Hormonal and maternal adaptations to pregnancy Flashcards

1
Q

What changes occur in the maternal red blood cells of a pregnant woman?

A

Synthesis increases (stimulated by erythropoetin)
Number increases, but apparent anaemia due to dilution
Haematocrit falls from approx 40% to 32%
30% increase in 2,3-DPG facilitates offload of O2 to foetus

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2
Q

What can low folate levels in pregnancy lead to?

A

Neural tube defects

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3
Q

What role do oestrogens play in pregnancy?

A

Stimulate synthesis of liver fatty acids and cholesterol
Cardiovascular adaptation to pregnancy
Growth of uterus
Priming of uterus for labour
Weak any-insulin activity (via enhanced cortisol)
Onset of labour-relative risk
Cervical ripening

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4
Q

What is the role of progesterone in pregnancy?

A

Prepares and maintains the endometrium to allow implantation

Produced initially by corpus luteum (up to day 50-60) then placenta

Suppresses maternal immunologic response to foetal antigens, preventing maternal rejection of trophoblast

Plays a role in parturition

Acts as a substrate in foetal adrenal production of glucocorticoidss and mineralocorticoids

Growth of mammary glands

Maintenance of pregnancy (inhibits uterine contractility, prevents ripening of cervix)

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5
Q

Where is progesterone produced in pregnancy?

A

Produced initially by corpus luteum (up to day 50-60) then placenta

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6
Q

What are the functions of hCG

A

Rescue and maintenance of function of corpus luteum (continued progesterone production)

Stimulation of maternal thyroid activity (binds to TSH receptors of thyroid cells)

Maternal lipolysis and increase in maternal free fatty acids, providing a source of energy for maternal metabolism and foetal nutrition

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7
Q

What placental protein is low in preeclampsia?

A

PlGF, placenta growth factor

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8
Q

What cells secrete leptin?

A

Cytotrophoblast cells, syncytiotrophoblast cells

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9
Q

How are leptin levels in pregnancy vs. in non-pregnant women

A

Sig. higher in pregnant women then in non-pregnany women

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10
Q

What is leptin used for in pregnancy?

A

Stimulates placental amino acid/fatty acid transport

Correlated positively with foetal birthweight

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11
Q

What causes peripheral resistance to fall in pregnancy?

A

Increased NO synthesis
Increased prostacyclin synthesis
Increased compliance of vessels due to structural changes

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12
Q

Describe how renal function changes during pregnancy

A

Plasma concentrations of renal function (like urea, creatinine) decrease
Glycosuria
Calciuria
Urinary freq. increases
Urinary stasis due to dilatation of collecting system

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13
Q

Describe how pulmonary function changes during pregnancy

A
Tidal volume increases
Deep breathing stimulated by progesterone
Respiratory rate unchanged
Expiratory reserve reduced
PCO2 falls, PO2 increases
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14
Q

Describe how the gastrointestinal tract changes in pregnancy

A

Reduced smooth muscle tone (lower motility, mobility, cardiac sphincter tone)
Leads to biliary stasis, gastric reflux, increased nutrient absorption, water reabsorption

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