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Elevated glucose levels in early puerperium, and association with high cortisol levels during parturition

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Risberg A

1

, Sjöquist M

2

, Wedenberg K

3

, Larsson A

4

1 Institution of Health Sciences ,Section of Health and Rehab, Luleå University of Technology, Luleå, Sweden. 2 Swedish Centre for Animal Welfare, Swedish University of Agricultural Sciences, Uppsala, Sweden. 3 The section of womens health, Vasteras Hospital, Sweden. 4 Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Elevated glucose levels in early puerperium, and

association with high cortisol levels during parturition

Introduction

Pregnancy and parturition is a part of life when several changes in physiology appears all to support the women and the foetus and is an example of the rhythm of life.

Most of the time everything goes well during pregnancy and parturition but

some-times the demands of the womens body lead to development of disorders, for example metabolic disturbances like diabetes. Gestational diabetes is one of the most common metabolic problems associated with pregnancy and an accurate diagnosis is critical in order to give adequate care. Research has shown that pregnant women have high

levels of cortisol during the last stage of parturition. As cortisol is a diabetogenic hormone causing increased glucose levels, we wanted to study the association

between cortisol and glucose levels during parturition.

Event Normal Slow

Arrival 975 (814-1148) 733 (685-914) Stage 2 1447 (1269-1703) 1610 (1446-1693) Parturition Aftercare 1204 (1085-1384) 1286 (1092-1431) P+9 h 696 (547-822) 523 (415-750)) P+27 h 539 (377-651) 381 (257-756) R p-value

Cortisolstage1 & glucosestage2 0.69 0.00018

Cortisolaftercare & glucoseP+9h 0.46 0.00152

CortisolP+9h & glucoseP+9h 0.42 0.00482

cortisolP+15h & glucoseP+15h 0.59 0.00007

Materials and Methods

Glucose and cortisol were analyzed during parturition in 51 females divided

according to slow (n = 11) and normal labors (n = 40). Blood samples were analyzed three times during the parturition and four times in the first day after delivery.

Glucose levels were also measured once in each trimester.

Results

In the normal group, the glucose concentration increased from 6.2 (IQR 5.6-8.0) mmol/L in the latency phase to 11.6 (10.0-13.3) mmol/L at aftercare (p < 0.05).

After parturition the glucose concentrations decreased gradually. There were Signifi-cant Spearman rank correlations between glucose and cortisol values. Se above.

Table I. Serum cortisol concentrations in nmol/L in normal (n=40) and slow (n=11) labors. The concentrations are presented as median values and interquartile ranges (within brackets).

Table II. Spearman rank order correlations (R and p-values) between glucose and cortisol values at different sampling times. Only correlations with p <.05 are shown.

Conclusion

The demands associated with birth causes significant elevations of cortisol and glucose around parturition.

References

1] Bohrer J, Ehrenthal DB. Other adverse pregnancy outcomes and future chronic disease. Semin Perinatol 2015;39:259-63.

2] Casey ML, MacDonald PC, Mitchell MD. Despite a massive increase in cortisol secretion in women

during parturition, there is an equally massive increase in prostaglandin synthesis. A paradox? J Clin Invest 1985;75:1852-7.

3] Riad M, Mogos M, Thangathurai D, Lumb PD. Steroids. Curr Opin Crit Care 2002;8:281-4.

References

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