Hormonal Changes and The Maternal Adaptation to Pregnancy Flashcards
what is the average weight gain of a mother during gestation
1.5-4.5
what components of the pregnant mother contribute to weight gain
blood, fetus, amniotic fluid, adipose tissue, placenta, breast,extracellular water
when is most weight gained during pregnancy
after week 20
what happens to plasma volume during pregnancy
increases the more children you have the more the plasma increases
what hormone causes increases rbc synthesis in mother during pregnancy
erythropoietin
why does a mother with increased rbc during pregnancy appear anemic
number increases but apparent anaemia
due to dilution of hb
what happens to Haematocrit value
drops from 40 to 32 percent ratio of rbc to total blood volume
why does intracellular dpg increase by approx 30% during pregnancy
DPG (2-3 diphosphoglycerate) facilitates
offload of O2
release to fetus
by stabilising tense state
outline fatty acid transport in blood
Lipoprotein lipase releases non-esterified fatty acids ((NEFAS) from the trigyclerides in lipoproteins (LP). NEFAS are then transported across the trophoblast cells by fatty acids transport proteins (FATP)
why are women advised to take folic acid supplements early on
folate supplements in
early pregnancy reduce
neural tube defects and The essential role of Folate and Vitamin B12
in DNA Synthesis
what are the three main hormones to bear in mind from the placenta
hcg, progesterone and estrogen
what happens to estrogen conc as pregnancy progresses
it keeps rising and rising
what does estrogen at high conc do to anterior pituitary
inhibits fsh and lh preventing ovulation
Stimulate synthesis of liver fatty acids and
cholesterol which hormone during pregnancy is responsible
estrogen, fat stored and needed for energy throughout pregnancy and when baby is born for breast feeding
how does estrogen effect uterus for maternal adaptations during pregnancy
- Growth of uterus
* ‘Priming’ of uterus for labour
what does estrogen do to raas
Stimulates Renin-Angiotensin- Aldosterone axis
how does estrogen effect heart during pregnancy
causes cardiac adaptation to aid higher bp and blood volume
how does estrogen affect blood glucose
Weak anti-insulin activity
what does estrogen do to the cervix
cervical ripening
list the effects of estrogen
• Stimulate synthesis of liver fatty acids and
cholesterol
• Cardiovascular adaptation to pregnancy
• Growth of uterus
• ‘Priming’ of uterus for labour
• Weak anti-insulin activity (via enhanced cortisol)
• Onset of labour-relative rise v fall in progesterone?
• Cervical Ripening
• Stimulates Renin-Angiotensin- Aldosterone axis
what does progesterone do to facilitate implantation
Prepares and maintains the endometrium to allow
implantation
after day approx day 60 where does progesterone get produced
placenta
why is progesterone important in delivering child
Plays a role in parturition, just does play a role don’t question
why is progesterone important to fetus
underveloped so Serves as a substrate for fetal adrenal gland
production of glucocorticoids and mineralocorticoids
how does progesterone affect maternal immmune response during gestation
May have a role in suppressing the maternal
immunologic response to fetal antigens thereby
preventing preventing maternal rejection of the
trophoblast
what does progesterone do during preganncy to breathing and c02
• Induces overbreathing and lowering of
maternal CO2
how does progesterone maintain pregnancy
– Inhibition of uterine contractility
– Prevention of ripening of cervix
how does hcg effect corpus luteum
Rescue and maintenance of function of the corpus luteum (continued progesterone production
why is the corpus luteum and hcg so important in first seven weeks of pregnancy
Survival of the pregnancy is dependent on corpus luteum
progesterone until the 7th week of pregnancy
what are the biological functions of hcg apart from maintaining corpus luteum
• Stimulation of maternal thyroid activity
– hCG binds to the TSH receptors of thyroid cells
– LH-hCG receptor is expressed in the thyroid
– Possibly, hCG stimulates thyroid activity via the LHhCG
receptor and by the TSH receptor
where is hpl secreted from
placenta syncytiotrophoblast
why is Maternal lipolysis important during pregnancy and what hormone causes it
HPL, - providing a source of energy for
maternal metabolism and fetal nutrition
Describe HPL anti insulin action
Anti-insulin or “diabetogenic” action - increase in
maternal insulin - favoring provision of mobilizable
amino acids and fetal protein synthesis as well as
glucose for transport to the fetus
describe hpl potent angiogenic action
• Potent angiogenic hormone - may play an important
role in the formation of fetal vasculature
describe and outline action of leptin during pregnancy
secreted by both cytotrophoblast cells and
syncytiotrophoblast; maternal levels are significantly
higher than in non pregnant women and that in the
fetal circulation
• Stimulates placental amino acid/fatty acid transport
• Fetal leptin levels
– correlated positively with fetal birthweight
• Probably plays an important role in fetal development
and growth
what happens to TPVR during pregnancy
decreases
what causes tpvr to fall during gestation
• Increased nitric oxide synthesis • Increased prostacyclin synthesis • Relaxin? • Increased compliance of vessels due to structural changes
what happens to cardiac output during pregnancy
increases
what causes co to increase
increased blood volume due to frank Stirling mechanism
what causes blood volume to increase and ultimately co,
Oestrogen leads to AII-renin- aldosteroneincrease
• Progesterone leads to aldosterone increase
• Vasodilatory PGs aldosterone increase
• ‘Shunting’ of blood to uterine circulation stimulates
sympathetic activity leads to renin increase
• Renal Na loss due to increased GFR leads to renin increase
• hCG leads to renin increase
where does blood flow in pregnancy significantly increase in
skin , kidneys, uterus
during pregnancy what can increased blood flow to skin cause in women
Leads to – increase skin temperature – increase nail growth – increase % of hairs actively growing – disappearance of Raynaud’s syndrome – nose bleeds, nasal stuffiness, snoring
how does pregnancy affect renal function
glycosuria (glucose in urine), calciuria(calcium in urine) ,
frequent urination, urine statsis, and plasma conc of urea and creatinine decrease
what happens to tidal volume during pregnancy
tidal volume increase more gaseous exchange needed to support metabolism and respiration of foetus and mother
what happens to residual volume during pregnancy
decreases
appreciate difference in ribcage of pregnant mother compared to female, due to pressure from uterus and fetus
rib cage in pregnancy widens and rises higher, out and squished up more
outline the main aspects of Pulmonary function in pregnancy
• Tidal volume increases
• Deep breathing stimulated by progesterone
• Respiratory rate unchanged
• Expiratory reserve reduced
• pCO2 decrease , pO2 increase, pH unchanged (HCO3
falls)
• Costal margin and diaphragm altered
what happens to smooth muscle tone of GI tract in pregnancy
reduced
what doe Reduced smooth muscle tone in gi tract during pregnancy leads to
decrease cardiac sphincter tone and mobility, increase nutrient absorption ,water reabsorption and gastric refluc
what changes occur to induce low grade increase in
coagulability -advantageous at delivery
Factors VII, VIII and X increase
– Plasma fibrinogen increase leads to ESR increase
Fibrinolytic activity decreases
