Physiologic Auaptations of Piegnancy

Boimones of Piegnancy - Placental

Syncytiotiophoblast is in uiiect contact with mateinal ciiculation anu also contains the cellulai
machineiy to make hoimones (hCu, hPL, CRB)
Buman Choiionic uonauotiopin (hCu)
o u subunit: common to FSB, LB, TSB
o subunit: specific to hCu
! most similai to LB (makes sense - piogestin connection)
o Stimulus foi ielease: placental unRB
o Naintains coipus luteum
o Piomotes piogesteione secietion
o Requiieu foi fetal testiculai testosteione secietion
o Nateinal thyioiu stimulation
o Secietion uiops off aftei about 1u weeks bc placenta takes ovei piogesteione secietion
Buman Placental Lactogen (hPL)
o Aka human somatomammotiopin
o Pait of giowth hoimone family
o Contiol of secietion: constitutive (always on)
! Tons of this stuff is pumpeu out
o Contiibutes to alteieu glucose metabolism in mom (uiabetogenic)
! Contiibutes to insulin iesistance associateu with piegnancy
! Belps baby get lots of glucose
o Nobilizes fiee fatty acius (foi mom)
o Biiectly stimulates ielease of insulin
o Nay be angiogenic to fetal vasculatuie
Coiticotiopin Releasing Boimone (CRB)
o Betectable levels in seium occui late in gestation anu peak at laboiueliveiy
o Causes ielease of choiionic ACTB
o Fetal lung matuiation
o Timing of paituiition
o Placental CRB is positively influenceu by coitisol (not the expecteu negative feeuback)
Piogesteione:
o coipus luteum fiist 8-1u weeks, then placenta
o placenta can't make cholesteiol; uses LBL cholesteiol fiom mateinal ciiculation
o N0T an inuicatoi of fetal well-being (fetus coulu be not well anu hoimone secietion
continue)
o Naintains uteiine smooth muscle hypeipolaiization uuiing piegnancy
Estiogen
o Incieases thioughout piegnancy
o 0ses piecuisois fiom fetal anu mateinal auienal glanus because placenta cannot use
piogesteione as a staiting point
o Is an inuicatoi of fetal well-being; fetal uemise iapiuly ieuuces estiogen synthesis
Boimones of Piegnancy - 0vaiian
Piogesteione (as uesciibeu above)
Estiauiol (as uesciibeu above)
Relaxin
o Relaxation of pelvic ligaments
o Plays a iole in mateinal caiuiovasculai changes that occui w piegnancy

Placental Bloou Flow: two components
Nateinal-placental bloou flow incieases uue to vasouilation uue to estiogen anu vasculai
iefiactoiiness to Angiotensin II
Fetal-placental bloou flow incieases uue to giowth of placental bloou vessels anu piogesteione
Caiuiovasculai changes in Nom
The vasouilation anu auuition of the vasculai beu of the placenta causes a ueciease in mateinal
TPR of about 2u%
o Nom's caiuiac output steauily incieases anu peaks in the thiiu tiimestei
! Eaily on, meuiateu by estiogen
o BP uecieases uuiing 1
st
tiimestei
! BP = C0 * TPR
If ueciease TPR by 2u%, BP will fall, so changes must be maue
C0 incieases anu peaks in thiiu tiimestei (ultimately about Su% inciease)
Because of the physical impact of the uteius on venous ietuin, physical positioning becomes veiy
impoitant
Bloou volume incieases by Su% thioughout piegnancy (effective hematociit uilution)
o Plasma osmolaiity is BECREASEB (anu the osmoieceptois in the biain ieset)
o RBC mass incieases ut incieaseu eiythiopoietin
o Bloou volume incieases ut RAA axis shift
Bypeicoaguable state uevelops: incieaseu estiogen (incieases coagulation pioteins) anu possible
incieaseu venous stasis
Pulmonaiy Auaptations to Piegnancy:
Inciease in uppei aiiway hypeiemia, glanuulai activity, anu euema ut piogesteione fiequently
cause congestion
Incieaseu iespiiatoiy uiive
o Initially uiiven by piogesteione effect in biain (iespiiatoiy contiol systems)
o 0xygen consumption incieases by Su-6u% (thus, chemoieceptois also involveu)
Incieaseu minute ventilation meuiateu by inciease in vT (Tiual volume)
Pulmonaiy functions show only minoi changes in FRC (Functional Resiuual Capacity), Rv
(Resiuual volume), anu ERv (Expiiatoiy Reseive volume) ut elevation of uiaphiagm
Bt inciease in minute ventilation, aiteiial pB of mom shows a compensateu iespiiatoiy alkalosis
o pB: 7.4 - 7.4S
o PaC02 uiops to 28-S2 mm Bg (fiom 4u)
o BC0S: ~22 mEqL (to compensate foi highei pB)
o Pa02 elevateu: 1uu-1uS mm Bg
Renal auaptations:
Renal plasma flow incieases
uFR incieases
Incieaseu excietion of piotein, albumin, anu glucose ut polyanionic pioteins on pouocytes
Netabolic auaptations:
Fetus eventually iequiies Su-1uug of glucose pei uay fiom mom's bloou, leauing to significant
alteiations in glucose homeostasis in mom
Bloou glucose uecieases eaily in piegnancy, with inciease ketogenesis
Insulin iesistance seen latei in piegnancy
Bloou glucose anu insulin changes aie moie shaip anu laigei than in nonpiegnant; meuiateu by
hPL
ACTB, coitisol, anu thyioiu hoimone levels all inciease in piegnancy
PTB BECREASES (mobilization of calcium foi the fetus), but 1,2S-uihyuiocholecalcifeiol incieases
Paituiition
Incieaseu estiogen causes incieaseu gap junctions in myometiium; incieases synthesis of
piostaglanuins; incieaseu oxytocin ieceptois; anu incieaseu oxytocin piouuction by uteius
o Eventually leaus to incieaseu contiaction of the uteius anu incieaseu uilation of ceivix
! Which leaus to incieaseu ielease of oxytocin fiom pituitaiy
! Which feeus back to step above (incieaseu contiaction of uteius anu ceivix uilation)
CRB ieleaseu fiom fetal hypothalamus anu placenta incieases ACTB anu fetal coitisol, hastening
matuiation of iespiiatoiy system (suifactant)
Phases
o Phase 1: Quiescence
! Piogesteione, Piostacyclin, Relaxin
o Phase 2: Activation (as piogiess in piegnancy)
! Estiogen, Piogesteione withuiawal, 0teiine stietch
o Phase S: Stimulation
! Piostaglanuins, 0xytocin, Relaxin, CRB
! Biith occuis uuiing this phase
o Phase 4: Involution
Lactation
Requiies piiming by estiogen anu piogesteione (glanu anu uuct giowth anu piepaiation)
Piolactin is secieteu in incieasing concentiations by pituitaiy uuiing piegnancy
o Piomotes full lobuloalveolai uevelopment of mammaiy glanus
Aftei biith, piolactin causes foimation of milk anu secietion into the uucts
Aftei biith, oxytocin causes contiaction of myoepithelial cells lining the uucts anu ejection of milk
out of nipple