Lecture 3b: Pregnancy and Physiological Changes Flashcards

1
Q

What are the main physiological changes during pregnancy?

A
  • Hormonal
  • Haematological (blood)
  • Gastrointestinal
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2
Q

What happens to progesterone and oestrogen throughout pregnancy?

A

Rise continually throughout pregnancy - suppressing the menstrual cycle

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3
Q

What happens to HCG throughout pregnancy?

A

Huge sudden increase then plateau and decline after about 12-16 weeks then continue as low and stable levels

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4
Q

What do high circulating levels of oestrogen promote?

A

Prolactin production (pituitary gland enlargement)

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5
Q

What do higher levels of prolactin production mediate?

A

A change in the structure of the mammary gland from ductal to lobular-alveolar = milk hormone

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6
Q

What do high levels of parathyroid hormone promote?

A

enhance calcium uptake in the gut and reabsorption by the kidney - to support the second skeleton being development

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7
Q

What are the main increased hormonal changes during pregnancy?

A
  • Progesterone
  • Oestrogen
  • HCG
  • Prolactin
  • Parathyroid Hormone
  • Cortisol
  • Aldosterone
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8
Q

What is HPL?

A

Human Placental Lactogen

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9
Q

Where is HPL produced?

A

In the placenta

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10
Q

What is the role of HPL?

A
  • Decreases maternal insulin sensitivity and maternal glucose utilisation
  • Increases gluconeogenesis
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11
Q

How does decreasing maternal insulin positively influence the fetus?

A

Raises maternal blood glucose levels, which helps to ensure adequate fetal nutrition

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12
Q

What is chronic hypoglycemia?

A

blood sugar levels remain consistently lower than normal over an extended period

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12
Q

What does chronic hypoglycemia lead to?

A

a rise in HPL, which induces lipolysis with the release of FFA’s - become available for mother as a fuel so more glucose can be utilised by the fetus

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12
Q

How does increasing gluconeogenesis positively influence the fetus?

A

To increase maternal glucose levels so more glucose is available for the fetus

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13
Q

How much does blood volume change during pregnancy?

A

Increases 40-45% - proportionally with cardiac output

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14
Q

What happens to blood volume in the first trimester?

A

Plasma volume increases early in pregnancy, faster than RBC volume = hematocrit falls

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15
Q

What happens to blood volume in the second trimester?

A

Increase in RBC is synchronised with the plasma volume increase = hematocrit stabilises

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16
Q

What is dilution anemia?

A

the concentration of red blood cells (RBCs) in the blood is reduced due to an increase in plasma volume proportionally - haemoglobin will be lower

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17
Q

If plasma volume increases, will haemoglobin be lower or higher?

A

Lower

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18
Q

What is the side effects of dilution anemia?

A

Susceptible to iron deficiency, reduced ferritin and haemoglobin

19
Q

What are common GI changes during pregnancy?

A

Constipation, decreased GI motility, heartburn/belching, HCl production decreases

20
Q

Why does constipation occur during pregnancy?

A

Pressure from the enlarging uterus on the rectum and lower portion of the colon

21
Q

Why does GI motility decrease during pregnancy?

A

Elevated levels of progesterone relax smooth muscle

22
Q

Why is heartburn/belching common during pregnancy?

A

Resulting from delayed gastric emptying and gastroesophageal reflux due to relaxation of the lower esophageal sphincter

23
Q

What is a positive effect of decreased HCl production?

A

Ulcers become less severe

24
Q

What is NVP?

A

Nausea and vomiting in pregnancy

25
Q

What is NP?

A

Nausea in pregnancy only

26
Q

What is morning sickness?

A

Definition spans from slight dizziness and dry retching to continuous vomiting - not necessarily in the morning

27
Q

When does morning sickness commonly occur?

A

Between 5 and 18 weeks - for some women starts earlier and continues after

28
Q

How many women report some degree of nausea, with or without vomiting?

A

50-80%

29
Q

What is hyperemesis gravidarum (HP)?

A

Extreme form of NVP accompanied by weight loss, electrolyte imbalance and dehydration requiring hospitalisation

30
Q

How severe is hyperemesis gravidarum (HP)?

A

Can be life threatening (10%) and can affect the health of the child

31
Q

What hormone has found to be linked to NVP?

A

Growth Differentiation Factor 15 (GDF15)

32
Q

What is the impact of GDF15 on NVP?

A

Women with severe NVP or HG often have higher levels of GDF15

33
Q

What are birth outcomes among women experiencing NVP or NP?

A

Women with NVP or NP more likely to develop pregnancy complications but do exhibit mostly favorable delivery and birth outcomes

34
Q

What are the goals of treatment for NVP?

A
  1. Reduce symptoms
  2. Prevent consequences
  3. Minimise fetal effects
35
Q

What are examples of pregnancy complications among women experiencing NVP?

A
  • Increased pelvic pain
  • Proteinuria
  • High BP
  • Pre-clampsia
36
Q

How is NVP managed by diet?

A
  • Eat what appeals
  • Eat slowly and small amounts often
  • Avoid full/empty stomach
  • Frequent small CHO
  • Cold, clear, carbonated or sour fluids
37
Q

Can ginger reduce symptoms of NVP?

A

Improved general symptoms, reduced severity of nausea but did not reduce vomiting

38
Q

Can B6 reduce symptoms of NVP?

A

Unclear about effectiveness

39
Q

Is ginger safe during pregnancy?

A

No increased risk, some small studies showed conflicting results so we just need to be careful

40
Q

When does the risk of ginger during pregnancy increase?

A

Close to labour or in those with history of miscarriage, vaginal bleeding or clotting disorders - NVP tends to be early on so less of an issue

41
Q

What does of ginger is safe to prescribe?

A

1g per day - divided into 3-4 doses per day

42
Q

What is Maori culture towards placenta?

A

Traditionally bury the placenta to emphasise the relationship between humans and the earth

43
Q

What is western culture towards placenta?

A

Most often incinerated or encapsulated

44
Q

What is placentophagia?

A

the practice of consuming the placenta after childbirth

45
Q

What are the suggested benefits of placentophagia?

A
  • Improved lactation, bonding, iron stores, energy, pain
  • Prevent postpartum depression
46
Q

What are the concerns surrounding placentophagia?

A
  • Safe release of placenta from hospital setting
  • Introducing harmful bacteria through processing
47
Q

What is the bottom line for placentophagia?

A

Limited/no evidence for benefits, exposes mothers and infants to infectious risks - should be discouraged