The mother: Adaptation to pregnancy and normal metabolism

The mother

Adaptation to pregnancy and normal metabolism

Francesca Parisi, Alice Zavatta, Roberta Milazzo, and Irene Cetin


During pregnancy, several maternal anatomical and physiological changes occur in order to ensure proper development of the growing fetus and to prepare the mother for labor and delivery. In this context, maternal adaptation to pregnancy includes numerous cardiovascular, renal, hematologic, respiratory, and metabolic changes that finally lead to increased oxygen and nutrient supply to the fetoplacental unit and to enhanced protection against postpartum hemorrhage for the mother. Table 1.1 summarizes the main mechanisms of maternal adaptation to pregnancy with a systems approach.

Table 1.1 Maternal adaptation to pregnancy





Heart rate

Systemic vascular resistance

Blood volume

Systemic blood pressure

Cardiac output

Blood viscosity (Hct and Hb)

Venous stasis


Plasma volume

Protein S activity

Red blood cell mass

Prothrombin time (slightly)

Fibrinogen, factors II, VII, VIII, X, XII, XIII

Hemoglobin concentration

Thrombin activatable fibrinolytic inhibitor, PAI-1, PAI-2

Platelet count (slightly)


Resistance to activated protein C


Organ volume


Renal blood flow



Urinary frequency and nocturia

Dilatation of the ureters and renal pelvis

Proteinuria and glucosuria

Excretion of HCO3


Minute ventilation

Functional residual capacity



Slight alkalosis

Oxygen consumption


Gastroesophageal reflux

Intestinal peristalsis

Lithogenicity of bile

Gallbladder motility

Serum alkaline phosphatase

Serum level of AST, ALT, γ-GT

Albumin concentration


Insulin resistance

Starving glycemia

Postprandial glycemia

FFA concentration

Cholesterol and triglyceride concentrations


Leukocytes count

Leukocytes function

Th2 response

Th1 response


Immunoglobulin titles

Moreover, an evolutionary revolution occurred over the last decades: the intrauterine period of development has been shown to permanently shape the adult life, mainly through epigenetic modifications that affect the postnatal phenotype of the offspring in later life (1). This concept has given a new pivotal role to obstetric care also for improving the health status and the risk of chronic disease of future generations. In this context, maternal maladaptation to pregnancy may lead to short-term derangements in intrauterine development, with abnormal fetal growth, birth weight, and morphological development, and may finally shape the risk of chronic diseases of the child and the adult as a long-term effect.

Periconceptional period

Despite the great attention given to the second half of pregnancy, the research focus has recently moved to the first trimester and the time around conception (the “periconceptional period”) in order to grant early screening and diagnosis of subsequent adverse pregnancy outcomes with long-term health effects (Figure 1.1). The periconceptional period represents a chaotic time window from a biological point of view, starting with gamete maturation, going through the events of fertilization and implantation, and ending with the development of the embryonic structures and the first stages of placentation. This period is crucial for a normal adaptation to pregnancy, and any pathological deviation in this time window may finally lead to overt diseases in the second half of pregnancy and to larger shifts in the adult phenotype than the second half of pregnancy. In fact, if it is true that perinatal morbidity and mortality and the risk of noncommunicable diseases are mainly related to complications diagnosed during the second part of pregnancy (e.g., hypertensive disorders, intrauterine growth restriction, preterm birth), it is also evident that these conditions originate during the very first stages of pregnancy and even before, thus involving the most important stages of gamete, placenta, and embryo development (2).

May 10, 2020 | Posted by in GYNECOLOGY | Comments Off on The mother: Adaptation to pregnancy and normal metabolism
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