Pregnancy

Question 1

Lactogens

Answer 1

GH

• hGH
• PRL

By placenta

• hGH-V
• hPL

All bind @ PRL R

regulate nutrient mobilization & utilization during pregnancy

Question 2

Growth Hormone

Answer 2

hGH & hGH-V

hGH-V replaces hGH during 2nd trimester

Question 3

Reduced hCG-V

Answer 3

impaired placental f

low maternal IGFs

red nutrient delivery

IUGR (intra uterine growth restriction) &/ SGA (small for gestational age)

hCG-V continuous manner

I GHRH & pit GH

Question 4

PRL

Answer 4

Rise during pregnancy

Reg nutrient mobilization & growth & dev

Question 5

Hormonal suppression of lactogenesis during pregnancy

Answer 5

Progesterone blocks lactogenesis

• acts on breast
• suppress up reg of PRL R
• blocks true lactogenesis
• PRL is elevated by can’t stimulate lactogensis
• Estrogen stim alveoli & duct dev
• estrogen stim colostrum

Clostrum- rich in Y, protein, mild laxative, low in lipid, carbs & H2O

Question 6

hPL

Answer 6

4-5 wk of gestation

homology w/ GH & PRL

Interacts w/ PRL & GH R

elevated associated w/ maternal insulin R

Question 7

Normal glucose transport

Answer 7

glucose primary substrate for fetal metabolism

GLUT on both sides of trophoblast

Via facilitated diffusion

Placenta consumes 50-75%

4-8 mg/kg/min

Question 8

Gestational Diabetes

Answer 8

weight reduction

hazy eyesight

incontinency

increased thirst & hunger

exasperation & irritation

Question 9

Hyperglycemia & GDM

Answer 9

Prevalence in cultures (high w/ american indians, asians, hispanic & black women)

Hihger risk of developing DM2

Question 10

Insulin R

Answer 10

can increase by 3x in pregnancy

2nd & 3rd trimesters

• increase hPL, hGH-V, IGF-1, PRL, CRH & progesterone
• decreased pit hGH
• lower pancreatic B cell compensation
• increased calories

elevated hPL correlates w/ hyperglycemia/insulin R/GDM

Question 11

Insulin R

Answer 11

Mother–> hyperglycemic–> preeclampsia & hyperT–> can cause preTerm delivery

placenta & fetus–>hyperglycemia–>increased fetal growth–> can cause LGA infant

Question 12

BV Changes

Answer 12

anemia is normal during pregnancy (slight)

Plasma vol increases disproportionate to RBC cell mass

Question 13

Uterine Blood Flow

Answer 13

Question 14

CV Changes

Answer 14

Question 15

Renal & GFR

Answer 15

GFR increases to handle increase in PV & CO

Decrease in 3rd trimester so increase vasoconstriction of renal BVs w/ preeclampsia

Incrased release of vasoactive cmpds

renal vascular endothelium exhibits lesions

symport across renal endothelium is dysregulated

Leads to proteinuria

Question 16

Preeclampsia

Answer 16

Hemolysis

ELevated liver enz

Low Platelet count

Question 17

Preeclampsia

Answer 17

vascular change & proteinuria

decrease in RPF

Increase endothelins

Increase ROS

Vasoconstriction & swelling

Reduced endotehlial fenestrae

Dysregulated symport across renal endothelium

Question 18

Maternal Fetal O2 exchange

Answer 18

maternal & fetal blood travel in same direction

for most nutrients fetal levels equilbrate w/ mom venous levels

Question 19

O2

Answer 19

adequate blood flow supplies embryo/fetus w/ nutrients & O2

FHB has higher O2 binding affinity than maternal Hb

This allows for highly efficient transfer of low sat maternal blood in intervillous space to yeild highly ox blood in umbilical v.

fetal EPO from fetal liver that cant cross placenta

Question 20

O2 transport

Answer 20

O2 transport across placenta is by diffusion & highly efficient

1. diffuse through RBC mem
2. into syncytiotrophoblast
3. into BM & across villous stroma
4. across vascular endoth lining fetal BV
5. into fetal RBC
6. quickly binds to FHb

Placenta consumes 30% of O2