Endocrine System 1

in
Maternal Physiology

Dwi Cahya Febrimulya

 Endocrine System 2

GH
Prolactine
Pituitary Oxytocin
Gland ADH

Thyroid
Gland

Parathyroid Hormone and Calcium

Parathyroi Calcitonin and calcium

d Gland Vitamin D and calcium

Adrenal
Gland
 3
Pituitary Gland

During normal pregnancy the pituitary gland

enlarges by approximately 135 percent
compress the optic chiasma

Changes in vision during normal pregnancy are

minimal
 Pituitary Gland 4

Anterio GH
r Prolactin

Posteri Oxytocin
or ADH
 Pituitary Gland-Growth
5
Hormone
Time Maternal Fetal
First Trimester GH secreted predominantly from
maternal pituitary gland
8 weeks pregnancy GH from placenta
becomes detectable
10 weeks pregnancy Maternal serum values increase
slowly from approximately 3.5
ng/mL
14 to 15 weeks Growth hormone peaks in
amnionic fluid
17 weeks pregnancy Placenta is the principal
source of GH
after 28 weeks plateau at approximately 14
ng/mL
after 36 weeks GH in amniotic fluids
slowly declines at
baseline values
 PITUITARY GLAND - PROLACTIN
6

To ensure lactation

Initiate DNA synthesis and mitosis of

glandular epithelial cells and the presecretory alveolar cells of
the breast (in early pregnancy)

increases the number of estrogen

and prolactin receptors in these same cells

Promotes mammary alveolar cell RNA synthesis,

galactopoiesis, and production of casein
and lactalbumin, lactose, and lipids
 Pituitary Gland - Prolactin 7

# at 20 to 26 weeks up to 10,000 ng/mL (in amniotic fluid)

#after 34 weeks levels decrease and reach a nadir

#after delivery the plasma prolactin concentration decreases

even in women who are breast feeding

#early lactation pulsatile bursts of prolactin secretion occur

apparently in response to suckling
 Pituitary Gland - Prolactin 8

the uterine decidua is the site of prolactin synthesis in amnionic fluid

it has been suggested that amnionic fluid prolactin impairs the transfer
of water from the fetus into the maternal compartment

preventing fetal dehydration during late pregnancy when amnionic fluid

is normally hypotonic
 Thyroid Gland 9

the thyroid undergoes moderate enlargement

caused by glandular hyperplasia and increased
vascularity
mean thyroid volume increased from 12.1 mL in the first trimester to 15.0
mL at delivery

These enlargements are not

pathological

any goiter should be

investigated
early in the first trimester,
thyroxine-binding globulin
increases, reaches its
zenith at about 20 weeks
Total serum thyroxine
(T4) increases sharply
beginning between 6
and 9 weeks
1
0
Free serum T4 levels rise
slightly and peak along
with hCG levels, then
they return to normal
As a result structural
similarity, hCG has intrinsic
thyrotropic activity, and
thus, high serum levels
cause thyroid stimulation
 1
1

Thyrotropin-releasing hormone (TRH) increases the secretion of thyrotropin (TSH), which stimulates
the synthesis and secretion of trioiodothyronine (T3) and thyroxine (T4) by the thyroid gland. T3
and T4 inhibit the secretion of TSH, both directly and indirectly by suppressing the release of TRH.
T4 is converted to T3 in the liver and many other tissues by the action of T4 monodeiodinases.
Some T4 and T3 is conjugated with glucuronide and sulfate in the liver, excreted in the bile, and
partially hydrolyzed in the intestine. Some T4 and T3 formed in the intestine may be reabsorbed.
 Thyroid Gland 1
2

As a result of structural similarity, hCG has intrinsic

thyrotropic activity, and thus, high serum levels cause
thyroid stimulation
basal metabolic rate increases progressively
during normal pregnancy by as much as 25
percent
many complex alterations in thyroid regulation during
pregnancy do not appear to alter maternal thyroid status as
measured by metabolic studies

Thyroid-releasing hormone (TRH) levels are not increased during

normal pregnancy, but this neurotransmitter does cross the
placenta and may stimulate the fetal pituitary to secrete
thyrotropin
Parathyroid Glands Parathyroid
1
Hormone 3
and Calcium
action of this hormone on bone resorption, intestinal absorption,
and kidney reabsorption is to increase extracellular fluid calcium
and decrease phosphate.

Parathyroid Hormone decrease during the first trimester ,

then increase progressively throughout the remainder of pregnancy
 1
4

Estrogens appear to block the action of parathyroid hormone on bone

resorption, resulting in another mechanism to increase parathyroid hormone
during pregnancy. The net result of these actions is a physiological
hyperparathyroidism of pregnancy, likely to supply the fetus with
 Parathyroid Glands - Calcitonin
1
and Calcium 5

to oppose those of parathyroid hormone and vitamin D

to protect skeletal calcification during times of calcium stress

During Pregnancy and lactation these times,

calcitonin levels are appreciably higher than in nonpregnant women

Various gastric hormonesgastrin, pentagastrin,

glucagon, and pancreoxyminand food ingestion
also increase calcitonin plasma levels
 Parathyroid Glands - Vitamin D and
Calcium 1
6
Vitamin D,
(a hormone that is
synthesized
in the skin or ingested)

the liver

25-hydroxyvitamin
D3
Facilitated by parathyroid hormone and by kidney, decidua,
low calcium and phosphate plasma levels and placenta
and opposed by calcitonin

1,25-dihydroxyvitamin D3
(increased during normal
pregnancy)

stimulates resorption of calcium from bone

and absorption from the intestines
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7
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8

TERIMA
KASIH