Question

discusses the physiological changes associated with pregnancy. Discuss the effects of pregnancy on maternal metabolism. For carbohydrate, what are the “diabetogenic effects of pregnancy” and what are strategies to deal with insulin resistance when it develops?

Answer 1

physiological changes associated with pregnancy

genital changes

Vaginal changes like soft, moist, and bluish colouration during birth process can be seen

Vulva: shows increased vascularity

Cervix: becomes soft, edematous, mucus plug is seen closing cervical canal

Uterus:

Shows changes in all parts of uterus body, isthmus and cavity

Non pregnant women uterus weigh about 60 gms where as term uterus weigh about 900-1000gms

Vascularity, shape and position also will be changed

Ovary: shows increased vascularity

fallopian changes:

The length of tube gets increased and congested

breast changes:

Increased vascularity and size, tender breasts.

Increased pigmentation of nipple and areola

Montgomery tubercles appear on areola

skin changes:

Linea nigra chloasma, striae gravidarum ( stretch Mark's on abdomen) can be noticed

weight changes:

Due to increase in the size of maternal organs and increase storage of fat, and growth of fetus the weight will be approximately 12.5 kg increased by term

skeletal changes:

Increased lumbar lordosis

Pelvic joints and ligaments will be relaxed

Urinary changes:

Kidneys increase in size

Renal plasma flow will be increased

GFR will be increased by 50% throughout the pregnancy

Dilation of urethra can be observed

Bladder: increased frequency and stress incontinence can be seen

Hematological changes:

Blood volume increases up to 40-50%

Plasma volume also increases up to 50% to the extent of 1.25 liters

RBC will be increased up to 20-30% and increased oxygen demand can be seen

Hb falls about 2 grams from non pregnant state

Respiratory changes:

Shape of chest and circumference will change

Oxygen consumption will be increased

Respiratory alkalosis can be seen

cardiovascular changes:

Heart rate and stroke volume increases

Changes in the cardiac output and

Changes in the blood pressure can be seen

Digestive system:

Increased salivation

Heart burn, nausea, vomiting

Increased appetite ,Constipation

Hepatic synthesis of albumin and globulin increases

Neurological changes:

Mood changes, irritability, sleeplessness can be found

Endocrine changes:

Placental hormones produces several hormones which increases estrogen and progesterone

Posterior pituitary releases oxytocin in frequency pulses which will be helpful for uterine contractions

Thyroid gland increases in size

Carbohydrate metabolism

Insulin secretion is increased in response to glucose and amnio acids

This increased insulin level leads to increased lipogenesis that is fat storage, which make sure for continuous supply of glucose to fetus

Hyperplasia and hypertrophy of beta cells of pancreas can be seen

Diabetogenic effects of pregnancy

It can cause high blood pressure

Risk of getting type 2 diabetes

It may leads to certain complications like preterm birth, overweight of baby, breathing difficulties and hypoglycemia in baby, preeclampsia, still birth.

strategies to develop for insulin resistance

Follow insulin resistance diet such as eat less fat and sugar

Watch for the calories and skip processed foods

Do not skip meals

Choose food with more vitamins, minerals and fiber

Add green leafy vegetables and fresh fruits in diet

Regularly monitor glucose levels, urinalysis, triglycerides and cholesterol

Regular exercise can help to maintain glucose levels but before going for exercise have to consult to a doctor