152 SAMJ VOL 81 1 FEB 1992
Thanks are due to Mr R K. Berry for the amino acid analysis
and Mrs A. Philips for sample preparation.
REFERENCES
I. Callender ST, Wemer GT, Cope E. Treatment of menorrhagia with
rranexamic acid: a double blind study. BM] 1970; 4: 214-215.
2. Westrom 1., Bengrsson LP. Effect of rranexamic acid (A.~CA) in menor-
rhagia associated with intra-uterine contraceptive devices. ] Reprod Mea
1970; 5: 205-216.
Salivary calcium, magnesium, phosphate,
chloride, sodium and potassium
in pregnancy and labour
F. GUIDOZZI, M. MACLENNAN, K. M. GRAHAM, C. P. JOOSTE
Summary
Pregnancy and labour produce significant changes in salivary
calcium, magnesium, phosphate and chloride when pregnant
patients in labour are compared with non-pregnant patients.
There is a decrease in concentration of these constituents in the
3rd trimester of pregnancy followed by a marked increase when
labour occurs. Magnesium and chloride are the constituents
most significantly affected and show the largest increase during
labour. Changes in saliva flow rate were accounted for and are
not responsible for these changes noted. Sodium and potas-
sium follow a similar pattern. When their levels are corrected for
saliva flow rate changes, both show a significant increase with
the onset of labour.
S Air Med J 1992; 81: 152-154.
A number of publications exist in which the authors have
shown varying effects of normal pregnancy on the homeostasis
of calcium, magnesium, phosphate and electrolytes in blood
during pregnancy and labour. 1-6
At the time we undertook this study we were unable to find
any reports determining the effects of normal pregnancy and
labour on the abovementioned constituents and electrolytes in
saliva. Given the findings that the salivary progesterone profile
in pregnancy mimicked the progesterone in blood/,s we de-
cidedro deterrnille wllether the
profiles of salivaryCalCium,
magnesium, phosphate, chloride, sodium and potassium
Department of Obstetrics and Gynaecology, Johannesburg
Hospital and University of the Witwatersrand, Johannes-
burg
F. GUIDOZZI, M.B. B.CH., M.RC.O.G.
K. M. GRAHAM, M.B. B.CH.
Department of General Physiology, Dental School,
University ofthe Witwatersrand, Johannesburg
M. MACLE1>.TNAN, B.Sc.
C. P. JOOSTE, B.CH.D.
Accepted 23 July 1991.
Reprint requests [0: Dr F. Guidozzi, Depr of Obsremcs and Gynaecology, University of the
Wirnr3rersrand .M,edical School, 7 York Road, Parkroy.n, 2193 RSA.
3. Nilsson 1., RJbo G. Treatment of menorrhagia. Am] Obstl Gyneco11971;
110: 713-7b.
4. Tauber PF, Wolf AS, Herring W, Zaneveld LJD. IUD-induced hemor-
rhage: control by local proteinase inhibition. Fercil SteriI 1970; 28: 1375-
1376.
5. Ragab MI, Thomas MN. The use ofrranexamic acid (AMCA) in IUDs as
an antibleeding agent. Indian] Obslel Gynaeco11970; 14: 137-139.
6. Pilbrant AS, Schannong M, Vessman]. Pharmacokinetics and bioavaila-
biliry of rranexamic acid. Eur] Clin Pharmaco11981; 20: 65-69.
7. Morrison DF. Mullivariace Statistical Melhods. New York: McGraw-Hill,
1967: 205,216-222.
showed any significant changes when the pregnant patient was
compared with the patient in labour and the non-pregnant
subject.
Materials and methods
Whole mixed, unstimulated, saliva samples were collected
between 09hOO and IlhOO from 9 controls, 25 patients in the
3rd trimester (32 - 40 weeks) and 15 patients considered to
be ill labour. All patients were between 18 - 31 years, had not
eaten, had fluids or smoked for at least 2 hours before collec-
tion. The saliva specimens were collected in 10 ml glass tubes
with rubber stoppers over a IO-minute period. All the controls
were within 7 days of the start of their last menstruation.
Samples were immediately stored at -20C until analysis,
which in all the specimens was within 24 hours. Ten millilitre
blood samples, collected in lithium heparinised vacutainers
after the saliva collection, were centrifuged for 10 minutes at
3 500 rpm also within 24 hours. No control patient was on
medication or the oral contraceptive pill. All pregnant patients
had no underlying medical complications and were only 0
routine oral iron and folate supplementation.
Analysis. Atomic absorption spectrophotometry was used
to measure calcium and magnesium concentration using 2
Varian Spect AA-IO (Varian Techtron, Springvale, Australia)
Phosphate levels were measured using the Technicon RP
Systems Autoanalyser, while the chloride concentrations wert
determined with a CMT 10 chloride titrator (Radiometer.
Copenhagen). The salivary and plasma sodium and potassiurr
were analysed using a FIM3 flame photometer (Radiometer
Copenhagen) and the osmolality was determined using,
Wescor 5100C vapor pressure osmometer (Wescor Inc., Utah
USA). Data are expressed as mean with SE, the statistic a
significance being determined by Student's unpaired (-test, :
P-value of < 0,05 being considered statistically significant.
Results
The mean and SE of salivary calcium, magnesium, phosphatf,
chloride, sodium and potassium and osmolality are shown i,
Table 1.
 SAMJ VOL. 81 1 FEB 1992 153

TABLE I. MEAN SALIVARY CALCIUM, MAGNESIUM, PHOSPHATE, CHLORIDE, SODIUM, POTASSIUM

AND OSMOLALITY (SE)
Control 3rd trimester Labour
Calcium(mmol) 0,88 (0,03) 0,85 (0,19) 1,37 (0,11)
Magnesium (mmol/I) 0,15 (0,02) 0,14 (0,01) 0,39 (0,10)
Phosphate (mmol/I) 6,95 (1,12) 4,27 (0,45) 5,55 (0,63)
Chloride (mmol/I) 25,04 (2,31) 17,79 (0,82) 34,40 (7,55)
Sodium (mmol/I) 43,13 (2,64) 39,95 (3,48) 35,70 (2,09)
Potassium (mmol/I) 63,10 (11,18) 22,95 (3,11) 32,94 (4,53)
Osmolality (meq/I) 158,10 (6,79) 121,SO (2,87) 155,18 (18,48)

There was a significant increase in salivary calcium and With the flow rate adjustment, there was a significant
nagnesium in labouring patients when compared with 3rd decrease in amounts from the control group compared with
rimester and control patients (P < 0,01). Calcium and magne- the 3rd trimester group (all P-values < 0,01) and subsequently
ium showed no change in concentration when 3rd trimester a significant increase during labour (all P-values < 0,01). The
=vels were compared with the control group. single exception was magnesium which did not show an initial
Salivary phosphate and chloride concentration showed a decrease in the 3rd trimester, but showed a very significant
ignificant decrease (P < 0,05 and 0,01, respectively) when 3rd increase during labour (P < 0,01).
;mester levels were compared with the levels of the control The mean and SE of calcium, magnesium, phosphate,
roup. However, when the levels in the labour group were chloride and osmolality in plasma are listed in Table Ill.
Jmpared with those in the 3rd trimester group, the phosphate There was a significant decrease in calcium in plasma when
ad chloride showed a significant increase (P < 0,05 and 0,01, the 3rd trimester group was compared with the control group
=spectively) . and, although there was a further decrease when the labour
Osmolality similarly showed changes, i.e. control con- group was compared with the 3rd trimester group, it was not
entrations greater than those in the 3rd trimester group statistically significant. The other constituents and osmolality
p < 0,01) and concentrations in the labour group greater than . in'plasma did not show any significant chan~es.
,ose in the 3rd trimester group (P < 0,01).
The sodium concentration in the control group was signifi-
mtly greater than in the labouring patients (P < 0,05) but no Discussion
gnificant change was seen when the 3rd trimester group was
Jmpared with the labour or control groups. Published repons do not offer any explanation for the drama-
Potassium had greater value in the control group than in tic changes in salivary calcium, magnesium, phosphate, chlo-
,e 3rd trimester group (P < 0,01) and control group value ride, sodium and potassium that occur when labour begins. It
as also greater than labour group (P < 0,02). Although there is interesting that many of our patients had palpable Braxton-
-as an increase in the labour group salivary potassium when Hicks contractions but no salivary changes were noted in the
Jmpared with the 3rd trimester group, it was not statistically 3rd trimester group. Based on published studies in non-preg-
.gnificant. nant patients, we have attempted to supply some explanation.
In order to determine whether these changes in concentra- From our study it is apparent that there is no correlation
on were brought about by changes in saliva flow rate, the between the changes noted in the saliva and those noted in the
oncentrations of salivary calcium, magnesium, phosphate, blood. Despite magnesium, phosphate, chloride and osmola-
hloride, sodium and potassium were divided by the salivary lity showing no significant changes in blood, the salivary gland
ow rates to give amounts expressed as /.lIDoVmin (Table m. acts independently to produce significan~_ch_anges in saliva.

TABLE 11. MEAN CONSTITUENTS AFTER CORRECTING FOR SALIVA FLOW RATE CHANGES (SE)
Control 3rd trimester Labour
Calcium (llmol/min) 8,37 (2,56) 3,51 (0,52) 11,75 (2,80)
Magnesium (llmol/min) 0,69 (0,20) 0,72 (0,20) 3,20 (0,96)
Phosphate (llmol/min) 62,04 (18,73) 15,16 (2,30) 37,66 (7,70)
Chloride (llmol/min) 205,86 (50,22) 69,57 (10,30) 349,00 (118,90)
Sodium (llmol/min) 288,04 (64,70) 162,44 (32,90) 276,90 (53,28)
Potassium (llmol/min) 469,06 (139,30) 106,30 (29,40) 256,70 (74,10)

TABLE Ill. MEAN CALCIUM, MAGNESIUM, PHOSPHATE, CHLORIDE AND OSMOLALITY IN PLASMA (SE)
Control 3rd trimester Labour
Calcium (mmol/I) 2,10 (0,09) 1,66 (0,05) 1,59 (0,67)
Magnesium (mmoll) 0,70 (0,05) 0,66 (0,01) 0,68 (0,04)
Phosphate (mmol/I) 1,01 (0,15) 1,18 (0,06) 1,11 (0,04)
Chloride (mmol/I ) 105,00 (4,60) 106,00 (0,62) 108,00 (0,61)
Osmolality (meq/I) 289,00 (10,22) 287,00 (2,51) 294,00 (2,18)
154 SAMJ VOL. 81 1 FEB 1992

TABLE IV. CHANGES IN CONSTITUENTS, ELECTROLYTES AND OSMOLALITY IN SALIVA AND BLOOD
Saliva Plasma
Variables Control P-value 3rd trimester P-value Labour P-value Control P-value 3rd trimester P-value Labour P-value
Calcium C>3 0,01 C>3 0,01 3<L 0,01 C>3 0,01 C>3 0,01 C>L 0,01
Magnesium NS 3<L 0,01 3<L 0,01 NS NS NS
Phosphate C>3 0,02 NS 3<L 0,01 NS NS NS
Chloride C>3 0,01 NS 3<L 0,01 NS NS NS
Sodium NS NS NS NS tils NS
Potassium C>3 0,01 NS 3<L 0,05 NS NS NS
Osmolality C>3 0,01 3<L 0,01 3<L 0,01 NS NS NS
Control =C; Labour = L; 3 = 3rd trimester.

The changes in saliva calcium are similarly nar brought about
by changes in the blood (Table IV).
The -levels of parathyroid hormone in blood have been
shown to increase during late pregnancy, with a maximal surge
during labour. 2,5 Furthermore, intravenous perfusion of para-
thyroid hormone will increase salivary calcium concentra-
tion. 9 ,lo We feel thar it is this surge of parathyroid hormone
levels in the blood that may be responsible for the dramatic
increase in salivary calcium.
It is difficult to explain why there is such a dramatic
increase in salivary magnesium levels once labour begins,
although this may be regulated by those factors that precipitate
the surge in the salivary calcium levels.
The significant changes in the salivary sodium and potas-
sium levels in labour may be brought about by the pregnancy-
associated higher levels of aldosterone having its effect on the
salivary glands, as well as markedly increased sodium/paras-
sium adenosine triphosphatase activity of the salivary gland. 11
During labour, the increased sympathetic autonomic ner-
vous system and adrenal gland activity results in hormonal
stimulation of the salivary gland. This leads to decreased sali-
vary flow rate and increased metabolic activity. This can result
in increased accumulation of bicarbonate in the salivary acinar
cell, which inhibits the influx of chloride into the salivary
gland, resulting in significantly raised levels of chloride in the
salivary duel.
In conclusion, we have presented a study of the changes
noted in salivary calcium, magnesium, chloride, phosphate,
sodium, potassium and osmolality when non-pregnant
patients are compared with 3rd trimester patients and patients
in labour. These changes are not brought about by concomi-
tant changes in blood or changes in the flow rate of saliva.
This study is at present ongoing and the aim is to deter-
mine whether salivary magnesium and chloride can be used as
a reliable indicator of onset of labour.
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