Session 6 - Pregnancy changes Flashcards
Describe changes to metabolism in pregnancy
Increased gluconeogenesis, switch main fuel to FAs/ketones, lay down fat as reserve store, produce more insulin in response to meal and become less responsive to insulin,
Describe changes to blood/heart in pregnancy
50% more plasma volume, BP increases, SV increased, tachycardia, loud S1 and S2, systolic murmur, more blood flow to kidneys, boobs and GI, heart bigger and shifted upwards and L
ST depression and T wave inversion
What does progesterone do to mother
Relaxes smooth muscle so get GI symptoms e.g. nausea, constipation, acid reflux, less gastric motility
Increases appetite
Fat storage in mother for extra fuel
Dilates kidney pelvis, can cause urinary stasis and UTIs
What stimulates breast growth in pregnancy
Prolactin and GH
What immunological changes are seen in pregnancy
Less IgA, G and M
What causes change in metabolism in pregnancy
hPL (placental lactogen)
What increase prolactin in pregnancy
Oestrogen
What lowers BP in third trimester and what problems does this cause
Progesterone levels much higher in third term, lowers BP (but volume still high) so causes varicose veins, haemorrhoids, distension, engorgement
What causes baby bone mineralisation?
Placenta makes calcitriol (which increases gut and kidney absorption of Ca2+)
What renal changes occur in pregnancy?
GFR 160% up
Urinary problems during pregnancy
Bladder compressed by gravid uterus causing incontinence, uterus compresses ureters causing pyelonephritis
What is an abnormal heart change in pregnancy
ST elevation
What are risks ass. w gestational diabetes?
If there is maternal hyperglycemia that can cause increased fetal insulin so hyperinsulinemia so promotes storage in fetus so macrosomia, which puts baby at risk for obesity later in life
Risks of macrosomia
At birth: birth trauma, brachial plexus injury, asphyxia, c-section, neonatal hypoglycemia
Later: obesity, congenital abnormalities (VSD, anal atresia)
Why do you need more iron in pregnancy
More plasma volume
