Physiological changes in pregnancy

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Abstract

Physiological changes occur in pregnancy to nurture the developing foetus and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease. It is important to differentiate between normal physiological changes and disease pathology. This review highlights the important changes that take place during normal pregnancy.

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Most cited references 33

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Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus.

Faraz N. Butte (2000)

This article reviews maternal metabolic strategies for accommodating fetal nutrient requirements in normal pregnancy and in gestational diabetes mellitus (GDM). Pregnancy is characterized by a progressive increase in nutrient-stimulated insulin responses despite an only minor deterioration in glucose tolerance, consistent with progressive insulin resistance. The hyperinsulinemic-euglycemic glucose clamp technique and intravenous-glucose-tolerance test have indicated that insulin action in late normal pregnancy is 50-70% lower than in nonpregnant women. Metabolic adaptations do not fully compensate in GDM and glucose intolerance ensues. GDM may reflect a predisposition to type 2 diabetes or may be an extreme manifestation of metabolic alterations that normally occur in pregnancy. In normal pregnant women, basal endogenous hepatic glucose production (R(a)) was shown to increase by 16-30% to meet the increasing needs of the placenta and fetus. Total gluconeogenesis is increased in late gestation, although the fractional contribution of total gluconeogenesis to R(a), quantified from (2)H enrichment on carbon 5 of glucose (65-85%), does not differ in pregnant women after a 16-h fast. Endogenous hepatic glucose production was shown to remain sensitive to increased insulin concentration in normal pregnancy (96% suppression), but is less sensitive in GDM (80%). Commensurate with the increased rate of glucose appearance, an increased contribution of carbohydrate to oxidative metabolism has been observed in late pregnancy compared with pregravid states. The 24-h respiratory quotient is significantly higher in late pregnancy than postpartum. Recent advances in carbohydrate metabolism during pregnancy suggest that preventive measures should be aimed at improving insulin sensitivity in women predisposed to GDM. Further research is needed to elucidate the mechanisms and consequences of alterations in lipid metabolism during pregnancy.

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Placental hormones and the control of maternal metabolism and fetal growth.

Dorothee Newbern, Michael Freemark (2011)

To examine the roles of the placental and pituitary hormones in the control of maternal metabolism and fetal growth. In addition to promoting growth of maternal tissues, placental growth hormone (GH-V) induces maternal insulin resistance and thereby facilitates the mobilization of maternal nutrients for fetal growth. Human placental lactogen (hPL) and prolactin increase maternal food intake by induction of central leptin resistance and promote maternal beta-cell expansion and insulin production to defend against the development of gestational diabetes mellitus. The effects of the lactogens are mediated by diverse signaling pathways and are potentiated by glucose. Pathologic conditions of pregnancy are associated with dysregulation of GH-V and hPL gene expression. The somatogenic and lactogenic hormones of the placenta and maternal pituitary gland integrate the metabolic adaptations of pregnancy with the demands of fetal and neonatal development. Dysregulation of placental growth hormone and/or placental lactogen in pathologic conditions of pregnancy may adversely impact fetal growth and postnatal metabolic function.

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Renal physiology of pregnancy.

Katharine L Cheung, Richard A Lafayette (2013)

Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and fetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values. The threshold for thirst and antidiuretic hormone secretion are depressed, resulting in lower osmolality and serum sodium levels. Blood pressure drops approximately 10 mmHg by the second trimester despite a gain in intravascular volume of 30% to 50%. The drop in systemic vascular resistance is multifactorial, attributed in part to insensitivity to vasoactive hormones, and leads to activation of the renin-aldosterone-angiostensin system. A rise in serum aldosterone results in a net gain of approximately 1000 mg of sodium. A parallel rise in progesterone protects the pregnant woman from hypokalemia. The kidneys increase in length and volume, and physiologic hydronephrosis occurs in up to 80% of women. This review will provide an understanding of these important changes in kidney physiology during pregnancy, which is fundamental in caring for the pregnant patient.

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Author and article information

Contributors

Priya Soma-Pillay

Nelson-Piercy Catherine

Heli Tolppanen

Alexandre Mebazaa

Heli Tolppanen

Alexandre Mebazaa

Journal

Journal ID (nlm-ta): Cardiovasc J Afr

Journal ID (iso-abbrev): Cardiovasc J Afr

Journal ID (publisher-id): TBC

Title: Cardiovascular Journal of Africa

Publisher: Clinics Cardive Publishing

ISSN (Print): 1995-1892

ISSN (Electronic): 1680-0745

Publication date (Print): Mar-Apr 2016

Volume: 27

Issue: 2

Pages: 89-94

Affiliations

Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

Department of Obstetric Medicine, Women’s Health Academic Centre, King’s Health Partners; Guy’s and St Thomas’ Foundation Trust, and Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare Trust, London, UK

INSERM UMRS 942, Paris, France

Heart and Lung Centre, Helsinki University Central Hospital, Finland

University Paris Diderot, Sorbonne Paris Cité, Paris; Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, France

Article

DOI: 10.5830/CVJA-2016-021

PMC ID: 4928162

PubMed ID: 27213856

SO-VID: fa70024f-c4b4-43a9-a720-6d9d02c07f70

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Physiological changes in pregnancy

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Abstract

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HLA-G and immune tolerance in pregnancy

Most cited references 33

Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus.

Placental hormones and the control of maternal metabolism and fetal growth.

Renal physiology of pregnancy.

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