Chapter 47 describes the major endocrinological aspects that govern the initiation, maintenance, and termination of pregnancy. Supporting the growth and development of the fetus imposes significant challenges to maternal homeostasis and requires adjustments in the function of virtually every organ system. In this chapter, we consider the responses and adaptations of cardiovascular, renal, and respiratory systems to the demands of pregnancy. Such adaptations must accommodate the metabolic needs of the fetus while preserving the ability of the mother to make homeostatic adjustments to changing environmental demands. At the same time, physiological changes that take place during pregnancy must also prepare the mother to withstand the arduous birthing process and to provide sustenance for her newborn baby. Many of these adjustments are orchestrated by the placenta through the release of hormones and other bioactive substances into the maternal circulation. It is important to note that all of the regulatory and feedback mechanisms that maintain homeostasis in the nonpreg-nant woman remain operative during pregnancy, but the sensitivity to physiological signals or the set-points of feedback systems are modified. Some changes in maternal physiology in the late stages of pregnancy are adaptations to the physical presence of the expanded mass of the gravid uterus.
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