METABOLIC CHANGES

JACOB TRISUSILO SALEAN, MD

METABOLIC CHANGES
WEIGHT GAIN
CARBOHYDRATE METABOLISM

WATER METABOLISM

METABOLIC CHANGES

FAT METABOLISM

PROTEIN METABOLISM

ELECTROLYTE & MINERAL METABOLISM

FAT METABOLISM
Concentrations of lipids, lipoproteins, and apolipoproteins in plasma increase appreciably The storage of fat occurs primarily during midpregnancy Deposited mostly in central rather than peripheral sites Later in pregnancy, as fetal nutritional demands increase remarkably, maternal fat storage decreases.

FAT METABOLISM
LDL-C peak week 36: consequence of the hepatic effects of estradiol and progesterone (3rd trimester: 245 10 mg/dL) HDL-C peaks at week 25, decreases until week 32, and remains constant for the remainder of pregnancy (3rd trimester: 59 3 mg/dL) After delivery decrease at different rates.

FAT METABOLISM
Leptin: Produced by placenta Primarily secreted by adipose tissue Progressively increase peaking during 2nd trimester 3 to 4 times higher than in nonpregnant woman

FAT METABOLISM
Ghrelin : Secreted by adipose tissue Expressed in placental tissue Hormone regulates growth hormone secretion. Maternal serum levels of ghrelin increase and peak at midpregnancy and then decrease until term

ELECTROLYTE & MINERAL METABOLISM

SODIUM & POTASSIUM

Normal pregnancy Retained: Sodium 1000 mEq & Potassium 300 mEq
CALSIUM

Serum calcium levels decline during pregnancy reflecting lowered plasma albumin concentration decrease in the amount bound to protein. 3rd trimester 200 mg of calcium are deposited in the fetal skeleton per day

ELECTROLYTE & MINERAL METABOLISM

MAGNESIUM & PHOSPATE

Decline during pregnancy Pregnancy a state of extracellular magnesium depletion. oCompared with nonpregnant women both total and ionized magnesium were significantly lower during normal pregnancy oSerum phosphate levels are within the nonpregnant rang