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During Pregnancy
Deeona Elizabeth Johnston
sensitivity and this results in the appropriate changes to carbohydrate, lipid, and amino acid
metabolism (McLaughlin, 2009).
Pregnancy is an anabolic state and requires an increase in energy requirements. Some of
this increase is due to the elevated basal metabolic rate, which is thought to be a result of
increased oxygen consumption. This increase of oxygen is due to the increased work the
mothers body must do to support maternal circulation, respiration, increased tissue mass and
renal function (Lof, 2005). However, when a woman has other health concerns, their metabolic
changes can be more drastic and will require more attention than a normal pregnancy (Therese,
2015). Another factor that can affect a normal change in metabolism is if the woman is carrying
more than one baby. The biggest change is the reabsorption of bone (Nakayama, 2011).
When a woman is prescribed a medication, they are asked if they are pregnant or nursing.
This question is asked because the medication could harm the mother or fetus, but there is
another reason as well. The drug may be metabolized differently due to the pregnant state. This
difference in metabolism could increase or decrease the absorption of the drug (Tracy, 2005).
Due to this change, the dosage must be carefully monitored to make sure that mother is receiving
the recommended amount.
BODY: The most commonly researched area in pregnancy metabolism is carbohydrates. This is
very important to understand since most of the energy used by the brain, red blood cells, and the
growing fetus is from carbohydrates (McLaughlin, 2009). All of these organs get their portion of
the glucose and leave very little for the mother. However, her body has turned to a different
source of energy. During the first two trimesters, a womans adipocytes undergo morphological
and functional changes. Hypertrophy of the adipocytes leads to the increase of fat storage, which
will become the mothers main energy source during the third trimester. Within 15 weeks the
mother will store about 3.3 kg of fat (McLaughlin, 2009). The fat storage is triggered by the
increase of insulin receptors, which increases the responsiveness to insulin in the first trimester.
Along with the increase of insulin, lipogenesis is promoted and lipolysis is suppressed.
Triglycerides have the highest increase in circulation along with a reduction in hepatic lipase.
Within three days after birth, maternal free fatty acid levels will have fallen back down to normal
and within two weeks triglyceride levels will fall back down to normal.
Change to amino acid metabolism is also very important. Amino acids are needed for
both maternal and fetal development, but maternal plasma concentrations fall during pregnancy.
The increased insulin levels, transfer of amino acids to the fetus, and diversion of amino acids for
gluconeogenesis have been shown to be related to the decrease. Unlike carbohydrates, protein
breakdown during fasting is decreased. Also, following a meal, amino acid levels increase just
like they do in a non-pregnant state, but these levels do not increase as much and for a shorter
amount of time (McLaughlin, 2009).
Another type of metabolic change that takes place during pregnancy is with drug
metabolism. Many pathways may be altered resulting in an increased or decreased absorption of
a drug. Three common metabolisms are CYP1A2, which metabolizes drugs for co-existing
conditions, CYP2D6, which metabolizes drugs used in clinical care like antidepressants, and
CYP3A, which metabolizes drugs like antiviral compounds used in clinical care. The amount of
absorption of these types of drugs is very important to the well-being of the mother and baby.
All medications should be monitored closely to determine how the body is metabolizing the drug
(Tracy, 2005).
during the day. Chemical diabetic patients experienced an increase of 0.32 mmol/L while insulin
dependent diabetics had a 0.57 mmol/L increase (Gillmer, 1975).
A woman experiencing a normal pregnancy has very little fluctuation in plasma glucose
concentrations. The only time the glucose increased above normal was a half hour after a meal.
This continuous level provides a constant supply of glucose to the fetus to promote growth and
development. Insulin dependent women showed more fluctuation in glucose levels. The levels
increased more after a meal and the significantly dropped during the night. This unstable
glucose environment could have unwanted effects on the fetus. Poor glucose control during the
early stages of pregnancy may be linked to abnormal fetal development and neurological defects
(Gillmer, 1975).
SUMMARY: Pregnancy is an anabolic state, which through many complex processes ensures
that the mother and fetus will have enough energy to promote growth and development. The
pregnant womans body undergoes many metabolic changes to provide this energy and nutrients.
Lipid metabolism changes the function of the adipocytes and deposits more fat. This fat will
become the mothers energy source later in the pregnancy when most of the glucose is given to
the fetus. Amino acid metabolism is also changed so that the amino acids and shuttled to the
liver to begin the process of gluconeogenesis (McLaughlin, 2009). Drug absorption may be
increased or decreased depending on the metabolic pathway used (Tracy, 2005).
Pregnancy is already a very complicated state, but sometimes there are other factors that
cause even more drastic changes. One factor is twin pregnancy. Twin pregnancy causes the
mothers body to increase bone reabsorption (Nakayama, 2011). Also, women who have a
previous medical condition, diabetes, have more fluctuations in the plasma glucose. These
fluctuations may be related to abnormal development of the fetus (Gillmer, 1975). There is very
little research conducted on metabolism during pregnancy. There are many changes that are still
not understood.
References
Gillmer, M.D.G.; Beard, R.W.; Brooke, F.M.; Oakley, N.W.. (1975). Carbohydrate
metabolism in pregnancy: Part 1: Diurnal plasma profile in normal and diabetic women.
The British Medical Journal, 3, 399-402.
Karlsson, T.; Andersson, L.; Hussain, A.; Bosaeus, M.; Jansson, N.; Osmancevic, A.;
Hulthen, L.; Holmang, A.; Larsson, I. (2015). Lower vitamin D staus in obese compared
with normal-weight women despite higher vitamin D intake in early pregnancy. Clinical
Nutrition, 34, 892-898.
Lof, M.; Olausson, H.; Bostrom, K.; Janerot-Sjoberg, B.; Sohlstrom, A.; Forsum, E.. (2005).
Changes in basal metabolic rate during pregnancy in relation to changes in body weight
and composition, cardiac output, insulin-like growth factor 1, and thyroid hormones and in
relation to fetal growth. American Society for Clinical Nutrition, 81, 678-685
McLaughlin, C.; Hadden, D.R.. (2009). Normal and abnormal maternal metabolism during
pregnancy. Seminars in Fetal & Neonatal Medicine, 14, 66-71.
Nakayama, S.; Ysui, T.; Suto, M.; Sato, M.; Kaji, T.; Uemura, H.; Maeda, K.; Irahara, M..
(2011). Differences in bone metabolism between singleton pregnancy and twin pregnancy.
Bone, 49, 513-519.
Tracy, T.S.; Venkataramanan, R.; Glover, D.D.; Caritis, S.N.. (2005). Temporal changes in
drug metabolism (CYP1A2, CYP2D6, and CYP3A activity) during pregnancy. American
Journal of Obstetrics and Gynecology, 192, 633-639.