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Metabolism Changes

During Pregnancy
Deeona Elizabeth Johnston

ABSTRACT: Pregnancy is an anabolic state with many complicated metabolic changes.


Some of these changes ensure that the mother and fetus will be supplied with enough nutrients to
promote growth and development, like lipid and amino acid metabolism (McLaughlin, 2009).
Other changes can cause complications in the pregnancy if not regulated closely, like
metabolisms in diabetic patients and drug metabolism (Gillmer, 1975; Tracy, 2005).
INTRODUCTION: Pregnancy is a very complicated state that is still not fully
understood on a metabolic scale. For many years pregnancy was thought as a parasite introduced
to a non-pregnant metabolism (McLaughlin, 2009). This was a common theory when it was
thought that the mothers metabolism didnt undergo change until the fetus was big enough to
deplete the reserves of the mother.
This theory, however, is very outdated and flawed. Research has shown that many of the
metabolic changes that a mothers body undergoes actually begin in the early stages of
pregnancy, not the later stages. These changes happen when the fetus is too small to demand a
lot of energy from its mother. These changes are very complex and wide-spread. As the
pregnancy progresses, the changes become even more complex (McLaughlin, 2009).
There are two underlying metabolic adaptations that a womens body undergoes during
pregnancy. These are accelerated starvation and facilitated anabolism (McLaughlin, 2009).
Accelerated starvation is the exaggerated change to overnight fasting from a non-pregnant state.
Overnight fasting causes a decrease in plasma glucose and amino acids, increase in plasma fatty
acids, and enhanced ketogenesis. Facilitated anabolism is a maternal adaptation that ensures that
the fetus will have an adequate supply of nutrients as it develops. There is a decrease in insulin

sensitivity and this results in the appropriate changes to carbohydrate, lipid, and amino acid
metabolism (McLaughlin, 2009).
Pregnancy is an anabolic state and requires an increase in energy requirements. Some of
this increase is due to the elevated basal metabolic rate, which is thought to be a result of
increased oxygen consumption. This increase of oxygen is due to the increased work the
mothers body must do to support maternal circulation, respiration, increased tissue mass and
renal function (Lof, 2005). However, when a woman has other health concerns, their metabolic
changes can be more drastic and will require more attention than a normal pregnancy (Therese,
2015). Another factor that can affect a normal change in metabolism is if the woman is carrying
more than one baby. The biggest change is the reabsorption of bone (Nakayama, 2011).
When a woman is prescribed a medication, they are asked if they are pregnant or nursing.
This question is asked because the medication could harm the mother or fetus, but there is
another reason as well. The drug may be metabolized differently due to the pregnant state. This
difference in metabolism could increase or decrease the absorption of the drug (Tracy, 2005).
Due to this change, the dosage must be carefully monitored to make sure that mother is receiving
the recommended amount.
BODY: The most commonly researched area in pregnancy metabolism is carbohydrates. This is
very important to understand since most of the energy used by the brain, red blood cells, and the
growing fetus is from carbohydrates (McLaughlin, 2009). All of these organs get their portion of
the glucose and leave very little for the mother. However, her body has turned to a different
source of energy. During the first two trimesters, a womans adipocytes undergo morphological
and functional changes. Hypertrophy of the adipocytes leads to the increase of fat storage, which

will become the mothers main energy source during the third trimester. Within 15 weeks the
mother will store about 3.3 kg of fat (McLaughlin, 2009). The fat storage is triggered by the
increase of insulin receptors, which increases the responsiveness to insulin in the first trimester.
Along with the increase of insulin, lipogenesis is promoted and lipolysis is suppressed.
Triglycerides have the highest increase in circulation along with a reduction in hepatic lipase.
Within three days after birth, maternal free fatty acid levels will have fallen back down to normal
and within two weeks triglyceride levels will fall back down to normal.
Change to amino acid metabolism is also very important. Amino acids are needed for
both maternal and fetal development, but maternal plasma concentrations fall during pregnancy.
The increased insulin levels, transfer of amino acids to the fetus, and diversion of amino acids for
gluconeogenesis have been shown to be related to the decrease. Unlike carbohydrates, protein
breakdown during fasting is decreased. Also, following a meal, amino acid levels increase just
like they do in a non-pregnant state, but these levels do not increase as much and for a shorter
amount of time (McLaughlin, 2009).
Another type of metabolic change that takes place during pregnancy is with drug
metabolism. Many pathways may be altered resulting in an increased or decreased absorption of
a drug. Three common metabolisms are CYP1A2, which metabolizes drugs for co-existing
conditions, CYP2D6, which metabolizes drugs used in clinical care like antidepressants, and
CYP3A, which metabolizes drugs like antiviral compounds used in clinical care. The amount of
absorption of these types of drugs is very important to the well-being of the mother and baby.
All medications should be monitored closely to determine how the body is metabolizing the drug
(Tracy, 2005).

CYP1A2 is a very common pathway for drug metabolisms. During pregnancy,


CYP1A2s activity is decreased in pregnancy. The greatest decrease is during the third trimester.
In the first trimester, CYP1A2 can experience a decrease of 35%, and by the third trimester the
decrease could be up to 65%. CYP2D6 and CYP3A are the opposite. They both experience an
increase in activity during pregnancy. CYP2D6 can have an increase of 25% in the first
trimester and a 50% increase by the third trimester. CYP3A, however, is more consistent at a
30% increase throughout the entire term (Tracy, 2005).
Earlier, this paper discussed that metabolisms can be even more drastically changed if
there are other factors that could cause complications. One of these factors that causes a drastic
change is twin pregnancy. Bone metabolism in twin pregnancy is very different than a single
pregnancy. Bone reabsorption markers, called serum cross-linked type 1 collagen N-telopeptides
and urinary C-terminal telopeptide of type 1 collagen, were found in higher concentrations in
twin pregnancy. They were also detected at higher levels earlier in the pregnancy compared to
single pregnancy (Nakayama, 2011).
Some research has shown that there is no significant difference in serum calcium levels
between single and twin pregnancies. However, women with twin pregnancy have a higher level
of albumin-corrected serum calcium. They also have a higher serum phosphate level. This is
thought to be because of the increased fetal load to the renal system (Nakayama, 2011).
Another factor that could drastically change metabolism is if the mother is diabetic. In a
normal pregnancy, the diurnal plasma glucose should increase by about 0.22mmol/L. This is due
to the increased insulin resistance, which can result in an increase of up to 30% in fasting glucose
production. A diabetic woman, however, experiences a greater increase and more fluctuations

during the day. Chemical diabetic patients experienced an increase of 0.32 mmol/L while insulin
dependent diabetics had a 0.57 mmol/L increase (Gillmer, 1975).
A woman experiencing a normal pregnancy has very little fluctuation in plasma glucose
concentrations. The only time the glucose increased above normal was a half hour after a meal.
This continuous level provides a constant supply of glucose to the fetus to promote growth and
development. Insulin dependent women showed more fluctuation in glucose levels. The levels
increased more after a meal and the significantly dropped during the night. This unstable
glucose environment could have unwanted effects on the fetus. Poor glucose control during the
early stages of pregnancy may be linked to abnormal fetal development and neurological defects
(Gillmer, 1975).
SUMMARY: Pregnancy is an anabolic state, which through many complex processes ensures
that the mother and fetus will have enough energy to promote growth and development. The
pregnant womans body undergoes many metabolic changes to provide this energy and nutrients.
Lipid metabolism changes the function of the adipocytes and deposits more fat. This fat will
become the mothers energy source later in the pregnancy when most of the glucose is given to
the fetus. Amino acid metabolism is also changed so that the amino acids and shuttled to the
liver to begin the process of gluconeogenesis (McLaughlin, 2009). Drug absorption may be
increased or decreased depending on the metabolic pathway used (Tracy, 2005).
Pregnancy is already a very complicated state, but sometimes there are other factors that
cause even more drastic changes. One factor is twin pregnancy. Twin pregnancy causes the
mothers body to increase bone reabsorption (Nakayama, 2011). Also, women who have a
previous medical condition, diabetes, have more fluctuations in the plasma glucose. These

fluctuations may be related to abnormal development of the fetus (Gillmer, 1975). There is very
little research conducted on metabolism during pregnancy. There are many changes that are still
not understood.

References
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