Energy Requirements

Energy requirements increase gradually from 10 weeks to 36 weeks by 50 to 100 kcal/day. In the final 4 weeks, requirements increase by 300 kcal/day.

TABLE 4-1. Summary of Changes in the Body During Pregnancy

(1-14 wks)

(14-28 wks)

T3 (28 wks-term) Term = 37-42 wks

During Labor

9-Month Period

Body water

T by 8.5 L

Energy requirements

kcal/d

T by 300 kcal/d

Body weight

T (primarily reflects maternal growth)

T (primarily reflects maternal growth)

T (primarily reflects fetal growth)

T by 25-35 lb

Tidal volume

T

T by 200 mL

Vital capacity

T

T by 100-200 mL

Cardiac output

T by 60%

T by 30% during each contraction May T further in second stage of labor

T

Blood pressure (BP)

i

T by 10-20 mm Hg during each contraction May T further in second stage of labor

Systolic BP

^

Diastolic BP

i

i by 15 mm Hg at 16-20 wks

T to T1 level

Heart rate

T by 10-15%/min

Stroke volume

T by 10%

T During each contraction

Central venous pressure

T of 3-5 mm Hg during each contraction

Systemic vascular resistance

i from pre-pregnancy level

ii from pre-pregnancy level

T, but not to prepregnancy level

T with each contraction

Glomerular filtration rate (GFR)

above nonpregnant levels by 16 wks

T

Renal plasma flow

above nonpregnant levels by 20 wks

Peaks at 30 wks

T

Plasma aldosterone

T w/in 2 wks of conception

T 3-5 times the nonpregnant level

T 8-10 times the nonpregnant level

(Continued)

TABLE 4-1. Summary of Changes in the Body During Pregnancy (continued)

TABLE 4-1. Summary of Changes in the Body During Pregnancy (continued)

(1-14 wks)

(14-28 wks)

37-42 wks During Labor

9-Month Period

Serum alkaline phosphatase

t

Plasma prolactin

T

t 10-20 times nonpregnant level

Cortisol and other corticosteroids

T from 12 wks

T

t

t to 3-5 times nonpregnant levels

Glucagon

t

Insulin sensitivity

T

i at 20 wks

i

Fasting insulin levels

T at 20 wks

Peak at 32 wks

Plasma volume

T

T

t

t by 50%

Red blood cell (RBC) mass

T

T

t

t by 18-30%

Mean corpuscular volume (MCV)

^ or T from 82-84 fL

t from 86-100 fL or more

Neutrophils

T

T

t to 30 wks

Erythrocyte sedimentation rate (ESR)

T

t

Albumin blood levels

i

i from 3.52.5 g/100 mL

i by 22%

Total globulin

T by 0.2 g/100 mL

Total proteins

i by 20 wks from 76 g/100 mL

Thyroxine-binding globulin

t (Thyroxine-binding globulin levels double)

Total plasma cholesterol

i by 5%

T

t

t by 24-206%

Low-density lipoprotein (LDL)

t by 50-90%

Very low-density lipoprotein (VLDL)

Peaks at 36 wks

t by 36%

High-density lipoprotein (HDL)

T by 30%

Decreases from T2

t by 10-23%

Triglycerides

Reach 2-4 times nonpregnant level at 36 wks

t by 90-570%

Lipoprotein (a)

T until 22 wks i to nonpregnant levels

Lipoprotein (a)

T until 22 wks i to nonpregnant levels

Uterine contractions

Begin at 20 wks T

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