Metabolic and systemic changes occur in pregnancy to meet the needs of the growing fetus. There are increases in the basal metabolic rate, protein metabolism, and fat storage. Carbohydrate metabolism is altered with potential hypoglycemia during fasting and hyperglycemia after delivery due to changes in insulin resistance. The kidneys enlarge and have increased blood flow, which can cause hydronephrosis. The liver has decreased function but increased production of bile acids. Calcium demand increases for fetal bone growth while maternal calcium levels are maintained. Respiratory rate and urinary, gastrointestinal, nervous, and endocrine systems all undergo changes as well.

1. METABOLIC AND
SYSTEMIC CHANGES IN
PREGNANCY

2. METABOLIC CHANGES
GENERAL CHANGES:
BMR increases by 30%
To meet the needs of
growing fetus.

3. • PROTEIN METABOLISM
• Preg is a anabolic state.
• +ve nitrogenous balance.
• At term:
• Suppressed urea formation; B.urea falls to 15-20mg%
• AA: ACTIVELY transported to fetus across placenta.
Fetus and placenta •500g
Maternal gain •500g (breast, uterus ,blood)
AA(protein breakdown) Ammonia urea

4. CARBOHYDRATE METABOLISM

6. • During MATERNAL FASTING: hypoglycemia , hypoinsulinemia,
hyperlipidemia, hyperketonemia.
• OVERALL EFFECT :
• OGTT may show an abnormal pattern
• GF of glucose is increased to exceed tubular abs. threshold . Thus
glucosuria is seen in 50% of normal preg females.
FASTING
HYPOGLYCEMIA
•DUE TO FETAL CONSUMPTION
PP HYPERGLYCEMIA
AND
HYPERINSULINEMIA
•DUE TO ANTI INSULIN FACTORS

7. • Fat metabolism
• Regulation by LEPTIN
• LIPID METABOLISM:
• HYPERLIPIDEMIA OF PREG IS NOT ATHEROGENIC.
• LPL activity is increased.
Avg. of 3-4 kg fat
Abd wall breasts Hips & thighs

8. IRON METABOLISM
Iron req for fetus and placenta : 5oomg
Iron req for red cell increment : 500mg
post partum loss: 180 mg
lactation for 6 mn : 180 mg
total req. : 1360mg
350 mg subtracted (saved as a result of amenorrhoea)
So actual extra demand : 1000mg

9. Total : 1000mg
Early
pregnancy
2.5mg/day
20-32
wks
5.5mg/day
32-40
wks
6.8mg/day

10. SYSTEMIC CHANGES
RESPIRATORY SYSTEM URINARY SYSTEM
ALIMENTARY SYSTEM
LIVER AND GALL
BLADDER
NERVOUS SYSTEM
CA METABOLISM AND
SKELETAL SYSTEM
ENDOCRINE SYSTEM

11. RESPIRATORY SYSTEM

12. URINARY SYSTEM
Kidney enlarges by
1cm
Ureter,pelvis,calyces
show dialatation
Physiological
hydronephrosis
RPF
INC. by 50-75%(16-
34wks)
Then dec. by 25%
GFR
INC BY 50%
Throughout
Low S.Cr, BUN ,UA and
dec. reabs of
glucose,aa,ua,vit from
tubules
Hypomotility of
ureters
Stasis of urine Inc. chances of UTI
BLADDER
Inc. frequency in first
trimester
Inc freq in late preg
again
Stress incontinence
CONGESTION
&HYPERTROPHY OF Ms.

14. Alimentary system
Hormonal
changes produce
smooth muscle
relaxation
decreased
peristalsis (inc
abs. of food)
constipation and
bloating of the
abdomen
Relaxation of
cardiac
sphincter of
the esophagus
gastric reflux
and heartburn
Morning
sickness,
nausea and
pica
Dec. gastric
secretion &
delayed gastric
emptying
Reduced risk
of peptic ulcer

15. LIVER AND GALL BLADDER
LIVER
• Fn are depressed.
• Only ALP is raised
• Mild cholestasis(d/t estrogen).
• GALL BLADDER
Atonicity
(d/t
progestron))
Inc. blood
cholestrol
stones

16. NERVOUS SYSTEM
• Estrogen and progesterone cause irritability, anxiety,
depression, mental confusion and decreased concentration.
(OR may be d/t psychological background)
• Fatigue and sleep deprivation can occur.
• Postpartum blues
• Carpal tunnel syndrome
• Compression of lat. Cut. Nv. Of thigh.

17. CALCIUM METABOLISM
• Inc demand ,sp. In last trimester for bone mineralization
• RDA :1-1.5mg
• Total maternal Ca is
• But S. ionized Ca is unchanged
• I,25 DH vit D3 abs. of Ca from gut & kidney
• CALCITONIN ; To protect maternal skeleton from osteoporosis
• Maternal phosphate is unchanged.

18. Skeletal system