Adaptations of Digestive System

Question 1

What percentage of women have an increased appetite and thirst during pregnancy?

Answer 1

• 50%

Question 2

Why do women have an increase in appetite in early pregnancy?

Answer 2

• Due to pregnancy induced CENTRAL LEPTIN RESISTANCE
• Causes increased food intake and fat deposit

Question 3

Why do women have an increased thirst during pregnancy?

Answer 3

• HCG affects the hypothalamus by DECREASING osmotic threshold for thirst.

Question 4

What does pregnancy induced central leptin resistance increase? (x2)

Answer 4

• Food intake
• Fat deposit

Question 5

What does leptin usually do?

Answer 5

• Suppress appetite to maintain a healthy BMI.

Question 6

In late pregnancy why does gastric displacement occur?

Answer 6

• Due to the enlarging uterus which causes a reduction in capacity for food intake.

Question 7

What 2 hormones affect appetite? How?

Answer 7

• PROGESTERONE (stimulates appetite)
• OESTROGEN (decreases appetite)

Question 8

Cravings and Aversions

Answer 8

• Some food choices are deliberate (recommended/avoided in pregnancy via midwife’s advice) e.g. listeria avoided
• Taste buds are DULLED during pregnancy, women may crave strong flavours e.g. pickles
• Aversions to alcohol/tea/coffee/smoking
• PICA (extreme craving of non-nutritious substance) e.g. coal/disinfectant
• Changes to smell/taste linked to HCG secretion in early pregnancy

Question 9

What is pica? (cravings and aversions)

Answer 9

• Extreme craving of a non-nutritious substance e.g. coal/ soap/ disinfectant

Question 10

Gums (+saliva)

Answer 10

• Increased vascularity/oedema/spongy gums
  (due to oestrogens effects on blood)
• Gums bleed more during pregnancy
• Saliva becomes more acidic (rare cases saliva can increase pytalism)

Question 11

Heartburn

Answer 11

• Caused by regurgitation of stomach contents
• PROGESTERONE –> relaxes cardiac sphincter at entrance of stomach
  (continues throughout pregnancy due to mechanical displacement of the stomach due to enlarging uterus)

MIDWIVES ROLE
–> refer to GP for gaviscon/omeprozole

Question 12

What is heartburn caused by?

Answer 12

• Regurgitation of stomach contents

Question 13

What medications are prescribed by the GP to individuals with severe heartburn?

Answer 13

• Gaviscon
• Omeprazole

Question 14

What does progesterone do in relation to heartburn?

Answer 14

• Relaxes cardiac sphincter at entrance of the stomach

Question 15

Why does regurgitation of the stomach contents continue to occur throughout pregnancy, sometimes causing heartburn?

Answer 15

• Due to mechanical displacement of the stomach (Due to enlarging uterus)

Question 16

What is the midwives role in relation to heartburn?

Answer 16

• Refer to GP for gaviscon or omeprazole.

Question 17

How does omeprazole work to reduce heartburn?

Answer 17

• Prevents proton pumps working properly (proton. pumps line the stomach and make acid for digestion)
• This reduces the amount of acid the stomach makes

Question 18

What is often the first symptom of pregnancy and how long can this symptom occur for?

Answer 18

• Nausea and vomiting
• 16th weeks gestation

Question 19

Why has progesterone been linked to vomiting?

Answer 19

• Delayed GASTRIC EMPTYING
• (because it relaxes the smooth muscle)

Question 20

Why is nausea and vomiting seen as a evolutionary mechanism?

Answer 20

• Protects the fetus from potential teratogenic substances

Question 21

What is a teratogenic substance?

Answer 21

• Substances that can cause congenital disorders in developing embryos/fetus’
• E.g. drugs, infections, toxins

Question 22

What has been linked to vomiting and nausea but has not been clearly established?

Answer 22

• Peak HCG levels in early pregnancy

Question 23

What is severe sickness called?

Answer 23

• Hyperemesis

Question 24

What is the midwives role for individuals with severe nausea and vomiting?

Answer 24

• Dietary advice (eating little and often) (dry foods)
• Referrals if required (e.g. anti-sickness medication/ IV hydration drip i.e isotonic saline)

Question 25

What are the 2 increased maternal demands that cause maternal metabolism changes in pregnancy?

Answer 25

- Accumulation of energy stores for labour and lactation e.g. glucose--->glycogen - Facilitation of fetal growth and development

Question 26

What fetal aspect causes a change in metabolic rate?

Answer 26

- Need to facilitate the accumulation of fetal energy stores for its transition to extrauterine life.

Question 27

What happens to the metabolic rate during pregnancy?

Answer 27

- INCREASES

Question 28

What is the role of the midwife in metabolic rate?

Answer 28

- Dietary advice

Question 29

How does progesterone link to constipation during pregnancy?

Answer 29

- Relaxation of smooth muscle causes movement of chyme in the large intestine to slow down. (allows for more time for reabsorption of WATER and NUTRIENTS)

Question 30

Which 5 components are absorbed increasingly during pregnancy? + What is the benefit of this?

Answer 30

- IRON - CALCIUM - GLUCOSE - WATER - AMINO ACIDS (supplies body and fetes with required nutrients)

Question 31

What is the role of the midwife if an individual suffers with constipation during pregnancy?

Answer 31

- Referral to GP for lactulose - Advise to drink lots of water

Question 32

What happens in early pregnancy in relation to carbohydrate metabolism and insulin resistance?

Answer 32

- Increased response to insulin so blood glucose levels drop. - Increased sensitivity to insulin which means there is an increased uptake of nutrients by cells. (promotes maternal tissue growth)

Question 33

How does oestrogen effect insulin secretion during early pregnancy?

Answer 33

- Stimulates growth of pancreatic beta cells causing insulin secretion to also increase.

Question 34

What happens in late pregnancy in relation to carbohydrate metabolism and insulin resistance?

Answer 34

- Fetal unit growth and placental hormones (e.g. HPL) increase. (These are ANTAGONISTIC to insulin) - This means maternal tissues become resistant to insulin, meaning insulin is less effective at stimulating glucose uptake

Question 35

What component has an increased level during pregnancy which is transported to the foetus? (insulin res and carb met)

Answer 35

- Circulatory glucose