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Maternal Adaptations During Pregnancy > Maternal Adaptations to Pregnancy > Flashcards

Maternal Adaptations to Pregnancy Flashcards

1
Q

why does female body undergo remarkable physiological adaptations when pregnant

A

to support developing foetus

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2
Q

what plays a crucial role in mediating the bodily adaptations to pregnancy

A

maternal hormones

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3
Q

what adaptations are involved during pregnancy

A
  • cardiovascular shifts
  • respiratory modifications
  • metabolism alterations
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4
Q

what changes in pregnancy make nutritional deficiencies a risk, who can this impact during pregnancy

A
  • increased macronutrient and micronutrient demands to support mother and developing foetus
  • nutritional deficiencies during pregnancy can have adverse effects on maternal and foetal health
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5
Q

describe cardiovascular maternal adaptations and why they are occurring

A
  • increase in plasma volume and cardiac output
  • to supply blood to placental vascular bed & increase supply to maternal organs to support extra work they do during pregnancy
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6
Q

[renal adaptations] maternal kidney must adapt during pregnancy. what role does it have

A
  • clearance of waste for foetus and for maternal organs that have increased workload (ie/ more waste)
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7
Q

[renal adaptations] list the renal adaptations (adaptations of kidney) during pregnancy

A
  • increase renal blood flow
  • increase renal size
  • increased glomerular filtration rate (GFR)
  • increased reabsorption of sodium
  • dilation of urinary collecting ducts
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8
Q

[renal adaptations] describe why there is increased renal blood flow

A
  • due to increasing relaxin in circulation
  • induces nitric oxide release
  • causes vasodilation of renal blood vessels
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9
Q

[renal adaptations] describe when and how much renal blood flow increases

A
  • increases early in pregnancy
  • increases ~80% by end of first trimester
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10
Q

[renal adaptations] why doesn’t glomerular pressure increase with the increase in renal blood flow

A
  • because afferent and efferent arterioles dilate
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11
Q

[renal adaptations] why does renal size increase

A
  • since there is greater blood flow into kidney
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12
Q

[renal adaptations] when and by how much does renal size increase

A
  • peaks mid-pregnancy
  • by 1-1.5cm
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13
Q

what is glomerular filtration rate (GFR)

A

measure of how well kidneys are filtering your blood
- kidneys filter blood by removing waste and extra water to make urine
measure how well kidneys functioning

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14
Q

[renal adaptations] when does glomerular filtration rate (GFR) increase and by how much

A
  • increases quickly during pregnancy (within first trimester)
  • by 40-50%
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15
Q

[renal adaptations] what does elevated GFR result in lower serum concentrations of (2)

A
  • urea
  • creatinine
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16
Q

[renal adaptations] what does increased GFR often do to renally-cleared medications & what does this depend on

A
  • increases elimination (20-65%)
  • reduced half-lives (time it takes for concentration in body of that drug to be reduced by exactly half)
  • but effect depends on whether reabsorption in distal tubules also changes which varies between drugs
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17
Q

[renal adaptations] why does reabsorption of sodium in distal tubules increase

A
  • due to elevated aldosterone
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18
Q

[renal adaptations] how does elevated aldosterone lead to increased reabsorption of sodium in distal tubules (less sodium in urine)

A
  • actions of aldosterone contribute to water and sodium retention in pregnancy
    (aldosterone leads to incr sodium resorption from urine back into bloodstream -> osmotic gradient -> hence water follows out of renal tubules into bloodstream)
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19
Q

[renal adaptations] increased water and sodium retention in pregnancy leads to (from incr reabsorption of sodium)

A
  • increase in total body water
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20
Q

[renal adaptations] what does increase in total body water result in (from incr reabsorption of sodium)

A
  • increase in plasma volume
  • provides water in foetus, placenta, amniotic fluid
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21
Q

[renal adaptations] what can increased plasma volume do (from incr sodium reabsorption)

A
  • can decrease circulating concentrations of compounds that are carried in plasma eg/ some drugs and hormones
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22
Q

describe amniotic fluid is and its function

A
  • fluid surrounding developing foetus in utero
  • formed from mother’s plasma (fluid part of blood)
  • functions as: cushion for growing foetus; facilitate exchange of nutrients, water, biochemical products between mother and foetus
  • helps protect baby, help support development
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23
Q

(fluid surrounding foetus in uteruo) what causes dilation of urinary collecting ducts

A
  • due to smooth muscle relaxation
  • induced by progesterone and relaxin (both released during pregnancy)
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24
Q

what is relaxin

A
  • reproductive hormone produced by ovaries (corpus luteum) and placenta
  • helps to relax muscles, joints, ligaments during pregnancy to help body stretch
  • also helps body prepare for delivery by loosening muscles and ligaments in pelvis
  • relaxin is made during normal menstrual cycle
  • relaxin functions: relax uterus; prepare endometrium for implantation; prevent contractions
  • if conception not occur, levels go down until next menstrual cycle
  • if conception occurs, relaxin stays high & continues to rise throughout first trimester
  • relaxin rises more in luteal phase
  • ovaries produce relaxin in normal menstrual cycle (from corpus luteum) during luteal phase; if become pregnant, placenta will also begin to produce & relaxin levels conitnue to rise throughout first trimester
  • in body at low levels during follicular phase, until around ovulation when starts to rise (since corpus luteum formed at ovulation?)
  • relaxin production will soar if become pregnant
  • relaxin levels will peak around end of first trimester (12wks)
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25
Q

list the clinical consequences of renal adaptations and growth of uterus during pregnancy

A
  • risk of UTI
  • glucosuria (glucose in urine) and proteinuria (protein in urine)
  • increased frequency and urgency of urination
26
Q

[renal adaptations] why does risk of UTI increase during pregnancy

A
  • likely due to retention of urine in kidneys (urinary stasis) within dilated collection ducts
  • with outflow of collection ducts compromised by uterine suppression, esp for right kidney (slower urine flow)
27
Q

[renal adaptations] why can glucosuria and proteinuria occur

A
  • due to increased GFR and reduced reabsorption in renal tubules
28
Q

should glucosuria be investigated even though mild glucosuria can be physiological in pregnancy

A
  • yes as may indicate gestational diabetes mellitus
29
Q

[renal adaptations] what do increased frequency and urgency of urination reflect physiological from pregnancy

A
  • increased urine production
  • bladder compression
    esp later in pregnancy
30
Q

[respiratory adaptations] maternal respiratory system has to adapt during pregnancy to achieve:

A
  • meet increased requirements for oxygen
  • clear carbon dioxide from both maternal and foetal systems
31
Q

[respiratory adaptations] adaptations occur despite upward compression of lungs due to what

A

expanding uterus

32
Q

[respiratory adaptations] list important respiratory FUNCTIONAL changes during pregnancy

A
  • O2 consumption increase by 30%
  • 20-50% increase in minute ventilation (volume of air passing thru lungs per minute)
  • 30-50% increase tidal volume (500ml -> 700mL)
  • small incr RR 1-2 breaths per minute
  • increased ventilation (exchange of air between lungs and outside air)
  • 10-25% decrease in functional residual capacity (volume of air remaining in lungs upon normal passive exhalation)
33
Q

[respiratory adaptations] what does the 20-50% increase in minute ventilation (volume of air passing thru lungs per minute) help

A
  • help to meet increased demand for O2
34
Q

[respiratory adaptations] how does the 20-50% increase in minute ventilation (volume of air passing thru lungs per minute) help meet increased O2 demand

A
  • mostly due to increasing tidal volume (amount of air move thru lungs each time inhale and exhale)
35
Q

[respiratory adaptations] how does ventilation (exchange of air between lungs and outside air) increase

A
  • partly due to effects of progesterone - that increases sensitivity of brain respiratory centres to CO2
    => ventilation increases more steeply in response to increasing circulating CO2 than in non-pregnant person
36
Q

[respiratory adaptations] why do pregnant women have lower O2 reserves and more susceptible to become hypoxic - 2 reasons

A
  • higher oxygen consumption
  • lower functional residual capacity
37
Q

[respiratory adaptations] what do the respiratory functional changes in pregnancy lead to in PaO2 and PaCO2

A
  • higher PaO2 (oxygen pressure in arterial blood)
  • PaCO2 lower
38
Q

[respiratory adaptations] what does higher PaO2 and lower PaCO2 facilitate with the foetus

A
  • facilitates O2 and CO2 exchange with the foetus
  • occurring down concentration gradients
39
Q

[respiratory adaptations] what does resulting higher PaO2 and lower PaCO2 result in & what does this do

A
  • result in mild respiratory alkalosis (PH> 7.4)
  • which may benefit O2 exchange across placenta
  • despite partial compensation by increased renal excretion of bicarbonate (to make more acidic)
40
Q

[respiratory adaptations] what are the key respiratory STRUCTURAL changes during pregnancy

A
  • elevation of diaphragm by 4-6cm due to expanding uterus
  • maintenance of lung volume by expansion of rib cage
41
Q

[respiratory adaptations] in respiratory structural change where rib cage expands to maintain lung volume, how does this occur?

A
  • ligaments connecting ribs to sternum relax <- response to elevated progesterone and relaxin (from pregnancy)
  • intercostal angle increases ~50% as rips move upwards and outwards
  • rib cage perimeter increases due to increases in transverse diameter
42
Q

[respiratory adaptations] after respiratory structural change, should spirometry parameters remain normal?

A
  • yes (since expansion of ribcage largely maintains lung volume)
43
Q

if there is abnormal spirometry parameters in a pregnancy and how should it be investigated considering pregnancy indication

A
  • yes
  • should be investigated as indicating potential respiratory disease, not considered as due to pregnancy
44
Q

[respiratory adaptations] there are changes to shape and location of ribcages during pregnancy, what happens to ribcage volume

A
  • stays stable
45
Q

[respiratory adaptations] what are the clinical consequences of respiratory adaptations during pregnancy

A
  • 60-70% normal pregnant women felt dyspnoea (shortness of breath) by thirs trimester
46
Q

[respiratory adaptations] is dyspnoea a physiological change & what is a physiological change with pregnancy

A
  • yes
  • physiological change is a change in normal for an organism to maintain homeostasis under different circumstances
47
Q

[respiratory adaptations] does the dyspnoea reported occur with hypoxia

A

no

48
Q

[feeding and digestive system adaptations during pregnancy] women carrying a singeton foetus gain how much % of their pre-pregnancy weight

A

10-15%

49
Q

[feeding and digestive system adaptations during pregnancy] what weight is included in the weight-gain during pregnancy

A
  • foetal weight gain
  • placental weight gain
  • deposition of adipose depots (fat) to support subsequent lactation
50
Q

[feeding and digestive system adaptations during pregnancy] pregnancy requires increased energy and nutrient needs, what adaptations are made

A
  • enable increased food take
  • enable increased food absorption
51
Q

[feeding and digestive system adaptations during pregnancy] how much does food intake increase by in third trimester & briefly how is this possible

A

~10%
- made by adaptations to central (brain) and peripheral (in GI tract) mechanisms which regulate food intake

52
Q

[feeding and digestive system adaptations during pregnancy] what are the maternal adaptations in CNS that enable increased food intake during pregnancy w/ MoA

A
  • resistance to action of leptin in brain -> increases in circulating leptin during pregnancy do not inhibit appetite
53
Q

[feeding and digestive system adaptations during pregnancy] what are the maternal adaptations in PNS that enable increased food intake during pregnancy w/ MoA

A
  • decreased gastric sensing of stretch -> enable larger meals to be eaten before fullness signals satiety
54
Q

what is leptin

A
  • hormone produced by adipose tissue (body fat) cells
  • helps body maintain your normal weight on long-term basis by regulating hunger
  • provides sensation of satiety (feeling full)
55
Q

[feeding and digestive system adaptations during pregnancy] maternal adaptations that enable increased food absorption

A
  • increased size and weight of small intestine
  • slowed motility of small intestine during pregnancy due to rising progesterone
56
Q

where in the body is the main site of nutrient absorption

A

small intestine

57
Q

[feeding and digestive system adaptations during pregnancy] what change in macronutrient absorption seen in pregnancy regarding glucose & what does this suggest

A
  • circulating glucose rises more after oral glucose, with a delayed peak, in pregnant women
  • suggests increase in small intestine capacity to absorb glucose
58
Q

[feeding and digestive system adaptations during pregnancy] change in which micronutrient absorption is seen in pregnancy & what are they critical for

A
  • absorption of iron, calcium, zinc - incr during pregnancy
  • these micronutrients are critical for foetal development and later, milk production
59
Q

[feeding and digestive system adaptations during pregnancy] what clinical consequences of gastrointestinal adaptations during pregnancy are there: (% affected included)

A
  • dyspepsia - affects 17-45% pregnant women
  • constipation - more common during pregnancy than in general population; affects 11-38% of pregnant women
60
Q

what is dyspepsia

A

pain / discomfort in the stomach such as indigestion and heartburn

61
Q

[feeding and digestive system adaptations during pregnancy] why is constipation a common clinical consequence of the GI adaptations made during pregnancy

A
  • constipation
  • due to reduced motility (adaptation) of GI tract
  • and due to compression of GI tract from enlarged uterus
62
Q

[feeding and digestive system adaptations during pregnancy] in maternal adaptation to enable increased food absorption, there is reduced motility of small intestine due to progesterone, MoA?

A
  • progesterone action on smooth muscle in gut to relax => don’t push food through GI system as quickly
    => increases time that gut contents (food) are in small intestine
    => more contact between food & surfaces of small intestinal - where absorption occurs
    -> promote nutrient absorption

Maternal Adaptations During Pregnancy (4 decks)

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