Chapter 4

Changes During Pregnancy

Abdiwahab .B. Omer

MPH
 CHANGES DURRING PREGNANCY

 The three main changes we are focusing in this

chapter are:

1. Physical Change
2. Physiological Change
3. Psychological Change
 DEFINITION
 Physical: refers to the body's external
characteristics and tangible attributes.
 Example: Height, body composition, weight,
temperature, color and texture.
 Physiological: refers to the body's internal
processes and functions.
 Example: Heart rate, sweating, and other responses
to a scary movie.
 Psychological Change
 Psychology: is the study of the mind and behavior.
 Psychological Change: is the study of how people perceive, process,
and adapt to changes in their environment.
 Psychological changes during pregnancy: the changes in
psychological functioning of pregnant women. It is usually associated
with ambivalence, frequent mood changes, varying from anxiety,
fatigue, exhaustion, sleepiness, and depressive reactions to
excitement.
 PHYSIOLOGICAL CHANGE

 AIMS
 TO GAIN AN UNDERSTANDING OF THE
PHYSIOLOGICAL CHANGES THAT OCCUR
DURING PREGNANCY.
 Changes in:
1. Cardiovascular System
2. Respiratory System
3. Digestive System
4. Urinary System
5. Endocrine system
6. Reproductive System
7. Skin
 1. Changes in the Cardiovascular
system
 The cardiovascular system undergoes many changes during
pregnancy, including:
 Blood volume: Increases by 30–50% to supply the growing baby.
 Heart rate: Increases by 10–15 beats per minute. The most
significant increases occur in the third trimester.
 Cardiac output: Increases by 30–50%.
 Blood pressure: Decreases by 10–15 mm Hg in the first and second
trimesters, and increases slightly in the third trimester.
 Systemic vascular resistance: Decreases due to vasodilation and the
placenta creating a low resistance circuit.
 Hematocrit level: Decreases because plasma volume increases more
than red cell mass.
 Hematological changes

Decrease in:
o Red cell count.
o Hemoglobin concentration.
o Platelets
Increase in :
o Plasma volume

o Red cell mass

o Total blood volume

o White cell count.

 2. Changes Respiratory System
 The respiratory system undergoes many changes during pregnancy,
including:
 Hormonal changes: Pregnancy hormones affect the airway mucosa
and upper respiratory tract, causing hyperemia, mucosal edema, and
hypersecretion.
 Anatomical changes: The growing fetus and hormonal changes cause
the thoracic cage to change. The diaphragm moves upward, the chest
increases in size, and the chest wall circumference enlarges.
 Increased oxygen demand: The metabolic rate increases by 15%,
and oxygen consumption increases by 20%.
 Increased minute ventilation: Minute ventilation increases by 40–
50%, mainly due to an increase in tidal volume.
 Increased risk of airway obstruction: The airway becomes more
difficult, and there is a greater risk of airway obstruction with
sedation.
 3. Change in Digestive System

 Digestive System Slow down

 Nausea and vomiting are common during the first trimester because
of raised human chorionic gonadotrophin (HCG) levels.
 Constipation
 Poor appetite may occur
 The enlarging uterus displaces the stomach upward
 Morning Sickness is Common.
Pregnancy can cause many changes to the digestive system,
including:
 Hormonal changes
The hormone progesterone causes the muscles in the

digestive system to relax, which can slow down digestion and

increase the risk of constipation.
Growing uterus

As the uterus grows, it can press on or block parts of the

digestive tract, which can slow down digestion and cause

constipation.
Gallbladder

Pregnancy can cause the gallbladder to empty more slowly,

which can increase the risk of gallstones.

 Nausea and vomiting
 Around 80% of women experience nausea and vomiting
during the first trimester.

 Heartburn
 The hormone progesterone relaxes the valve between the stomach and
esophagus, which can cause stomach acid to flow back up and irritate
the esophagus, leading to heartburn.
 Appetite changes
 Pregnancy can cause changes in appetite, such as increased hunger,
decreased appetite, cravings, or aversions.
 Pica
 A rare craving for non-food items, such as dirt, clay, ice, or raw rice,
which may indicate a nutritional deficiency.
 4. Changes in Urinary
System
 The urinary system undergoes many changes during
pregnancy, including:
 Bladder capacity: The bladder's capacity decreases as
the growing uterus compresses it.
 Urination: The bladder doesn't empty as well, and there
may be changes in the frequency and flow of urination.
 Urine color: Urine may change from light yellow to dark
yellow or orange-yellow.
 Urinary tract infections (UTIs): The risk of UTIs
increases due to hormonal and mechanical factors that
contribute to urinary stasis, ureteral dilation, and dilation
of the renal calyces.
 Pelvic floor muscles: Hormone changes cause the pelvic floor
muscles to loosen and weaken, making it harder to control urination.
 Urinary incontinence (UI): UI is a common symptom of pregnancy,
affecting between 32% and 64% of pregnant women. It's usually
permanent and can increase toward the end of pregnancy.
 Bladder control problems: Childbirth can also lead to bladder
control problems, such as pelvic nerve damage, pelvic organ prolapse,
or injury to the pelvic floor and anal sphincter muscles.
 5. Endocrine System Change
 Pituitary gland enlarges – production of prolactin
increases for breast development.
 Thyroid gland enlarges slightly.
 metabolic rate increases by 25% in pregnancy causing an
increased pulse rate, heat intolerance.
 Parathyroid gland secretes parathyroid hormone

(responsible for calcium and phosphorus metabolism).

 5. Change in Endocrine System

 The endocrine system undergoes many changes during pregnancy,

including:
 Hormone production
 The placenta takes over hormone production from the ovaries,
producing large amounts of estrogen and progesterone to support the
growing fetus. The placenta also produces other hormones, such as
chorionic gonadotrophin, which levels rise rapidly in the first
trimester.
 Pituitary gland
 The pituitary gland enlarges, and the levels of prolactin and oxytocin
increase. Prolactin levels are 10 times higher at term than in the first
trimester. Oxytocin levels peak at term and initiate labor.
 Parathyroid gland
 The parathyroid gland grows slightly to meet the increased need for
calcium.
 Metabolic rate
 Metabolic rates increase, which can cause pregnant women to feel
warmer or have hot flushes.
 Thyroid disorders
 Thyroid disorders can occur during pregnancy.
 Gestational diabetes
 Pregnancy can cause the body to produce high levels of hormones that
impair insulin action, which can raise blood glucose levels.
 6. Reproductive Organs
 During pregnancy, the reproductive system undergoes many
changes, including:
 Uterus
 The uterus increases in size from the size of a pear to five times its
normal size, and can be felt above the pubic bone by 12 weeks. The
uterus leaves the pelvis and ascends into the abdominal cavity,
reaching the navel by 20 weeks and the lower rib cage by 36 weeks.
 Vaginal discharge
 Vaginal discharge usually increases and is clear or whitish in
color. An unusual color, smell, or itching could indicate a vaginal
infection.
 Hormones
 Estrogen levels increase 30-fold by childbirth. Estrogens prevent
ovulation, promote fetal tissue growth, and stimulate maternal tissue
growth.
 Kidneys
 The kidneys increase in length, and the ureters become longer and
more curved. The smooth muscle of the renal pelvis and ureter relax
and dilate.
 Bladder
 The smooth muscle of the bladder relaxes, increasing capacity and
risk of urinary tract infection.
 7. Skin Changes
 Stretch marks
 Dark pigmented line on there abdomen.
 Pigment changes on their face and neck
 Small blood vessels in the face, neck and upper
chest
 Melasma

 Striae
 Risk Factors in Prenatal
Assessment

Maternal age: young adolescents ( associated with increased maternal

and neonatal morbidity and mortality – obstetric complications are
enormous)
Older than 35 – increased risks for mom and fetus
Socioeconomic status: low income associated with low birth weight.
 Under nutrition: lack essential nutrients; anemic; Vit A,C and
riboflavin deficient – affects fetal development; causes low birth weight
Physical Changes During
Pregnancy Monthly
Pregnancy Development
1st Trimester—1st month
 Mom
 Missed period

 Enlarged breasts

 Frequent Urination
Pregnancy Development
2nd month
 Mom
 Swelling of breasts

 Increased urination due to pressure

Nausea (morning sickness)

 Pregnancy Development
3rd month
 Mom
 Breasts become firmer and fuller, may ache.

 Nausea

 Fatigue

 Frequent urination may continue

 Abdomen becomes slightly larger

 Weight gain may total 2-4 pounds

 Pregnancy Development
2nd Trimester—4th month
 Mom
 Appetite increases

 Most unpleasantness of early pregnancy,

such as morning sickness, usually gone.

 Abdomen continues to grow slowly.
 Pregnancy Development
5th month
 Mom
 Enlarged abdomen becomes apparent

 Slight fetal movements felt

 Pregnancy Development
6th month

 Mom
 Fetal movements sensed as strong kicks,
thumps, and bumps---some may be visible
 Weight gain by the beginning of this month
may total 10-12 pounds.
 Pregnancy Development
3rd Trimester—7th month
 Mom
 Increased size may affect
 Pregnancy Development
8th month
 Mom
 Discomfort may result from increased size of
abdominal area
 Backache---fatigue
 Leg cramps---shortness of breath
 Fetal kicks may disturb the mother’s rest
 At the beginning of this month, weight gain totals about
18-20 pounds
 Physical Development
9th month
 Mom
 “Lightening” felt as the fetus drops into the
pelvis and decreases pressure on mother’s
organs; breathing becomes easier
 Other discomforts may continue
 A total weight gain of 25-35 pounds is typical
 False labor pains may be experienced