Maternal Physiologic Adaptations to Early Human Pregnancy

Clapp, James F.; Seaward, B. L.; Sleamaker, Robert H.; Hiser, John

doi:10.1097/00132582-198907000-00002

Cited by 47 publications

(60 citation statements)

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“…This confirms other reports (2) and is possibly due to a ϳ15% increase in plasma volume (11) and higher insulin sensitivity, as suggested by lower insulin concentrations. Thereafter, insulin sensitivity decreased, and insulin secretion and C-peptide levels increased with gestation.…”

Section: Proinsulinsupporting

confidence: 92%

Glucose Metabolism in Pregnancy at High Altitude

et al. 2001

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OBJECTIVE -To assess insulin sensitivity and ␤-cell function associated with lower maternal fasting plasma glucose levels at high altitude compared with sea level.RESEARCH DESIGN AND METHODS -We studied 215 pregnant women at 8 -42 weeks of gestation in Peru. The women were recruited from Cerro de Pasco, which is situated 4,370 m (14,340 feet) above sea level, and Lima, which is at sea level. We also examined 53 nonpregnant control subjects (22 in Cerro de Pasco and 31 in Lima). Fasting plasma glucose, insulin, C-peptide, and proinsulin concentrations were measured in samples obtained from the antecubital vein between 8:00 A.M. and 10:00 A.M. after an overnight period of fasting for 10 -14 h. Insulin resistance and ␤-cell function were calculated using homeostasis model assessment.RESULTS -Fasting C-peptide levels and ␤-cell function were similar, fasting concentrations of insulin and proinsulin were lower, and insulin sensitivity was higher at high altitude compared with sea level.CONCLUSIONS -Maternal fasting plasma glucose that is lower at high altitude than at sea level in the presence of similar insulin secretion is associated with higher peripheral insulin sensitivity. This may partly explain the lower birth weights at high altitudes.

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Section: Proinsulinsupporting

confidence: 92%

Glucose Metabolism in Pregnancy at High Altitude

et al. 2001

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“…Dilatation of the microvasculature, which makes up the bulk of the systemic vasculature, causes a decrease in peripheral resistance which is disproportional to the raised cardiac output, lowering maternal blood pressure early in the second trimester. 30 We observed the nadir of blood pressure at 19-week gestation, followed by a rise in the MAP throughout the late second and third trimesters to approximately baseline values, in concordance with pressures previously described in pregnancy.…”

Section: Discussionsupporting

confidence: 91%

Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

et al. 2013

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The microvasculature plays an important role in regulating cardiovascular changes in pregnancy, but changes in microvasculature have been difficult to document in vivo. This study objectively quantifies changes in the maternal retinal arteriolar and venular caliber over the course of healthy pregnancy. Healthy pregnant women (n=53) were recruited from Royal Prince Alfred Hospital, Sydney, Australia. Retinal images and mean arterial blood pressures (MAP) were collected at 13, 19, 29, and 38 weeks of gestation and at 6-month postpartum. Retinal vessels were analyzed and summarized as the central retinal arteriolar equivalent and central retinal venular equivalent. Central retinal arteriolar equivalent and central retinal venular equivalent were corrected for MAP. Paired t tests were performed comparing consecutive time points, with a significance level of P <0.01. There was a decrease in MAP between 13- and 19-week gestation ( P =0.001) followed by a return to baseline from 19 weeks to delivery. This was correlated by an increase in vessel caliber between 13- and 19-week gestation (central retinal arteriolar equivalent: P <0.001, central retinal venular equivalent: P =0.007) and a return to baseline from 19 weeks to delivery. There were no differences in the central retinal arteriolar equivalent or central retinal venular equivalent (both uncorrected and corrected for MAP) between nulliparous and parous women. The pattern of dilatation and constriction in the microvasculature mirrored the changes in MAP throughout pregnancy, reflecting changes in peripheral resistance. This study provides insights into physiological changes in the microvasculature throughout a healthy pregnancy. These results can be used as a baseline with which to compare the changes observed in pathological conditions of pregnancy.

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“…Maternal fat deposition begins early in pregnancy and has been estimated at 1.5 kg by 7 weeks gestation. 41 Therefore, early fat gain may be retained long term even after a short pregnancy. Our study found greater increases in both weight and girth associated with one or more short pregnancies compared to no pregnancies during follow-up, but only among overweight nulliparas.…”

Section: Discussionmentioning

confidence: 99%

Excess gains in weight and waist circumference associated with childbearing: The Coronary Artery Risk Development in Young Adults Study (CARDIA)

et al. 2004

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OBJECTIVE:To examine the association of childbearing with weight and waist circumference (WC) changes, we compared women with and without pregnancies or births during follow-up. STUDY DESIGN: A multicenter, longitudinal observational study over 10 years. Comparison groups defined by the number of pregnancies and births during follow-up: P0 (0 pregnancies; nongravid), P1 (1 þ miscarriages or abortions; 'short' pregnancies), B1 (1 birth), and B2 (2 þ births). Mean changes in weight and WC for P1, B1 and B2 groups vs P0 were examined separately by race (black and white), baseline parity (nulliparous and parous) and baseline weight status (normal weight; BMI o25 kg/m 2 and overweight; BMI Z25 kg/m 2 ). SUBJECTS: A population-based sample of 2070 women aged 18-30 y at baseline (1053 black subjects and 1017 white subjects) from Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California were examined five times between 1985-1986 and 1995-1996. MEASURMENTS: Weight and WC measurements were obtained using standardized protocol at baseline and examinations at years 2, 5, 7 and 10. Sociodemographic, reproductive, and behavioral attributes were assessed at baseline and follow-up examinations. RESULTS: Gains in weight and WC associated with pregnancy and childbearing varied by race (Po0.001), baseline parity (Po0.05) and overweight status (Po0.001). Among overweight nulliparas, excess gains in weight (black subjects: 3-5 kg, white subjects: 5-6 kg) and WC (black subjects: 3-4 cm, white subjects: 5-6 cm) were associated with 'short' pregnancies and one or more birth(s) during follow-up compared to no pregnancies (Po0.01 and 0.001). Among normal weight nulliparas, excess gains in weight (about 1 kg) and WC (2-3 cm) were associated with follow-up birth(s) (Po0.05). Among women parous at baseline, no excess weight gains were found, but excess WC gains (2-4 cm) were associated with follow-up births. CONCLUSION: Substantial excess weight gain is associated with both short pregnancies and a first birth in women overweight prior to initiation of childbearing. Excess weight gain was not associated with higher order births. Increases in waist girth were cumulative with both first and higher order births among overweight as well as normal weight women. Interventions to prevent obesity should be targeted at women who are overweight prior to initiation of childbearing. The impact of excess WC gains associated with childbearing on women's future health risk should be evaluated further.

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Maternal Physiologic Adaptations to Early Human Pregnancy

Cited by 47 publications

References 0 publications

Glucose Metabolism in Pregnancy at High Altitude

Glucose Metabolism in Pregnancy at High Altitude

Temporal Changes in Retinal Microvascular Caliber and Blood Pressure During Pregnancy

Excess gains in weight and waist circumference associated with childbearing: The Coronary Artery Risk Development in Young Adults Study (CARDIA)

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