Metabolism Changes

during Pregnancy
By Deeona Johnston

Metabolic Changes

Thought as introduction of a parasite

upon the normal non-pregnant
metabolism
Adjustments start in first trimester
Complex and wide spread
Become more complicated later in
pregnancy

Metabolic Changes

Essential for
Growth and development of fetus
Adequate energy stores and substrates

needed following birth

Meet altered needs of mother
To provide sufficient energy stores for the
mother

2 underlying adaptations
Accelerated starvation
Facilitated anabolism

Accelerated Starvation

Exaggerated changes to nonpregnant response to overnight

fasting

Fall in plasma glucose

Rise in plasma free fatty acids
Enhanced ketogenesis
Fall in plasma amino acids

Increased insulin resistance

Facilitated Anabolism

To ensure adequate supply of nutrients

to fetus
Bringing change to carbohydrate, lipid,
amino acid metabolism

Carbohydrates

Glucose first taken up by

Brain, red blood cells

Impaired insulin sensitivity and beta

cell function
Decreased sensitivity causes fat
deposition during 1st trimester

Lipids

Normal pregnancy hyperlipidemic

Greatest increase in triglycerides
Due to morphological changes in adipocytes
Increases fat storage during first two
trimesters
3.3 kg of fat stored in 15 weeks
Becomes energy source for mother
Promotes lipogenesis and suppression of
lipolysis
Fall back to non-pregnant levels within 3 days
Triglycerides fall back by 2 weeks

Amino Acids

Maternal plasma concentration falls

Increased placental uptake

Protein breakdown on fasting is

reduced
Hepatic diversion of amino acids for
gluconeogenesis
By 20 weeks
Serum albumin levels have fallen from 46

to 38 g/l

Metabolism and Diabetes

Normal vs Clinical Diabetics

Clinical Diabetics
Higher plasma glucose
Glucose levels fluctuated more
Insulin concentrations lower

Insulin Dependent Diabetics

High plasma glucose after breakfast
Strong tendency of hypoglycaemia at night

Bone Metabolism

Single vs Twin
Bone reabsorption markers higher in twin
May be due to increase in bone formation

Twin
Serum phosphate levels high through out

pregnancy
Change in renal function
Increase in fetal load

Vitamin D

Associated with lower birth weight,

gestational diabetes, pre-eclampsia
Twin pregnancy lower levels
Obese women

Lower GWG
Higher intake before
Lower levels during 1st trimester
Not significantly higher during 2nd and
3rd trimester

Drug metabolism

CYP1A2: metabolizes many drugs

Decreases absorption
35-65% reduction based on stage

CYP2D6: metabolizes drugs for obstetric

patients
Increases absorption
23-54% based on stage

CYP3A: metabolizes drugs used in clinical care

of pregnant women
Increases absorption
Constant around 30%

Summary

Different metabolism changes

Lipid metabolism
Amino Acid metabolism
Drug metabolism
Carbohydrate metabolism with diabetes
Vitamin D status

References

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