Hormonal Changes and The Maternal Adaptation to Pregnancy

Question 1

what is the average weight gain of a mother during gestation

Answer 1

1.5-4.5

Question 2

what components of the pregnant mother contribute to weight gain

Answer 2

blood, fetus, amniotic fluid, adipose tissue, placenta, breast,extracellular water

Question 3

when is most weight gained during pregnancy

Answer 3

after week 20

Question 4

what happens to plasma volume during pregnancy

Answer 4

increases the more children you have the more the plasma increases

Question 5

what hormone causes increases rbc synthesis in mother during pregnancy

Answer 5

erythropoietin

Question 6

why does a mother with increased rbc during pregnancy appear anemic

Answer 6

number increases but apparent anaemia

due to dilution of hb

Question 7

what happens to Haematocrit value

Answer 7

drops from 40 to 32 percent ratio of rbc to total blood volume

Question 8

why does intracellular dpg increase by approx 30% during pregnancy

Answer 8

DPG (2-3 diphosphoglycerate) facilitates
offload of O2
release to fetus
by stabilising tense state

Question 9

outline fatty acid transport in blood

Answer 9

Lipoprotein lipase
releases non-esterified
fatty acids ((NEFAS)
from the
trigyclerides in
lipoproteins (LP).
NEFAS are then transported
across the trophoblast cells
by fatty acids transport
proteins (FATP)

Question 10

why are women advised to take folic acid supplements early on

Answer 10

folate supplements in
early pregnancy reduce
neural tube defects and The essential role of Folate and Vitamin B12
in DNA Synthesis

Question 11

what are the three main hormones to bear in mind from the placenta

Answer 11

hcg, progesterone and estrogen

Question 12

what happens to estrogen conc as pregnancy progresses

Answer 12

it keeps rising and rising

Question 13

what does estrogen at high conc do to anterior pituitary

Answer 13

inhibits fsh and lh preventing ovulation

Question 14

Stimulate synthesis of liver fatty acids and

cholesterol which hormone during pregnancy is responsible

Answer 14

estrogen, fat stored and needed for energy throughout pregnancy and when baby is born for breast feeding

Question 15

how does estrogen effect uterus for maternal adaptations during pregnancy

Answer 15

• Growth of uterus

* ‘Priming’ of uterus for labour

Question 16

what does estrogen do to raas

Answer 16

Stimulates Renin-Angiotensin- Aldosterone axis

Question 17

how does estrogen effect heart during pregnancy

Answer 17

causes cardiac adaptation to aid higher bp and blood volume

Question 18

how does estrogen affect blood glucose

Answer 18

Weak anti-insulin activity

Question 19

what does estrogen do to the cervix

Answer 19

cervical ripening

Question 20

list the effects of estrogen

Answer 20

• Stimulate synthesis of liver fatty acids and
cholesterol
• Cardiovascular adaptation to pregnancy
• Growth of uterus
• ‘Priming’ of uterus for labour
• Weak anti-insulin activity (via enhanced cortisol)
• Onset of labour-relative rise v fall in progesterone?
• Cervical Ripening
• Stimulates Renin-Angiotensin- Aldosterone axis

Question 21

what does progesterone do to facilitate implantation

Answer 21

Prepares and maintains the endometrium to allow

implantation

Question 22

after day approx day 60 where does progesterone get produced

Answer 22

placenta

Question 23

why is progesterone important in delivering child

Answer 23

Plays a role in parturition, just does play a role don’t question

Question 24

why is progesterone important to fetus

Answer 24

underveloped so Serves as a substrate for fetal adrenal gland
production of glucocorticoids and mineralocorticoids

Question 25

how does progesterone affect maternal immmune response during gestation

Answer 25

May have a role in suppressing the maternal immunologic response to fetal antigens thereby preventing preventing maternal rejection of the trophoblast

Question 26

what does progesterone do during preganncy to breathing and c02

Answer 26

• Induces overbreathing and lowering of | maternal CO2

Question 27

how does progesterone maintain pregnancy

Answer 27

– Inhibition of uterine contractility | – Prevention of ripening of cervix

Question 28

how does hcg effect corpus luteum

Answer 28

``` Rescue and maintenance of function of the corpus luteum (continued progesterone production ```

Question 29

why is the corpus luteum and hcg so important in first seven weeks of pregnancy

Answer 29

Survival of the pregnancy is dependent on corpus luteum | progesterone until the 7th week of pregnancy

Question 30

what are the biological functions of hcg apart from maintaining corpus luteum

Answer 30

• Stimulation of maternal thyroid activity – hCG binds to the TSH receptors of thyroid cells – LH-hCG receptor is expressed in the thyroid – Possibly, hCG stimulates thyroid activity via the LHhCG receptor and by the TSH receptor

Question 31

where is hpl secreted from

Answer 31

placenta syncytiotrophoblast

Question 32

why is Maternal lipolysis important during pregnancy and what hormone causes it

Answer 32

HPL, - providing a source of energy for | maternal metabolism and fetal nutrition

Question 33

Describe HPL anti insulin action

Answer 33

Anti-insulin or "diabetogenic" action - increase in maternal insulin - favoring provision of mobilizable amino acids and fetal protein synthesis as well as glucose for transport to the fetus

Question 34

describe hpl potent angiogenic action

Answer 34

• Potent angiogenic hormone - may play an important | role in the formation of fetal vasculature

Question 35

describe and outline action of leptin during pregnancy

Answer 35

secreted by both cytotrophoblast cells and syncytiotrophoblast; maternal levels are significantly higher than in non pregnant women and that in the fetal circulation • Stimulates placental amino acid/fatty acid transport • Fetal leptin levels – correlated positively with fetal birthweight • Probably plays an important role in fetal development and growth

Question 36

what happens to TPVR during pregnancy

Answer 36

decreases

Question 37

what causes tpvr to fall during gestation

Answer 37

``` • Increased nitric oxide synthesis • Increased prostacyclin synthesis • Relaxin? • Increased compliance of vessels due to structural changes ```

Question 38

what happens to cardiac output during pregnancy

Answer 38

increases

Question 39

what causes co to increase

Answer 39

increased blood volume due to frank Stirling mechanism

Question 40

what causes blood volume to increase and ultimately co,

Answer 40

Oestrogen leads to AII-renin- aldosteroneincrease • Progesterone leads to aldosterone increase • Vasodilatory PGs  aldosterone increase • ‘Shunting’ of blood to uterine circulation stimulates sympathetic activity leads to renin increase • Renal Na loss due to increased GFR leads to renin increase • hCG leads to renin increase

Question 41

where does blood flow in pregnancy significantly increase in

Answer 41

skin , kidneys, uterus

Question 42

during pregnancy what can increased blood flow to skin cause in women

Answer 42

``` Leads to – increase skin temperature – increase nail growth – increase % of hairs actively growing – disappearance of Raynaud’s syndrome – nose bleeds, nasal stuffiness, snoring ```

Question 43

how does pregnancy affect renal function

Answer 43

glycosuria (glucose in urine), calciuria(calcium in urine) , | frequent urination, urine statsis, and plasma conc of urea and creatinine decrease

Question 44

what happens to tidal volume during pregnancy

Answer 44

tidal volume increase more gaseous exchange needed to support metabolism and respiration of foetus and mother

Question 45

what happens to residual volume during pregnancy

Answer 45

decreases

Question 46

appreciate difference in ribcage of pregnant mother compared to female, due to pressure from uterus and fetus

Answer 46

rib cage in pregnancy widens and rises higher, out and squished up more

Question 47

outline the main aspects of Pulmonary function in pregnancy

Answer 47

• Tidal volume increases • Deep breathing stimulated by progesterone • Respiratory rate unchanged • Expiratory reserve reduced • pCO2 decrease , pO2 increase, pH unchanged (HCO3 falls) • Costal margin and diaphragm altered

Question 48

what happens to smooth muscle tone of GI tract in pregnancy

Answer 48

reduced

Question 49

what doe Reduced smooth muscle tone in gi tract during pregnancy leads to

Answer 49

decrease cardiac sphincter tone and mobility, increase nutrient absorption ,water reabsorption and gastric refluc

Question 50

what changes occur to induce low grade increase in | coagulability -advantageous at delivery

Answer 50

Factors VII, VIII and X increase – Plasma fibrinogen increase leads to ESR increase Fibrinolytic activity decreases