Endocrine and metabolic adaptations to pregnancy; impact of obesity

2015 ◽  
Vol 24 (1) ◽  
Author(s):  
Sylvie Hauguel-de Mouzon ◽  
Luciana Lassance
Keyword(s):  
Metabolic Disease ◽  
Insulin Action ◽  
Maternal Obesity ◽  
Normal Pregnancy ◽  
Metabolic Homeostasis ◽  
Insulin Production ◽  
Successful Pregnancy ◽  
Healthy Pregnancy ◽  
Metabolic Adaptations ◽  
In Pregnancy

AbstractAdaptations of maternal endocrine and metabolic homeostasis are central to successful pregnancy. They insure that an adequate and continuous supply of metabolic fuels is available for the growing fetus. Healthy pregnancy is classically described as a mild diabetogenic state with significant adjustments in both insulin production and sensitivity. The placenta contributes to the endocrine adaptations to pregnancy through the synthesis of various hormones which may impact insulin action. Obesity has the highest prevalence among metabolic disease in pregnancy. This article summarizes the literature addressing the endocrine and metabolic adaptations implemented during normal pregnancy. Mechanisms of regulation are further examined in the context of maternal obesity.

scholarly journals Angiogenic Properties of Placenta-Derived Extracellular Vesicles in Normal Pregnancy and in Preeclampsia

2021 ◽  
Vol 22 (10) ◽  
pp. 5402
Author(s):  
Natalia Gebara ◽  
Yolanda Correia ◽  
Keqing Wang ◽  
Benedetta Bussolati
Keyword(s):  
Stem Cells ◽  
Extracellular Vesicles ◽  
Clinical Setting ◽  
Normal Pregnancy ◽  
Present Review ◽  
Successful Pregnancy ◽  
Healthy Pregnancy ◽  
Maternal Interaction ◽  
Gestational Tissues

Angiogenesis is one of the main processes that coordinate the biological events leading to a successful pregnancy, and its imbalance characterizes several pregnancy-related diseases, including preeclampsia. Intracellular interactions via extracellular vesicles (EVs) contribute to pregnancy’s physiology and pathophysiology, and to the fetal–maternal interaction. The present review outlines the implications of EV-mediated crosstalk in the angiogenic process in healthy pregnancy and its dysregulation in preeclampsia. In particular, the effect of EVs derived from gestational tissues in pro and anti-angiogenic processes in the physiological and pathological setting is described. Moreover, the application of EVs from placental stem cells in the clinical setting is reported.

scholarly journals The XXI International Society of Hypertension in Pregnancy meeting, São Paulo, Brazil – A global health perspective

2017 ◽  
Vol 10 (1) ◽  
pp. 30-32
Author(s):  
Sumedha Sharma
Keyword(s):  
Maternal Health ◽  
International Society ◽  
Maternal Obesity ◽  
Sao Paulo ◽  
São Paulo ◽  
Hypertension In Pregnancy ◽  
Life Course Approach ◽  
Global North ◽  
Development Goals ◽  
In Pregnancy

The 21st International Society of Hypertension in Pregnancy (ISSHP) meeting was held in São Paulo, Brazil from 23 to 26 October 2016. The discourse at this Congress brought global maternal health into the foray among basic science and clinical research. In concordance with the United Nations sustainable development goals which warrant an integrated view to health with investments in adolescence and childhood, the research at Congress focussed on a ‘life course’ approach to maternal health – examining intergenerational effects of maternal obesity and hypertension on the behavioral and physical developments of infants. Bringing in research from the Global South highlighted inequities in treatment and management of women with hypertensive disorders of pregnancy, in addition to the challenges in adoption of recommendations generated in Global North. The evidence shared can serve as platform for further discourse on global maternal health and in generating accountability to close the ‘evidence to policy’ gap.

Iron and folic acid tablets in pregnancy

1964 ◽  
Vol 2 (4) ◽  
pp. 13-14
Keyword(s):  
Folic Acid ◽  
Normal Pregnancy ◽  
Megaloblastic Anaemia ◽  
Combined Administration ◽  
Mild Deficiency ◽  
Iron And Folic Acid ◽  
In Pregnancy

Mild deficiency of folic acid is common in the later months of normal pregnancy, due apparently to increased demand and in some cases to impaired absorption1. Megaloblastic anaemia from this cause is not rare, but more frequently a lesser degree of deficiency complicates lack of iron, and in such cases the anaemia responds only to the combined administration of both substances. Deficiency of folic acid has been found in patients with accidental haemorrhage and may be found in anaemia in the puerperium.

Fibrin monomer complex in normal pregnant women: a potential thrombotic marker in pregnancy

2007 ◽  
Vol 44 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Hiroaki Onishi ◽  
Kimiko Kaniyu ◽  
Mitsutoshi Iwashita ◽  
Asashi Tanaka ◽  
Takashi Watanabe
Keyword(s):  
Pregnant Women ◽  
Late Pregnancy ◽  
Normal Pregnancy ◽  
Reference Ranges ◽  
Vein Thrombosis ◽  
Fibrin Monomer ◽  
Potential Marker ◽  
Deep Vein ◽  
Positive Results ◽  
In Pregnancy

Background: Pregnancy represents a major risk factor for deep vein thrombosis (DVT). Most coagulation/fibrinolysis markers currently utilized change during pregnancy, and therefore they cannot accurately evaluate thrombotic events in pregnancy because the rate of false positive results is high. Fibrin monomer complex (FMC) has recently become widely available for diagnosing DVT. The present study examined whether FMC is suitable for evaluating thrombotic status in pregnancy. Methods: Concentrations of FMC and other haemostatic markers were investigated in 87 pregnant women without major complications at early, mid- or late pregnancy. FMC concentrations were also measured in 127 normal non-pregnant women, and in one woman who developed DVT after delivery. Results: In normal pregnant women, FMC concentrations were unchanged during early or mid-pregnancy and slightly elevated during late pregnancy. Concentrations were within reference range in most cases, and none exceeded the cut-off value for DVT. In contrast, thrombin-antithrombin complex (TAT) and D-dimer (DD) concentrations were significantly elevated in late pregnancy, and median values exceeded reference ranges. The DVT case displayed significantly elevated FMC concentrations. Conclusions: Changes in FMC concentrations during normal pregnancy are minimal compared with other haemostatic markers. Because the rate of false positivity is lower, FMC could be a potential marker of thrombotic status in pregnancy rather than TAT and DD.

scholarly journals The consequences of obesity and excess weight gain in pregnancy

2011 ◽  
Vol 70 (4) ◽  
pp. 450-456 ◽  
Author(s):  
Jane E. Norman ◽  
Rebecca Reynolds
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Postpartum Haemorrhage ◽  
Maternal Obesity ◽  
Adverse Pregnancy Outcome ◽  
Operative Delivery ◽  
Adverse Pregnancy ◽  
In Pregnancy

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

Renal disease in pregnancy

1989 ◽  
Vol 1 (2) ◽  
pp. 177-192 ◽  
Author(s):  
Priscilla Kincaid-Smith ◽  
Kenneth Fairley
Keyword(s):  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Intimate Relationship ◽  
Physiological Changes ◽  
Anatomical Changes ◽  
The Right ◽  
In Pregnancy

There is an intimate relationship between the kidney and pregnancy. Renal plasma flow increases by 50–70% during a normal pregnancy and the glomerular filtration rate by about 50%.1These changes commence in the first trimester and fall in the last trimester reaching normal levels within about four weeks postpartum. These physiological changes are accompanied by striking anatomical changes which consist of dilatation of the ureter, pelvis and calyces, together with an increase in renal parenchymal size. The dilatation i s more marked on the right and may appear in the first trimester. At term, 90% of pregnant women show this change.2

scholarly journals Hyperlipidemia in pregnancy

2011 ◽  
Vol 152 (19) ◽  
pp. 753-757 ◽  
Author(s):  
Tatjána Ábel ◽  
Anna Blázovics ◽  
Márta Kemény ◽  
Gabriella Lengyel
Keyword(s):  
Cardiovascular Disease ◽  
Acute Pancreatitis ◽  
Cohort Studies ◽  
Pregnant Women ◽  
Breast Feeding ◽  
Normal Pregnancy ◽  
Large Cohort ◽  
Physiological Changes ◽  
Teratogenic Effects ◽  
In Pregnancy

Physiological changes in lipoprotein levels occur in normal pregnancy. Women with hyperlipoproteinemia are advised to discontinue statins, fibrates already when they consider pregnancy up to and including breast-feeding the newborn, because of the fear for teratogenic effects. Hypertriglyceridemia in pregnancy can rarely lead to acute pancreatitis. Management of acute pancreatitis in pregnant women is similar to that used in non-pregnant patients. Further large cohort studies are needed to estimate the consequence of supraphysiologic hyperlipoproteinemia or extreme hyperlipoproteinemia in pregnancy on the risk for cardiovascular disease later in life. Orv. Hetil., 2011, 152, 753–757.

Coagulation and Fibrinolytic Parameters in Normal Pregnancy and in Pregnancy Complicated by Intrauterine Growth Retardation

1998 ◽  
Vol 15 (02) ◽  
pp. 81-85 ◽  
Author(s):  
Jordi Bellart ◽  
Rosa Gilabert ◽  
Jordi Fontcuberta ◽  
Elena Carreras ◽  
Ramon Miralles ◽  
...  
Keyword(s):  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Normal Pregnancy ◽  
Intrauterine Growth ◽  
Fibrinolytic Parameters ◽  
In Pregnancy

A Versatile Radioimmunoassay for the Determination of Serum Oestriol in Pregnancy

1973 ◽  
Vol 10 (1-6) ◽  
pp. 159-166 ◽  
Author(s):  
J. E. H. Stafford
Keyword(s):  
Normal Pregnancy ◽  
Optimum Conditions ◽  
Random Series ◽  
The Mean ◽  
Hydrolysis Of ◽  
Selection Of ◽  
In Pregnancy

A versatile radioimmunoassay for serum oestriol in pregnancy has been developed which requires 10 μ| of serum (for total) or 50 μ| (for unconjugated). Selection of the optimum conditions for the hydrolysis of serum oestriol conjugates, the isolation of free oestriol, the displacement of tritiated oestriol by cold oestriol and the separation of the free and bound fractions is described. Total oestriol levels doubled between weeks 34 and 38 of normal pregnancy, very little change occurring in the mean level after the 38th week of gestation. In a random series of pregnancy sera there was a significant correlation between total and unconjugated oestriol.

Renin, Angiotensin and Aldosterone in Human Pregnancy and the Menstrual Cycle

1971 ◽  
Vol 16 (3) ◽  
pp. 183-196 ◽  
Author(s):  
J. I. S. Robertson ◽  
R. J. Weir ◽  
G. O. Düsterdieck ◽  
R. Fraser ◽  
M. Tree
Keyword(s):  
Angiotensin Ii ◽  
Plasma Renin ◽  
Normal Pregnancy ◽  
Maternal Plasma ◽  
Plasma Aldosterone ◽  
Sodium Depletion ◽  
Aldosterone Secretion ◽  
Renin Substrate ◽  
Plasma Aldosterone Concentration ◽  
In Pregnancy

Aldosterone secretion is frequently, although not invariably, increased above the normal non-pregnant range in normal pregnancy. Substantial increases in plasma aldosterone concentration have also been demonstrated as early as the sixteenth week. In pregnancy, aldosterone secretion rate responds in the usual way to changes in sodium intake. Plasma renin concentration is frequently, but not invariably, raised above the normal non-pregnant range. Plasma renin-substrate is consistently raised in pregnancy. Plasma angiotensin II has also been shown usually to be raised in a series of pregnant women. A significant positive correlation has been shown between the maternal plasma aldosterone concentration and the product of the concurrent plasma renin and renin-substrate concentrations. This suggests that the increased plasma aldosterone in pregnancy is the consequence of an increase in circulating angiotensin II, which in turn is related to the level of both renin and its substrate in maternal blood. For these reasons, estimations of renin activity in pregnancy are of dubious value. The increased renin, angiotensin and aldosterone concentrations may represent a tendency to maternal sodium depletion, probably mainly a consequence of the increased glomerular filtration rate. It is possible that the nausea and other symptoms of early pregnancy may be a consequence of this tendency to sodium depletion, with its attendant hormonal changes. In ‘pre-eclampsia’, renin and aldosterone values are generally slightly lower than in normal pregnancy. Human chorion can apparently synthesize renin independently of the kidney. The physiological significance of this remains at present obscure, but it seems unlikely that this source contributes much, if at all, to the often elevated maternal plasma renin. Plasma renin, renin-activity and angiotensin II concentrations, and aldosterone secretion are increased in the luteal phase of the menstrual cycle.

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