Maternal physiological changes in pregnancy are adaptations during pregnancy experienced by a woman's body to accommodate a growing embryo or fetus. These physiological changes are completely normal, and include behavior (brain), cardiovascular (heart and blood vessels), hematology (blood), metabolism, kidney (kidney), posture, and respiratory (breathing) change. Increased blood sugar, respiration, and cardiac output are expected changes that allow the body of a pregnant woman to facilitate the growth and development of the appropriate embryo or fetus during pregnancy. Pregnant women and placentas also produce many other hormones that have various effects during pregnancy.
Video Maternal physiological changes in pregnancy
Hormonal
Pregnant women experience many adjustments in their endocrine systems that help support the developing fetus. The fetal-placenta unit secretes steroid hormones and proteins that alter the function of the various endocrine glands of the mother. Sometimes, changes in certain hormone levels and their effects on their target organs can lead to gestational diabetes and gestational hypertension.
The fetal-placenta unit
Progesterone and estrogen levels rise steadily during pregnancy, suppressing the hypothalamic axis and then the menstrual cycle. Progesterone is first produced by the corpus luteum and then by the placenta in the second trimester. Women also experience an increase in human chorionic gonadotropin (? -hCG), which is produced by the placenta.
Pancreatic Insulin
The placenta also produces human placenta lactogen (hPL), which stimulates maternal lipolysis and fatty acid metabolism. As a result, this saves blood glucose for use by the fetus. It may also decrease the mother's tissue sensitivity to insulin, leading to gestational diabetes.
Pituitary gland
The pituitary gland grows about a third as a result of lactrotrof hyperplasia in response to high plasma estrogen. Prolactin, produced by laktrotrof, progressively increases during pregnancy. Prolactin mediates changes in the breast milk gland structure from the ductal to the lobular-alveolar and stimulates milk production.
Parathyroid
The formation of fetal skeletal and then lactation challenges the mother's body to maintain their calcium levels. The fetal skeleton requires about 30 grams of calcium at the end of pregnancy. The mother's body adapts to increasing parathyroid hormone, leading to increased calcium absorption in the intestine as well as increased reabsorption of calcium by the kidneys. Calcium total maternal serum decreased due to maternal hypoalbuminemia, but the ionized calcium content was maintained.
Adrenal Glands
Total cortisol increases up to threefold from non-pregnant levels in the third trimester. Increased estrogen in pregnancy causes increased production of corticosteroid binding globulin and as a response of the adrenal glands produces more cortisol. The net effect is increased free cortisol. It contributes to insulin resistance of pregnancy and possibly striae. Despite the increase in cortisol, pregnant women do not show Cushing syndrome or high cortisol symptoms. One theory is that high levels of progesterone act as antagonists to cortisol.
The adrenal glands also produce more aldosterone, which leads to an eightfold increase in aldosterone. Women show no signs of hyperaldosterone, such as hypokalemia, hypernatremia, or high blood pressure.
The adrenal glands also produce more androgens, such as testosterone, but this is buoyed by increased estrogen in sex hormone-binding globulin (SHBG). SHBG binds diligently to testosterone and to a lower level of DHEA.
Thyroid
The thyroid is enlarged and may be more pronounced during the first trimester. Increased renal release during pregnancy causes more iodides to be excreted and causes relative iodine deficiency and as a result increases thyroid size. Increased estrogen in thyroid binding globulin (TBG) causes an increase in total thyroxine (T4), but free thyroxine (T4) and triiodothyronine (T3) remain normal.
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Maps Maternal physiological changes in pregnancy
Breast size
Female breasts grow during pregnancy, usually 1 to 2 cup sizes and potentially multiple cup sizes. A woman who wears a C cup bra before her pregnancy may need to buy a cup of F â € Many people and even medical experts mistakenly think that breastfeeding causes sagging breasts (referred to as ptosis ) . As a result, some new parents are reluctant to breastfeed their babies. In February 2009, Cheryl Cole told British Vogue that she was hesitant to breastfeed because of its effect on her breasts. "I want to breastfeed," he said, "but I've seen what he can do, so I might have to reconsider." In fact, breastfeeding is not considered a major contributor to breast ptosis. In fact, the biggest factors affecting ptosis are smoking, body mass index (BMI), number of pregnancies, breast size before pregnancy, and age.
Cardiovascular
The heart adapts to the increased heart needs that occur during pregnancy in many ways. Cardiac output increases during early pregnancy, and peaks in the third trimester, usually 30-50% above the baseline. Estrogens mediate this increase in cardiac output by increasing the volume of pre-load and stroke, especially through higher overall blood volume (which increases by 40-50%). Heart rate increases, but generally not more than 100 beats/minute. Total systemic vascular resistance decreased 20% secondary to the effects of vasodilatation of progesterone. Overall, systolic and diastolic blood pressure dropped by 10-15 mm per week in the first trimester and then returned to baseline during the second half of pregnancy. All these cardiovascular adaptations can cause common complaints, such as palpitations, decreased exercise tolerance, and dizziness.
Uterine enlargement beyond 20 weeks' size may suppress the inferior vena cava, which can significantly reduce the return of blood to the heart or preload. As a result, a healthy pregnant patient in a supine or prolonged position may experience symptoms of hypotension.
Hematology
Blood Volume and Hemoglobin Concentration
During pregnancy plasma volume increases 40-50% and red blood cell volume only increases by 20-30%. These changes occur mostly in the second trimester and before 32 weeks of pregnancy. Due to dillution, the net result is a decrease in hematocrit or hemoglobin, which is a measure of red blood cell concentration. Erythropoietin, which stimulates the production of red blood cells, increases throughout pregnancy and reaches about 150 percent of their pregnancy rates over a period of time. A decrease in hematocrit or hemoglobin occurs less at the end of the second trimester and slowly improves when it reaches the time period.
Platelet and White Cell Count
The effects of pregnancy on platelet counts are unclear, with some studies showing mild decreases in platelet counts and other studies that did not show any effect. The number of white blood cells increases with the appearance of myelocytes or metamyelocytes in the blood occasionally. During labor, an increase in the number of leukocytes occurs.
Hypercoagulability
A pregnant woman will also become hypercoagulable, causing an increased risk for developing blood clots and emboli, such as deep vein thrombosis and pulmonary embolism. Women are 4-5 times more likely to develop clots during pregnancy and in the postpartum period than when they are not pregnant. Hypercoagulability in pregnancy tends to evolve to protect women from bleeding at the time of miscarriage or childbirth. In third world countries, the main cause of maternal death is bleeding. In the United States 2011-2013, bleeding consists of 11.4% and pulmonary embolism comprises 9.2% of all pregnancy-related deaths.
Increased risk of agglomeration can be attributed to several things. Plasma levels of pro-coagulant factors increased significantly in pregnancy, including: von Willebrand Factor, fibrinogen, factor VII, factor VIII, and factor X. Both prostacyclin production (platelet aggregation inhibitors) and thromboxane (platelet aggregation inducer) and vasoconstrictor) increased, but overall there is an increase in platelet reactivity that can lead to a predisposition to blood clotting. There is also an increase in blood stasis due to compression of the cava vena by enlarged uterus. Many factors have been shown to increase the risk of agglomeration in pregnancy, including basic thrombophilia, cesarean section, preeclampsia, etc. Clots usually develop in the left leg or the left iliac/femoral vein system. Recently, there have been reports of cases of May-Thurner's syndrome in pregnancy, where the right general iliac artery compresses the lower left communicular iliac veins.
Edema
Edema, or swelling, of the foot often occurs during pregnancy, in part because the enlarging uterus suppresses the veins and lymphatic drainage of the legs.
Metabolic
During pregnancy, protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is stored, with half getting into the fetus and placenta, and half going to the contractile uterine protein, breast gland tissue, plasma proteins, and hemoglobin.
Increased nutritional requirements are given by fetal growth and fat accumulation. Changes are caused by steroid, lactogen, and cortisol hormones.
Maternal insulin resistance can lead to gestational diabetes. Increased liver metabolism is also seen, with elevated gluconeogenesis to increase maternal glucose levels.
Weight Loss
Several levels of weight gain are expected during pregnancy. Enlarged uterus, growing fetus, placenta, amniotic fluid, a normal increase in body fat, and increased water retention all contribute to weight gain during pregnancy. The amount of weight gain can vary from 5 pounds (2.3 kg) to over 100 pounds (45 kg). In the United States, the recommended weight range is usually 25 pounds (11 kg) to 35 pounds (16 kg), less if the woman is overweight, more (up to 40 pounds (18 kg)) if she is thin.
Nutrition
Nutritionally, pregnant women require 300 kcal/day calorie increase and protein increase to 70 or 75 g/day. There is also an increase in folate requirement from 0.4 to 0.8 mg/day (important in preventing neural tube defects). On average, weight gain of 20 to 30 pounds (9.1 to 13.6 kg) is experienced.
All patients are advised to take prenatal vitamins to compensate for the increased nutritional needs. The use of Omega 3 fatty acids supports mental and visual development of infants. Choline supplementation from research mammals supports mental development that lasts throughout life.
Renal and reproduction tracts below
Progesterone causes many changes to the genitournary system. A pregnant woman may experience an increase in the size of the kidney and ureter due to an increase in blood volume and blood vessels. Later in pregnancy, the woman may have normal physiological and hydroureteric hydronephrosis. Progesterone causes vasodilation and increased blood flow to the kidneys, and as a result the glomerular filtration rate (GFR) typically increases by 50%, returning to normal about 20 weeks postpartum. Increased GFR increases the excretion of protein, albumin, and glucose. Increased GFR causes an increase in urine output, which women may experience as an increase in urinary frequency. Progesterone also causes decreased ureter motility, which can lead to urinary stasis and therefore increase the risk of urinary tract infections.
Pregnancy changes the vaginal microbiota by reducing species/genus diversity. Physiologic hydronephrosis can occur from six weeks.
Gastrointestinal
Changes in the gastrointestinal (GI) system during pregnancy are caused by an enlarged uterus and hormonal changes in pregnancy. Anatomically, the intestines and stomach are pushed from their original position by the enlarged uterus. Although there is no intrinsic change in the size of GI organs, the portal vein gets larger because of the hyperdynamic pregnancy state. Increased levels of progesterone and estrogen mediate most of the functional changes of the GI system during pregnancy. Progesterone causes smooth muscle relaxation that slows GI motility and lowers the low esophageal sphincter (LES) tone. Increased intragastric pressure combined with lower LES tones causes gastroesophageal reflux commonly experienced during pregnancy.
Increased occurrence of gallstones during pregnancy is due to inhibition of gallbladder contractions (as a result of an increase in smooth muscle relaxation mediated by progesterone) and reduced bile transport bile (mediated by estrogen) that results in pregnancy cholestasis.
Nausea and vomiting of pregnancy, commonly known as "morning sickness", is one of the most common GI symptoms of pregnancy. It starts between 4 and 8 weeks of pregnancy and usually subsides by 14 to 16 weeks. The cause of actual nausea is not fully understood but is correlated with increased levels of human chorionic gonadotropin, progesterone, and relaxation resulting from smooth muscle of the stomach. Hyperemesis gravidarum, which is a form of heavy nausea and vomiting of pregnancy can lead to nutritional deficiencies, weight loss, electrolyte imbalance and is one of the main causes of hospitalization in the first trimester of pregnancy.
Constipation is another GI symptom commonly encountered during pregnancy. This is related to the narrowing of the large intestine as it is driven by growing uterus found nearby leading to a mechanical blockade. Reduced mobility across the GI system as well as increased water absorption during pregnancy are considered contributing factors.
Cravings of diets and diets as well as avoidance of smell of certain types of foods are common in pregnancy. Although the exact mechanisms of these symptoms are not fully explained, it is thought that dietary cravings may arise from the thought that certain foods may help relieve nausea. Pica, which is a strong desire for unusual ingredients such as clay and ice has also been reported in pregnancy.
Hemorrhoids and gingival diseases are two common pregnancies associated with physical findings involving the gastrointestinal system. Hemorrhoids arise as a result of constipation and venous congestion are common in pregnancy. Gingival diseases are thought to be associated with softening of the gums and edema (swelling of the fluid collection) which is mostly observed in pregnancy. The mechanisms and reasons for gingival changes are poorly understood.
Immune tolerance
The fetus in pregnant women can be viewed as an extremely successful allograft, because it is genetically different from women. In the same way, many cases of spontaneous abortion can be described in the same way as maternal transplant rejection.
Musculoskeletal
Neuromechanical adaptation in pregnancy refers to changes in gait, postural parameters, and sensory feedback, as many of the anatomical, physiological, and hormonal changes that women undergo during pregnancy. Such changes increase their risk for musculoskeletal disorders and injury. Musculoskeletal disorders include lower back pain, leg cramps, and hip pain. Pregnant women fell at the same rate (27%) for women over the age of 70 years (28%). Most falls (64%) occur during the second trimester. In addition, two-thirds of waterfalls are associated with walking on slippery floors, rushing, or carrying objects. The root cause of this fall is unknown. However, several factors that may contribute to this injury include deviations from normal posture, balance, and gait.
Posture changes as pregnancy progresses. Pelvis leads and rear arches to help maintain balance. Poor posture occurs naturally from the stretching of a woman's abdominal muscles as the fetus grows. These muscles are less able to contract and keep the lower back in the right position. Pregnant women have different walking patterns. This step extends during pregnancy, due to weight gain and posture changes. On average, a woman's legs can grow half the size or more during pregnancy. In addition, increased pregnancy weight, fluid retention, and weight gain decrease the foot arch, increasing the length and width of the foot. The effects of increased hormones such as estrogen and relaxin initiate soft tissue, cartilage and ligament remodeling. Certain skeletal joints such as pubic symphysis and sacroiliac expansion or have increased omissions.
The addition of mass, especially around the torso, naturally changes the maternal mass of the mother (COM). Changes in COM require pregnant women to adjust their body to maintain balance.
Lorosis lumbar
To compensate for the additional burden due to pregnancy, pregnant women often extend their lower back. As fetal weights increase, women tend to bend their lower back, especially in the lumbar region of their vertebral columns to maintain postural stability and balance. The arch of the waist region is known as lumbar lordosis, which returns the center of mass to a stable position by reducing the hip torque. According to a study conducted by Whitcome, et al., Lumbar lordosis may increase from a 32-degree angle to 0% of fetal mass (ie women who are not pregnant or very early in pregnancy) to 50 degrees at 100% fetal mass (very late in pregnancy). Postpartum, the angle of the lordosis decreases and can reach the angle before pregnancy. Unfortunately, while lumbar lordosis reduces hip torsion, it also exacerbates spinal shear burden, which may be the cause of the common lower back pain experienced by pregnant women.
Men vs. women
Given the demands of fetal loading during pregnancy and the importance of generating offspring for human fitness, one can imagine that natural selection has a role in choosing an anatomy unique to the lumbar region in women. It turns out there is a gender difference in the male and female lumbar vertebral columns, which ultimately helps to reduce some of the discomfort due to fetal burden on women. There are 5 vertebrae in the lumbar area for men and women. However, the 3 lower vertebrae of the female lumbar region are the temporary tied backs for males, only the bottom 2 of the lumbar region being wedged in the dorsal section. When a woman arches her lower back, like during fetal loading, having an extra dorsal vertebra squeezed reduces shear strength. This lumbar sexual dimorphism in humans shows high natural selection pressures have acted to improve maternal performance in posture and locomosi during pregnancy.
Evolutionary implications
If natural selection has acted in the lumbar region of Homo sapiens to create this sexual dimorphism, then this characteristic must also be evident in the genus Australopithecus, a hominin known as ordinary bipedal for at least 2 million years after the earliest bipedial hominin. There are currently two almost complete lumbar australopith segments; one has three vertebrae clamped dorsally in the lumbar area while the other has two. The explanation for these findings is that the first is female, while the second is male. This kind of evidence supports the idea that natural selection has played a dimorphic role in designing the anatomy of the vertebral lumbar region.
Postural stability
The weight added during pregnancy development also affects the ability to maintain balance.
Perception
Pregnant women have a perception of a declining balance during a quiet stand, which is confirmed by an anterior-posterior increase (front to back) sway. This association increases during pregnancy and significantly reduces postpartum. To compensate for the decrease in balance stability (both actual and perceived), the width of attitude increases to maintain postural stability.
Response to perturbation
Under dynamic postural stability, which can be defined as a response to anterior (front) and posterior (back) translation disturbances, different pregnancy effects. Scratch start , total wobble , and rocking speed (see figure for variable description) was significantly less during the third trimester than during the second trimester and when compared with nonpregnant women. This biomechanical characteristic is probably the reason why it falls more commonly during the second trimester during pregnancy.
In addition, the time required for pregnant women (each stage of pregnancy) to react to translational disorders did not differ significantly compared to non-pregnant women. This alludes to a kind of stability mechanism that allows pregnant women to compensate for the changes they experience during pregnancy.
Gait
Gait in pregnant women often appears as "wiggling" - a frontal force that includes lateral components. However, studies have shown that advanced forces do not change during pregnancy. It has been found that gait parameters such as gait kinematics (speed, step length, and rhythm) remain unchanged during the third trimester of pregnancy and 1 year after delivery. These parameters show that there is no change in forward movement. Nevertheless, there is a significant increase in the kinetic kinik parameter, which can be used to explain how gait movements remain relatively unchanged despite increases in body mass, width and changes in the mass distribution of the waist during pregnancy. These kinetic kinetic parameters show an increased use of hip abductor muscle groups, extensor hip, and flexor muscles of the ankle. To compensate for this gait drift, pregnant women often perform adaptations that can cause musculoskeletal injuries. While the idea of ​​"wiggling" can not be eliminated, these results suggest that exercise and conditioning can help alleviate this injury.
Breathing
There are many physiological changes that occur during pregnancy that affect the status and function of breathing. Progesterone has a noticeable effect on respiratory physiology, increasing minute volume (amount of inhaled in and out of the lungs in 1 minute) by 40% in the first trimester by increasing tidal volume only, since respiratory rates do not change during pregnancy As a result, dioxide in the blood decreases and the blood pH becomes more alkaline (ie higher pH and more basic). This causes the mother's kidneys to secrete bicarbonate to compensate for this pH change. The combined effect of decreased serum concentrations from both carbon dioxide and bicarbonate leads to a slight increase in overall blood pH (to 7.44 compared with 7.40 in non-pregnant states). If an arterial blood plasma specimen (ABG) is taken in a pregnant person, it will reveal respiratory alkalosis (from a decrease in serum-mediated serum carbon dioxide) with compensatory metabolic acidosis (from decreased renal-mediated serum bicarbonate).
As the uterus and fetus continue to enlarge over time, the diaphragm progressively becomes displaced upward. This causes less space available for pulmonary expansion in the chest cavity, and causes decreased volume of expiratory reserves and residual volume. This culminates in a 20% reduction in functional residual capacity (FRC) during pregnancy travel.
Oxygen consumption increases by 20% to 40% during pregnancy, as the oxygen demand of the growing fetus, placenta, and increased metabolic activity of the maternal organs all increase the overall oxygen requirement of the pregnant person. Increased oxygen consumption paired with a decrease in FRC can potentially mean that pregnant people with existing and/or comorbid asthma, pneumonia, or other respiratory problems may be more susceptible to exacerbations of respiratory diseases and decompensation during pregnancy.
See also
- Pregnancy symptoms and discomfort
- Postpartum physiological changes
References
Source of the article : Wikipedia
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