Patterns of hormone excretion in abnormal pregnancy

Serial assays of urinary estrone, estradiol, estriol, pregnanediol, and HCG have been performed during pregnancy and the puerperium in 3 patients with essential hypertension, 2 pregnant diabetic patients, one subject with pre-eclamptic toxemia, and one with placental insufficiency. Considerable day-to-day fluctuations in steroid and HCG excretion were noted in all cases, again emphasizing the necessity for conducting serial rather than isolated determinations in such investigations. Values for urinary estriol were abnormally low for the appropriate stage of pregnancy in 4 subjects. In 5 a marked fall in estriol output occurred some days prior to delivery either by cesarean section or by the vaginal route. The ratio, pregnanediol/estriol, tended to be higher in abnormal than in normal pregnancy, and the pattern of values for the ratio throughout the gestation period differed in the two groups. In 4 patients a marked fall in the ratio to figures approaching normality was noted in the weeks immediately prior to delivery.