The alterations in water homeostasis which accompany human pregnancy provide a unique example of resetting of osmolar control. The changes have inherent interest as a physiological adaptive mechanism, but do they have pathological significance for patients with previously unrecognized disturbance of water balance? In this commentary we highlight briefly the physiological changes in osmoregulation which occur in pregnancy. The possible mechanisms for these changes, including alterations in the metabolism and action of arginine vasopressin (AVP), are described and we attempt to relate these to the rare, but well recognized, phenomenon of exacerbation of subclinical diabetes insipidus in pregnancy. The tentative associations between AVP metabolism, pre-eclampsia and diabetes insipidus are also addressed.
Normal pregnancy is characterized by an early decrease in serum osmolality of up to 10 mosmol/kg which continues throughout gestation (Davison, Valloton & Lindheimer, 1981). This hypotonicity is maintained by a decreased osmotic threshold
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