Am J Perinatol 2019; 36(09): 898-906
DOI: 10.1055/s-0038-1675243
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Normal Range for Maternal Lactic Acid during Pregnancy and Labor: A Systematic Review and Meta-Analysis of Observational Studies

Melissa E. Bauer
1   Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
Michael Balistreri
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, St. Mary's Hospital – Madison, Madison, Wisconsin
Mark MacEachern
3   Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
Ruth Cassidy
4   Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
Robert Schoenfeld
5   Medical College of Wisconsin, Milwaukee, Wisconsin
Keerthana Sankar
6   Wayne State University School of Medicine, Wayne State University, Detroit, Michigan
Daniel J. Clauw
4   Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
Elizabeth Langen
7   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Funding This study was funded by the Department of Anesthesiology, University of Michigan.
Further Information

Publication History

20 April 2018

18 September 2018

Publication Date:
05 November 2018 (online)


Objective This article systematically reviews the literature to establish the normal range of lactic acid in healthy pregnant women.

Study Design Ovid MEDLINE,, and were searched to identify studies that reported maternal lactic acid in healthy pregnant women. Pooled aggregate means and two standard deviations for each time period were computed using the inverse variance weighting technique. Analyses were performed separately for 1st, 2nd, and 3rd trimesters, scheduled cesarean delivery, early labor, active labor, 2nd stage of labor, and delivery.

Results Overall, 22 studies met the inclusion criteria. There were 1,193 patients, and 2,008 observations identified. All time periods had maternal venous lactic acid aggregate means and two-standard-deviation ranges less than 4 mmol/L. Outside of labor, all ranges were less than 2 mmol/L. All labor periods had a range higher than 2 mmol/L. While the pooled ranges were less than 4 mmol/L, many individual studies reported ranges > 4 mmol/L during labor.

Conclusion This meta-analysis suggests that venous lactic acid levels can be used as a screening tool in pregnant women just as the test would be used in nonpregnant women, except that elevations may be seen during labor, especially later in labor when there is maximal skeletal muscle contraction.

  • References

  • 1 Rhodes A, Evans LE, Alhazzani W. , et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 45 (03) 486-552
  • 2 Casserly B, Phillips GS, Schorr C. , et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 2015; 43 (03) 567-573
  • 3 Puskarich MA, Illich BM, Jones AE. Prognosis of emergency department patients with suspected infection and intermediate lactate levels: a systematic review. J Crit Care 2014; 29 (03) 334-339
  • 4 Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ. Saving Lives, Improving Mothers' Care - Lessons Learned to Inform Future Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–2012. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2014
  • 5 Bauer ME, Bauer ST, Rajala B. , et al. Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis. Obstet Gynecol 2014; 124 (03) 535-541
  • 6 Keski-Nisula L, Suonio S, Makkonen M, Katila ML, Puhakainen E, Kuronen A. Infection markers during labor at term. Acta Obstet Gynecol Scand 1995; 74 (01) 33-39
  • 7 Dapper DV, Ibe CJ, Nwauche CA. Haematological values in pregnant women in Port Harcourt, Nigeria. Niger J Med 2006; 15 (03) 237-240
  • 8 Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014; 371 (24) 2309-2319
  • 9 Derom R. Anaerobic metabolism in the human fetus: I. The normal delivery. Am J Obstet Gynecol 1964; 89: 241-251
  • 10 Erkkola R, Rauramo L. Correlation of maternal physical fitness during pregnancy with maternal and fetal pH and lactic acid at delivery. Acta Obstet Gynecol Scand 1976; 55 (05) 441-446
  • 11 Taricco E, Radaelli T, Rossi G. , et al. Effects of gestational diabetes on fetal oxygen and glucose levels in vivo. BJOG 2009; 116 (13) 1729-1735
  • 12 Steingrímsdóttir T, Ronquist G, Ulmsten U. Energy economy in the pregnant human uterus at term: studies on arteriovenous differences in metabolites of carbohydrate, fat and nucleotides. Eur J Obstet Gynecol Reprod Biol 1993; 51 (03) 209-215
  • 13 Marx GF, Greene NM. Maternal lactate, pyruvate, and excess lactate production during labor and delivery. Am J Obstet Gynecol 1964; 90: 786-793
  • 14 Jauniaux E, Jurkovic D, Gulbis B, Collins WP, Zaidi J, Campbell S. Investigation of the acid-base balance of coelomic and amniotic fluids in early human pregnancy. Am J Obstet Gynecol 1994; 170 (5 Pt 1): 1365-1369
  • 15 Bahado-Singh RO, Syngelaki A, Akolekar R. , et al. Validation of metabolomic models for prediction of early-onset preeclampsia. Am J Obstet Gynecol 2015; 213 (04) 530.e1-530.e10
  • 16 Clapp III JF, Seaward BL, Sleamaker RH, Hiser J. Maternal physiologic adaptations to early human pregnancy. Am J Obstet Gynecol 1988; 159 (06) 1456-1460
  • 17 Heenan AP, Wolfe LA, Davies GA. Maximal exercise testing in late gestation: maternal responses. Obstet Gynecol 2001; 97 (01) 127-134
  • 18 Piquard F, Schaefer A, Dellenbach P, Haberey P. Is fetal acidosis in the human fetus maternogenic during labor? A reanalysis. Am J Physiol 1991; 261 (5 Pt 2): R1294-R1299
  • 19 Jovanovic L, Kessler A, Peterson CM. Human maternal and fetal response to graded exercise. J Appl Physiol (1985) 1985; 58 (05) 1719-1722
  • 20 Oforofuo IA, Omu AE, Onakewhor JU. Comparative maternal lactate-pyruvate ratios in singleton and twin pregnancies and in babies delivered at term. J Obstet Gynaecol 1999; 19 (06) 617-619
  • 21 Schneider H, Prögler M, Ziegler WH, Huch R. Biochemical changes in the mother and the fetus during labor and its significance for the management of the second stage. Int J Gynaecol Obstet 1990; 31 (02) 117-126
  • 22 Scull TJ, Hemmings GT, Carli F, Weeks SK, Mazza L, Zingg HH. Epidural analgesia in early labour blocks the stress response but uterine contractions remain unchanged. Can J Anaesth 1998; 45 (07) 626-630
  • 23 Clapp III JF, Wesley M, Sleamaker RH. Thermoregulatory and metabolic responses to jogging prior to and during pregnancy. Med Sci Sports Exerc 1987; 19 (02) 124-130
  • 24 Ojengbede OA, Akanji AO, Osotimehin BO. Maternal and cord blood lactate and 3-hydroxybutyrate levels during labour in Nigerian women. Afr J Med Med Sci 1995; 24 (02) 169-172
  • 25 Jauniaux E, Jurkovic D, Gulbis B, Zaidi J, Meuris S, Campbell S. Biochemical composition of the coelomic fluid in anembryonic pregnancy. Am J Obstet Gynecol 1994; 171 (03) 849-853
  • 26 Kashyap ML, Sivasamboo R, Sothy SP, Cheah JS, Gartside PS. Carbohydrate and lipid metabolism during human labor: free fatty acids, glucose, insulin, and lactic acid metabolism during normal and oxytocin-induced labor for postmaturity. Metabolism 1976; 25 (08) 865-875
  • 27 Maguire PJ, Finlay J, Power KA. , et al. Evaluation of point-of-care maternal venous lactate testing in normal pregnancy. J Matern Fetal Neontal Med 2016; 29 (16) 2607-2610
  • 28 McMurray RG, Katz VL, Berry MJ, Cefalo RC. The effect of pregnancy on metabolic responses during rest, immersion, and aerobic exercise in the water. Am J Obstet Gynecol 1988; 158 (3 Pt 1): 481-486
  • 29 Yoshioka T, Roux JF. Correlation of fetal scalp blood pH, glucose, lactate and pyruvate concentrations with cord blood determinations at time of delivery and cesarean section. J Reprod Med 1970; 5 (05) 209-214
  • 30 Low JA, Pancham SR, Worthington D, Boston RW. Acid-base, lactate, and pyruvate characteristics of the normal obstetric patient and fetus during the intrapartum period. Am J Obstet Gynecol 1974; 120 (07) 862-867
  • 31 Anasuya A, Raman L. Significance of hyperuricemia in pre-eclampsia. Indian J Med Res 1979; 70: 767-770
  • 32 Katz M, Kroll D, Shapiro Y, Cristal N, Meizner I. Energy expenditure in normal labor. Isr J Med Sci 1990; 26 (05) 254-257
  • 33 Omu AE, Oforofuo IA. Comparison of the lactate-pyruvate ratio during labour and delivery in singleton and twin pregnancy. Arch Gynecol Obstet 1997; 259 (02) 59-64
  • 34 Trindade CE, Barreiros RC, Kurokawa C, Bossolan G. Fructose in fetal cord blood and its relationship with maternal and 48-hour-newborn blood concentrations. Early Hum Dev 2011; 87 (03) 193-197
  • 35 Devlin J, Paton B, Poole L. , et al. Blood lactate clearance after maximal exercise depends on active recovery intensity. J Sports Med Phys Fitness 2014; 54 (03) 271-278
  • 36 Menzies P, Menzies C, McIntyre L, Paterson P, Wilson J, Kemi OJ. Blood lactate clearance during active recovery after an intense running bout depends on the intensity of the active recovery. J Sports Sci 2010; 28 (09) 975-982
  • 37 Chatel B, Bret C, Edouard P, Oullion R, Freund H, Messonnier LA. Lactate recovery kinetics in response to high-intensity exercises. Eur J Appl Physiol 2016; 116 (08) 1455-1465
  • 38 Jones G, Cornett K, Crowell S, Carlyle J, Roland K, Jakobi J. Lactate clearance following exhaustive exercise differs between sexes and whole body vibration does not enhance recovery. Ann Sports Med Res 2015; 2: 1031-1039
  • 39 Say L, Souza JP, Pattinson RC. ; WHO Working Group on Maternal Mortality and Morbidity classifications. Maternal near miss--towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009; 23 (03) 287-296
  • 40 Kay HH, Zhu S, Tsoi S. Hypoxia and lactate production in trophoblast cells. Placenta 2007; 28 (8-9): 854-860
  • 41 Nakimuli A, Nakubulwa S, Kakaire O. , et al. The burden of maternal morbidity and mortality attributable to hypertensive disorders in pregnancy: a prospective cohort study from Uganda. BMC Pregnancy Childbirth 2016; 16: 205
  • 42 Mukherjee R, Ray CD, Ray S, Dasgupta S, Chaudhury K. Altered metabolic profile in early and late onset preeclampsia: an FTIR spectroscopic study. Pregnancy Hypertens 2014; 4 (01) 70-80
  • 43 Fadel HE, Northrop G, Misenhimer HR, Harp RJ. Acid base balance in pre-eclamptic, hypertensive and diabetic pregnancies. Maternal blood and amniotic fluid studies. J Perinat Med 1979; 7 (04) 202-208
  • 44 Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011; 19: 74