Term
|
Definition
Estrogen makes gums softer & hyperemic so they bleed more.
Increased risk for gingivitis and periodontal disease
Can form Epulis |
|
|
Term
|
Definition
| Localized vascular swelling of gums. |
|
|
Term
| Esophagus and lower esophageal spinchter in pregnancy |
|
Definition
Progesterone causes relaxation of the smooth muscles and sphincters of the esophagus.
Increases heartburn. |
|
|
Term
|
Definition
Displaced up and back by the uterus.
Increased N/V due to increased estrogen, Inc. HCG levels, Inc T4, slow bowels, and possibly maternal emotions. |
|
|
Term
|
Definition
Excessive salivation.
In pregnancy usually associated with nausea and GERD. |
|
|
Term
| Small and Large intestine |
|
Definition
Progesterone causes bowels to be relaxed.
Slowed peristalsis and transit time of food allows for increased absorption.
Increased absorption of H2O leads to constipation and often times hemorrhoids. |
|
|
Term
| Pancreas, serum amylase and lipase in pregnancy |
|
Definition
Estrogen can lead to increased risk for pancreatits.
Serum amylase and lipse decrease during first trimester of pregnancy |
|
|
Term
|
Definition
Progesterone causes slowed peristalsis which leads to inc. bile volume and bile stasis.
Estrogen can cause cholesterolin bile to increase dramatically.
Combined, this increases risk for gall stones. |
|
|
Term
|
Definition
Displaced up and back.
Estrogen increases clotting factors 7,8,9,10, as well as thyroxine-binding and corticosteroid binding globulins.
Progesterone causes and inc in cytochromic P450- important for drug therapy in pregnancy.
Alk Phos inc due to fetus and placenta.
Albumin and total protein dec, partially due to hemodilution. |
|
|
Term
|
Definition
Unchanged until labor and birth when they increase to twice normal value.
May continue to rise up to day 10pp, then back to normal by 2-3w. |
|
|
Term
| GGT (gamma glutamyl transaminase) in pregnancy |
|
Definition
slight decrease in upper limit.
Important in synthesis of amino acids for maternal and fetal use.
Increase in labor.
May continue to rise up to day 10pp, then back to normal by 2-3w. (p.400) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Alkaline Phosphatase in preg |
|
Definition
increase by 2-4x in preg, and inc further during labor.
Due to increased production by fetus and placenta, not maternal liver.
Decreases after delivery and back to normal by day 20, but may remain elevated up to 6w. |
|
|
Term
| Basal Metabolic Rate (metabolism) |
|
Definition
Increases 8x above pre-pregnancy rate.
Requires additional 300cal/d
It is possible that this is caused by leptin monitoring a woman’s prepregnancy energy stores and adjusting or coordinateing maternal metabolic resources. |
|
|
Term
|
Definition
First and second trimesters.
Food intake and appetite are increased, activity is decreased, approx. 3.5 kg of fat is deposited, energy reserves are established, and 900 g of new protein is synthesized by the mother, fetus, and placenta.
Time of construction of complex molecules for storage as fat or energy.
Insulin acts as a growth hormone.
Maternal weight gain is d/t fat stores and synthesis of proteins in tissues. |
|
|
Term
|
Definition
Third trimester.
Breakdown of complex molecules (stored fat) for energy.
Lipolysis increases and pregnancy hormones cause insulin resistance.
Maternal ketone production is increased.
Maternal weight gain is fetal growth. |
|
|
Term
|
Definition
In first half of preg insulin responses are enhanced. Mom's fat is more sensitive to insulin- lipogenesis and fat storage.
20w-term insulin secretions and resistance increase with decreased glucose uptake by maternal muscles and fat. Glucose goes to fetal siphon. |
|
|
Term
| Maternal leptin in pregnancy |
|
Definition
Increases 2-4x, produced & secreted by fat cells and placenta.
Helps regulate appetite and enhance energy use.
Contributes to fetal development.
Preeclamptic and DM patients will have even higher levels.
Low levels associated with SAB. |
|
|
Term
| Carbohydrate metabolism in pregnancy |
|
Definition
Pregnancy is a "diabetogenic" state.
Fasting glucose will be lower than non preg b/c of "fetal siphon". Baby takes what it needs.
Postprandial glu will be higher than non preg b/c of "facilitated anabolism", to help sustain needed glucose for fetus.
Insulin resistance is mediated by hPL (human placental lactogen), estrogen, progesterone, and leptin. |
|
|
Term
|
Definition
Occurs in catabolic state (3rd tri).
Insulin resistance is increased, making it more difficult for glucose to enter maternal cells.
Non preg pts. require 14-18hrs fasting before the body will switch from using glucose as the primary fuel source to lipolysis.
In pregnancy this switch occurs after only 2-3hrs of fasting.
These changes are caused in part by human placental lactogen which is anti-insulin & Lipolytic actions. |
|
|
Term
| Maternal protein metabolism in pregnancy |
|
Definition
Decreased
Amino acids are also decreased b/c they are transported from maternal blood to the fetus.
Maternal muscle does not get broken down to meet fetal needs. There are no byproducts in the urine. |
|
|
Term
| Fat (lipid) metabolism in pregnancy |
|
Definition
During the first two trimesters weeks 10-30), triglyceride synthesis and fat storage increase, d/t inc insulin responsiveness, progesterone, leptin, prolactin, and cortisol.
HPL will assist with fat breakdown because it is lipolytic and anti-insulinogenic.
Body will use accelerated starvation, thus, fats are used by the mother as an alternative energy source, allowing them to conserve glucose for the fetus during the 2nd half of gestation
Inc. triglycerides, cholesterol, and phospholipids. |
|
|
Term
| Triglycerides in pregnancy |
|
Definition
VLDL increases threefold in the 2nd and 3rd trimesters.
LDL decreases slightly initially, followed by rise.
HDL increases to 24 wks, then decreases to 32 wks and stabilizes.
Triglycerides increase 40% by 18 wks and 250% by term.
Phospholipids & cholesterol levels increase.
By late pg, cholesterol levels are 50% higher than prior.
Even with inc in cholesterol and triglycerides being pregnant does not increase your risk for heart disease or hypercholesterolemia. |
|
|
Term
| Common GI discomforts in pregnancy |
|
Definition
N/V- d/t inc. estrogen, HCG, T4
Constipation and flatulence- d/t progesterone and relaxin slowing GI tract and increased water absorption from bowel.
Gingivitis/Epulis-d/t inc estrogen.
Hemorrhoids- d/t constipation, gravity, and pressure from growing uterus.
Diastasis recti- d/t abd wall stretching by uterus.
Pica
Pytalism
Heartburn-d/t progesterone relaxing LES and later (3rd tri) from the pressure of the fetus on stomach. |
|
|
Term
|
Definition
Separation of the rectus abdominis muscle into right and left halves.
Cosmetic condition, with no associated morbidity or mortality.
Caused by the stretching of the rectus abdominis by the growing uterus.
More common in multiparous women due to repeated episodes of stretching. |
|
|
Term
|
Definition
| Cravings for non-food substances. |
|
|
Term
| Common metabolic discomforts in pregnancy |
|
Definition
Fatigue d/t inc. weight and anemia.
Faintness d/t dec BP. |
|
|
Term
| Which of the pregnancy hormones is an appetite stimulant? |
|
Definition
|
|
Term
| List the perinatal complications that periodontal disease can cause. |
|
Definition
Periodontal disease has been associated with intrauterine infection, and an inc. risk of preterm birth and low-birth weight risk.
Increased prostaglandin synthesis mediated by proinflammatory cytokines from inflamed gingival tissues or via release of bacterial endotoxins could initiate labor onset. |
|
|
Term
| Explain the changes in intestinal absorption of calcium, iron, glucose and water. |
|
Definition
Progesterone slows transit which increases absorption.
The amount & efficiency of intestinal calcium absorption increase, mediated by increased 1,25-dihydroxyvitamin D.
Absorption of iron increases nearly twofold by late preg, in response to a reduction of maternal iron stores.
The reduced motility and increased transit time in the large intestine increase water absorption in the colon. |
|
|
Term
| Weight gained during pregnancy can be divided 3 main parts. What are these parts and what percentage of weight gain can be attributed to each? |
|
Definition
Maternal: 64%
Fetal: 25%
Placental: 11% |
|
|
Term
| Why does lactation help with weight loss postpartum? |
|
Definition
| Lactation may facilitate postpartum weight and body fat loss as maternal tissue stores are catabolized to use as energy for milk production. |
|
|
Term
| Should food and fluids be restricted during labor in low-risk women? |
|
Definition
Most studies have not reported adverse effects of oral intake during labor in low-risk women.
Current guidelines from professional groups also support oral intake during labor in low-risk women.
Potential benefits of less restrictions include meeting maternal energy needs and reducing maternal stress and the risks of ketosis, hyponatremia, and vomiting. |
|
|
Term
| What are the effects on perinatal outcomes if the maternal BMI is low? |
|
Definition
Increased risk for:
preterm and small-for-gestational-age (SGA) infants.
Decreased risk for:
macrosomia
preeclampsia
cesarean birth |
|
|
Term
| What are the effects on perinatal outcomes if the maternal BMI is high? |
|
Definition
Increased risk for :
spontaneous abortion
congenital anomalies
intrauterine death
gestational diabetes
hypertensive disorders
preeclampsia
Decreased risk for:
SGA and growth-restricted infants
thromboembolic complications
cesarean birth |
|
|
Term
| What two hormones associated with the stress of labor will cause water and sodium retention and weight gain? |
|
Definition
| increased adrenocortical hormone and arginine vasopressin activity |
|
|
Term
| What does it mean when pregnancy is described as a diabetogenic state? |
|
Definition
Glucose utilization and insulin actions are altered during pregnancy by hPL, estrogen, progesterone, and possibly leptin.
These changes stimulate alterations in lipid and protein metabolism, and increase the availability of glucose and amino acids for transfer fetus, while at the same time providing an alternative energy (free fatty acids) to meet maternal needs and maintain homeostasis. |
|
|
Term
| Describe how women of different weights and situations may change their metabolism to sustain a pregnancy. |
|
Definition
The pregnant woman meets the energy demands of pg by increasing her intake, decreasing her activity, or limiting fat storage. 3 examples:
First, an underweight impoverished woman with limited food, poor fat stores, and need for physical work cannot increase food intake or limit physical activity during pg. Her body responds by decreasing basal energy expenditures so that pregnant energy needs are similar to prepregnant needs.
Second, a normal weight woman in a developed country with fat stores before pt and adequate nutrition during pg increases fat stores in pg and increases her BMR slightly.
Finally, an overweight woman in a developed country increases her BMR by 20% or more, perhaps to reduce additional fat deposition. |
|
|
Term
|
Definition
Appetite suppresant
Increases insulin secretions
Enhances glucose use
Increases plasma cortisol
Assists with insulin resistance |
|
|
Term
|
Definition
Appetite stimulant
Augments insulin secretion
Increases fasting plasma insulin
Decreases peripherial insulin effectiveness (insulin resistance) |
|
|
Term
|
Definition
Inhibits glucose uptake(insulin antagonist, makes glu in blood higher, assists with insulin resistance)
Increases liver glucose production |
|
|
Term
|
Definition
Stimulates insulin production
Assistes with insulin resistance |
|
|
Term
| Effects of human placental lactogen (hPL) |
|
Definition
The most potent insulin antagoinist of all the placental hormones.
The "Growth hormone" of the 2nd half preg.
Causes insulin resistance in mom |
|
|
Term
|
Definition
Helps regulate appetite and food intake
Enhances energy expenditure |
|
|
Term
|
Definition
| Regulates placenta growth hormone |
|
|
Term
|
Definition
Comes from maternal fat cells and placenta.
Serum levels increase in first 20 weeks, then decrease when insulin resistance increases. |
|
|
Term
| Describe the role of human placental lactogen (hPL) in carbohydrate metabolism. |
|
Definition
| Spares maternal carbs (glucose) by providing alternative enery sources such as free fatty acids for mother. Increases synthesis and availability of lipids. Lipids can be used by the mother as an alternative fuel, enhancing availability and transfer of glucose and amino acids to the fetus. |
|
|
Term
| Describe the role of estrogen, in carbohydrate metabolism. |
|
Definition
| Estrogen increases the level of plasma cortisol, stimulates B-cell hyperplasia (and thus insulin production), and enhances peripheral glucose utilization. This leads to dec. fasting glucose levels, improved glucose tolerance, and increased glycogen stores. |
|
|
Term
| Describe the role of progesterone, in carbohydrate metabolism. |
|
Definition
| Progesterone augments insulin secretion, decreases peripheral insulin effectiveness, and increases insulin levels after a meal. |
|
|
Term
| Describe the role of cortisol in carbohydrate metabolism. |
|
Definition
| Mediates the changes by estrogen and progesterone by inhibiting glucose uptake and oxidation, increasing liver glucose production, and possibly augmenting glucagon secretion. |
|
|
Term
| How do the changes in carb metabolism affect glucose tolerance tests? |
|
Definition
| Changes result in an elevated blood glucose response to carbohydrate load. |
|
|
Term
| What happens to serum amino acid and protein levels in pregnancy and why? |
|
Definition
Decreased serum amino acid and serum protein levels are found in pg, r/t increased placental uptake, increased insulin levels, hepatic diversion of amino acids for gluconeogenesis, and transfer of amino acids to the fetus.
The fetus uses some of these amino acids for glucose formation. Maternal plasma levels of amino acids that can be transferred into glucose (alanine, threonine, glutamate, and serine) are reduced d/t placental transfer of these amino acids. |
|
|
Term
| Describe protein metabolism in the first and second half of pregnancy. |
|
Definition
. During the first half of gestation, maternal protein storage increases.
During the second half, maternal protein use is more economic w/ decreased urinary nitrogen excretion, thus conserving protein. |
|
|
Term
| What is the role of progesterone in fat metabolism? |
|
Definition
| Increases fat synthesis = anabolic fat storage during early pregnancy |
|
|
Term
| What is the role of leptin in fat metabolism? |
|
Definition
| Modulates glucose metabolism, insulin sensitivity and adipose tissue lypolysis dring pregnancy, enhancing maternal breakdown of fat stores in the second half of pregnancy and availibility of glucose and lipids for the fetus. |
|
|
Term
| What is the role of hPL in fat metabolism? |
|
Definition
| Increases lypolysis which increases plasma free atty acids |
|
|
Term
| What is the role of prolactin in fat metabolism? |
|
Definition
| Aids in accelerated starvation (lypolysis) |
|
|
Term
| Describe the difference between fasting and postprandial (after eating a meal) glucose levels in women who are pregnant versus women who are not pregnant. |
|
Definition
Fasting serum glucose levels are lower in preg vs. non-preg pts due to fetal siphon (baby takes what it needs).
Postprandial serum glucose levels rise higher, and stay higher for a longer period of time to sustain needed glucose for fetus AKA FACILITATED ANABOLISM. |
|
|
Term
| Describe glucose and insulin requirements during labor. |
|
Definition
Maternal glu. consumption increases.
Insulin requirements fall for several reasons: exercising muscle can use glucose w/o insulin, oxytocin acts like insulin by stimulating glucose oxydation.
IV glu to mom during labor will cross to fetus causing hyperglycemia, increase insuin production and cause neonatal hypoglycemia. |
|
|
Term
| Is there any evidence to support routine use of IV fluids in low risk pregnancies during labor and birth? |
|
Definition
|
|
Term
| What are the disadvantages of routine IV fluids during labor and birth? |
|
Definition
Difficulty moving with IV can lead to increased use of supine position.
Increased use of meds b/c easy access.
Complications such as infection, phlebitis, hyponatremia, and fluid overload.
Hypervolemia in mom.
Use of hypertonic glucose can lead to neonatal hypoglycemia.
Lower cord blood NA has been linked with increased neonatal weight loss in the first 48hrs.
Water intoxication risk for mother and baby. |
|
|
Term
| What is the net retention of sodium during pregnancy? |
|
Definition
| 900-950mg total = 2-6mEq/d |
|
|
Term
| What are the two primary roles of the renin-angiotensin-aldosterone system (RAAS) during pregnancy? |
|
Definition
| Fluid & electrolyte balance, & maintaining blood pressure homeostasis |
|
|
Term
| How does the RAAS change during pregnancy? |
|
Definition
All components (renin, angiotensin, angiotensin II, and aldosterone) increase.
Body’s sensitivity to the pressor effects of angiotensin II decreases.
Changes peak at 30-32w.
Changes mediated by estrogen, progestrone, prostaglandins,and alterations in renal processing of NA.
The system still functions normally, just at a new "set point". |
|
|
Term
| Increased sodium is accompanied by |
|
Definition
| increased fluid retention and potential for edema |
|
|
Term
| How much fluid do pregnant women accumulate? |
|
Definition
6-7L, 2-3 of it is interstitial, the rest is extracellular.
Greater than 1.5L in interstitial fluid is associated with edema. |
|
|
Term
| How much weight gain during pregnancy can be attributed to fluid accumulation in the extracellular spaces? |
|
Definition
|
|
Term
| Why doesn't maternal blood pressure increase when intravascular fluid volume increases? |
|
Definition
| Effects of increased progesterone lead to increased relaxin which relaxes smooth muscle, which leads to vasodilation in the vascular system. |
|
|
Term
| What is arginine vasopressin (AVP)? |
|
Definition
AKA antidiuretic hormone.
Causes renal absorption of water which leads to the expansion of plasma vol. and other extracellular vol. |
|
|
Term
| What placental hormone is thought to have a role in resetting the thirst and osmostat receptors during pregnancy? |
|
Definition
|
|
Term
| During labor and birth, changes in the RAAS are important in the control of |
|
Definition
| Uteroplacental blood flow |
|
|
Term
| Explain natriuresis and diuresis during postpartum. |
|
Definition
The PP peroid is characterized by rapid and sustained natriuresis and diuresis, especially on days 2-5, as the sodium and water retention of pregnancy is reversed.
Fluid and electrolyte balane is generally restored to nonpregnant homeostasis by 21d pp and often earlier. |
|
|
Term
| Describe the changes in the pelvis, gait, and posture in pregnancy. |
|
Definition
Center of gravity changes.
Lordosis is prominent in spine. Increasing weight and ABD size leads to this lordosis (forward curvature of lumbar spine).
Relaxation of pelvic joints, by relaxin and progesterone, leads to “waddling walk”.
Increasing breast size leads to slumping of shoulders and compression of cervical spine. |
|
|
Term
| What are the roles of estrogen, relaxin, and progesterone in the changes of pelvis, gait, and posture? |
|
Definition
Progesterone and relaxin affect the cartilage and connective tissue of the sacroiliac joints and lead to waddling.
Estrogen effects lead to ligamentous laxity.
Estrogen and progesterone receptors on fibrobasts witin the walls of bloodvessels supplying the ACL increase and relaxin remodles the collagen fibers reducint their diameter leading to increased risk of injury in pregnancy. |
|
|
Term
| How does calcium metabolism change in pregnancy? |
|
Definition
Maternal serum Ca falls after fertilization reaching lowest point at 28-32w, plateaus then slight rise at term.
Intestinal absorption of Ca doubles due to slow bowel transit times.
Urinary excretion of Ca decreased.
Much of the Ca for the fetus is drawn from maternal skeleton.
Low Ca has a negative feedback effect that increases calcitonin and parathyroid hormone release which acts on bone reabsorption causing release of Ca from bone into serum. |
|
|
Term
| How does the mother meet fetal requirements for calcium? |
|
Definition
dietary intake
GI absorption doubles
Maternal skeleton
Parathyroid hormone/calcitonin neg feedback loop. |
|
|
Term
| During labor and birth, calcium is essential for |
|
Definition
|
|
Term
| Which of the following is a greater challenge to maternal calcium homeostasis, pregnancy or lactation? |
|
Definition
Lactation b/c the mom must provide 280-400mg/day of Ca.
Exclusive breastfeeding for 6months leads to 4x the calcium loss than in pregnancy. |
|
|
Term
| How soon after weaning does bone mineral status return to prepregnancy levels? |
|
Definition
|
|
Term
| What is the effect of excess phosphorus on calcium levels? Explain. |
|
Definition
| Too much dietary phosphorus binds calcium in the intestine causing increased urinary Ca excretion which may cause leg cramps. |
|
|
Term
| What dietary elements will increase the intake of phosphorus? |
|
Definition
| Chips, soda, other junk foods |
|
|
Term
| Increased phosphorus in the diet will increase risks for |
|
Definition
| osteoporosis and kidney stones. |
|
|
Term
| Low serum calcium and increased magnesium are associated with |
|
Definition
|
|
Term
| The CNM knows that the best evidence exists for treatment of leg cramps in pregnancy with |
|
Definition
| magnesium lactate or citrate |
|
|
