Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman’s body undergoes to accommodate the growing embryo or fetus. Pregnant women experience numerous adjustments in their endocrine system that help support the developing fetus. The fetal-placental unit secretes steroid hormones and proteins that alter the function of various maternal endocrine glands. Levels of progesterone and estrogen rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The progesterone is first produced by the corpus luteum and then by the placenta in the second trimester.
As a result, this conserves blood glucose for use by the fetus. It can also decrease maternal tissue sensitivity to insulin, resulting in gestational diabetes. The pituitary gland grows by about one-third as a result of hyperplasia of the lactrotrophs in response to the high plasma estrogen. Prolactin, which is produced by the lactrotrophs increases progressively throughout pregnancy. Fetal skeletal formation and then later lactation challenges the maternal body to maintain their calcium levels. The fetal skeleton requires approximately 30 grams of calcium by the end of pregnancy. Total cortisol increases to three times of non-pregnant levels by the third trimester.
The increased estrogen in pregnancy leads to increase corticosteroid-binding globulin production and in response the adrenal gland produces more cortisol. The adrenal gland also produces more aldosterone, leading to an eight-fold increase in aldosterone. Women do not show signs of hyperaldosterone, such as hypokalemia, hypernatremia, or high blood pressure. SHBG binds avidly to testosterone and to a lesser degree DHEA. The thyroid enlarges and may be more easily felt during the first trimester. The increased in kidney clearance during pregnancy causes more iodide to be excreted and causes relative iodine deficiency and as a result an increase in thyroid size. Effect of pregnancy on endocrine function tests. A woman’s breasts grow during pregnancy, usually 1 to 2 cup sizes and potentially several cup sizes.
A woman who wore a C cup bra prior to her pregnancy may need to buy an F cup or larger bra while nursing. A woman’s torso also grows and her bra band size may increase one or two sizes. The heart adapts to the increased cardiac demand that occurs during pregnancy in many ways. Uterine Compression of IVC and Pelvic Veins. Uterine enlargement beyond 20 weeks’ size can compress the inferior vena cava, which can markedly decrease the return of blood into the heart or preload. As a result, healthy pregnancy patients in a supine position or prolonged standing can experience symptoms of hypotension. These changes occur mostly in the second trimester and prior to 32 weeks gestation.
The effect of pregnancy on platelet count is unclear, with some studies demonstrating a mild decline in platelet count and other studies that show no effect. The white blood cell count increases with occasional appearance of myelocytes or metamyelocytes in the blood. A pregnant woman will also become hypercoagulable, leading to increased risk for developing blood clots and embolisms, such as deep vein thrombosis and pulmonary embolism. The increase risk of clots can be attributed to several things. Plasma levels of pro-coagulantion factors increased markedly in pregnancy, including: von Willebrand Factor, fibrinogen, factor VII, factor VIII, and factor X. Edema, or swelling, of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs. During pregnancy, both protein metabolism and carbohydrate metabolism are affected. An increased requirement for nutrients is given by fetal growth and fat deposition. Changes are caused by steroid hormones, lactogen, and cortisol.
Maternal insulin resistance can lead to gestational diabetes. Increased liver metabolism is also seen, with increased gluconeogenesis to increase maternal glucose levels. Some degree of weight gain is expected during pregnancy. The enlarging uterus, growing fetus, placenta, amniotic fluid, normal increase in body fat, and increase in water retention all contribute weight gain during pregnancy. There is also an increased folate requirement from 0. All patients are advised to take prenatal vitamins to compensate for the increased nutritional requirements. The use of Omega 3 fatty acids supports mental and visual development of infants. Progesterone causes many changes to the genitournary system.
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