conclusion: The increased blood glucose concentration in the third trimester of pregnancy was associated with acompensatory source of energy from fatty acid metabolism as evidenced by ketonuria.
Pak J Physiol 2018;14(1):16â€“8
2. Hadden DR. A historical perspectives on gestational diabetes. Proceeding of Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998;21(Suppl 2):B3â€“4.
3. Guyton AC, Hall JE, (Editors). Textbook of Medical Physiology. 11th Ed. UK: BailliÃ¨re Tindall; 2006. p.741â€“980.
4. Bijlani RL, (Editor). The endocrines: Pancreas. Understanding medical physiology. 3rd Edition. India: Jaypee; 2004.p.552â€“5.
5. Bishop ML, Fody EP, Schoeff L, (Editors). Clinical Chemistry Principle Procedure and Correlation. 5th ed. Philadelphia PA: Lippincott Williams & Wilkins; 2005.
6. Connolly CC, Holste LC, Aglione LN, Neal DW, Lacy DB, Smith MS, et al. Alterations in basal glucose metabolism during late pregnancy in the conscious dog. Am J Physiol Endocrinol Metab 2000;279:E1166â€“77.
7. Carr DB, Gabbe S. Gestational Diabetes: Detection, Management, and Implications. Clin Diabetes 1998;16(1):4â€“11.
8. Gillmer MD, Beard RW, Brooke FM, Oakley NW. Carbohydrate metabolism in pregnancy: Part I â€“ diurnal plasma glucose profile in normal and diabetic women. Br Med J 1975;3(5980):399â€“402.
9. Barbour LA, Shao J., Qiao L, Pulawa LK, Jensen DR, Bartke A, et al. Human placental growth hormone causes severe insulin resistance in transgenic mice. Am J Obstet Gynecol 2002;186:512â€“7.
10. Perkins JM, Dunn JP, Jagasia SM. Perspective in gestational diabetes mellitus: A review of screening, diagnosis and treatment. Clin Diabetes 2007;25(2):57â€“62
11. Catalano PM, Huston, L, Amini, SB, Kalhan, SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol 1999;180:903â€“916.
12. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998;21(suppl 2):B19â€“26.
13. Kirwan JP, Hauguel-De Mouzon S, Lepercq J, Challier JC, Huston-Presley L, Friedman JE, et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes 2002;51:2207â€“13.
14. Couzen A, Ward H, (Editors). Diabetes in pregnancy; womenâ€™s health. UK: NHS Foundation Trust; 2012. p. 2.
15. Handwerger S and Freemark M. The roles of placental growth hormone and placental lactogen in the regulation of human fetal growth and development. J Pediatr Endocrinol Metab 2000;13:343â€“56.
16. Sarah B and Roxana G. Understanding Urinalysis. Clues for the Obstetrician-Gynecologist. Expert Rev Obstet Gynecol 2012;7(3): 269â€“79.
17. Butte NF, Hopkinson JM, Mehta N, Moon JK, Smith EO. Adjustment in energy expenditure and substrate utilization during late pregnancy and lactation. Am J Clin Nutr 1999;69:299â€“307.
Pakistan Journal of Physiology, Pak J Physiol, PJP is free for research and academic purposes. It can be downloaded and stored, printed, cited and quoted with full reference of, and acknowledgement to the PJP.