Pathological Metabolism in 



Pregnancy 







HAROLD BAILEY 



NEW YOBK 



There are changes in the maternal metabolism in normal pregnancy 

 evidenced by the retention of nitrogen for the development of the fetus 

 (Hoff strom, Murlin and Bailey (6), Landsberg) and by marked gain in the 

 mother's weight due to the storage of fat and the growth of the uterus and 

 breasts. Moreover the maternal organs are required to detoxicate and ex- 

 crete certain metabolic products arising from the fetus. These physio- 

 logical changes place an extra burden upon the entire system but chiefly 

 upon the liver and kidneys, and if these organs have but little reserve 

 power, the borderline of the pathological condition is approached. 



It is possible that the liver suffers damage in the earlier part of preg- 

 nancy by the absorption into the general circulation of toxins of an enzyme 

 or ferment nature, derived from the action of certain cells of the ovum 

 the syncytium (Weichardt). An analogous condition of much milder 

 grade and shorter duration is believed by some to exist in the non-pregnant 

 state, in certain women, at the time of menstruation when the ovary 

 activates ferments which produce changes in the endometrium (Keiffer). 



It has been claimed by a number of observers that there is a specific 

 liver of pregnancy with a definite pathology which is shown by a mild 

 degree of fatty degeneration of the cells about the center of the lobules 

 and leading to a lessened glycogenic function (Roughtori, Hofbauer, 

 Ewing). That a similar condition exists in the kidney was established 

 by von Leyden (Leyden) and is now generally accepted. Here again, 

 the lesion is that of a slight degree of fatty degeneration of the cells of 

 the tubules and not infrequently accompanied by an albuminuria. 



These changes in the liver and -kidney occurring not uncommonly in 

 normal pregnancy may be looked upon as the precursors of degeneration 

 of a severe grade present in the conditions of pernicious vomiting, acute 

 yellow atrophy and eclampsia. 



Historical 



Following the demonstration by Lever in 1843 of an albuminuria in 

 9 of 10 cases of eclampsia and the further discovery that of 50 women at 



835 



