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PREGNANCY
Website : www.tamsmed.com

INTRODUCTION
Two compartment model is the simplest model in pregnant
ladies Mother & Fetus
But in practice, many compartments in mother & fetus may
present e.g. Placenta, amniotic fluid

Fetus  nutrient requiring organism
mainly glucose
Also amino acids, lactate, fatty acids, ketone bodies

METABOLIC CHANGES IN
PREGNANCY

METABOLIC CHANGES IN PREGNANCY
10-20 % increase in BMR by 3RD
trimester
Extra calories required = 300 kcal/day
Weight gain = 11 kgs

WEIGHT GAIN OF PREGNANCY
Due to:
1. Uterus
2. Breast
3. Increase blood volume
4. Increased extravascular extracellular fluid
5. Maternal reserves (increase in cellular w ater, fats &
proteins)

PREGNANCY INDUCED HYPERVOLEMIA
Functions
1. To meet metabolic demands of large uterus with its greatly
hypertrophied vascular system
2. To provide abundant nutrients for placenta & fetus
3. To protect mother & fetus against deleterious effects of
impaired venous return in supine & erect positions
4. To safeguard mother against adverse effects of blood loss
during parturition

INCREASE BLOOD VOLUME
More plasma
increase
RBCs increase

PITTING EDEMA OF PREGNANCY
Because of
1. Increased venous pressure below the level of uterus
because of partial vena cava occlusion
2. Decreased interstitial colloid osmotic pressure

CARBOHYDRATE METABOLISM
Pregnancy is characterized by:
1. Mild fasting hypoglycemia
2. Prolonged post prandial hyperglycemia
3. Hyperinsulinemia
After
meals
4. Greater suppression of glucagon
5. Peripheral insulin resistance
6. Switch in fuels

PERIPHERAL INSULIN RESISTANCE
To ensure a sustained postprandial supply of glucose to
fetus
Because of
1. Placental steroids (estrogen & progesterone)
2. Placental lactogen (causes lipolysis with liberation of
FFA
3. Placental GH is a major determinant of ins-R after mid
pregnancy

SWITCH IN FUELS
From glucose to lipids
Change rapidly from PP state to fasting
So plasma glucose
Plasma concentration of FFA, TG, cholesterol are higher
When fasting prolonged  these alterations are exaggerated
& ketonemia rapidly appears

FAT METABOLISM
Hyperlipidemic state (lipid , lipoprotein, apolipoprotein)
Increase lipolysis & decrease lipoprotein lipase
After delivery, lipid, lipoprotein and apolipoprotein decrease
Lactation speeds these changes

LEPTIN
Peptide hormone secreted by adipose tissue
in pregnancy (peak in 2nd
trimester)
Produced by placenta
ROLE in :
Regulation of increased maternal energy demands
Regulate fetal growth
Role in fetal macrosomia & growth restriction

GHRELIN
Hormone secreted by adipose tissue
in pregnancy (peak in mid pregnancy & then decrease)
Produced by placenta
Role in
Fetal growth & cell proliferation
Regulate growth hormone secretion

PROTEIN METABOLISM
Positive nitrogen balance
Amino acid concentration are higher in fetal rather than
maternal compartment
Regulated by placenta :
Placenta concentrates aa in fetal circ.
It is involved in prot synth, oxidation and transamination

PROTEIN METABOLISM
In pregnancy, though there is increased production on
proteins, decrease in amount of proteins occur due to hemo-
dilution LT hypo albuminemia
Due to decrease in protein binding, increase in free drug
concentration leads to increased therapeutic effect.

PROTEIN METABOLISM
Concentrations of lipoproteins and fat increase in pregnancy
which leads to increased binding of fat with protein
Therefore, availability of protein further decreases for the
drugs to get binding.
Serum albumin become normal after 5-7 wks after
parturition.

FASTING
Glucose
Amino acids
Insulin
Glucagon
Lactogen

FED STATE
Glucose
Amino acids
Insulin

ELECTROLYTE &
MINERAL
METABOLISM

ELECTROLYTE & MINERAL METABOLISM
Na & K retained
But serum Na & K slightly (expanded plasma volume)
Total serum Ca (decreased albumin)
Serum ionized Ca = unchanged
Both total & ionized Mg
Serum phosphate = unchanged

IRON METABOLISM
Early pregnancy in serum Fe & ferritin :
1. Minimal iron demands
2. Amenorrhoea
Requirement is large after mid-pregnancy

HB & HAEMATOCRIT
slightly
If Hb at term is < 11 mg %, it is because of iron deficiency
anemia , and not because of hypervolemia of pregnancy

IMMUNOLOGICAL FUNCTIONS
Suppression of Th 1 & Tc 1
IL-2, interferon Ύ, TNF-β
Upregulation of Th2 cells
IL-4,6,13

LEUKOCYTES
Chemotaxis & adherence functions are depressed
Distribution of cell type is altered:
Granulocyte & CD-8 T-lymphocytes
Monocytes & CD-4 T lymphocytes

INFLAMMATORY MARKERS
Leukocye alkaline phosphatase
CRP
ESR
Complement C-3 & C-4

COAGULATION & FIBRINOLYSIS
All clotting factors except 11, 13
HMW fibrinogen complexes

PLATELETS
Decreased slightly
One study found that in mid-pregnancy thromboxane A2 is
increased , which induces platelet aggregation

REGULATORY PROTEINS
1. Activated protein C
2. Free protein S
3. Protein Z
4. Antithrombin = unchanged

THE PHYSIOLOGICAL
CHANGES DURING
PREGNANCY IS LONGER (1DAY
TO 10 MONTHS) BU T RETURN
IS VERY QUICK (5-7 WKS
AFTER PARTURITION)

THANKS …

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