Changes during pregnancy: physiological, hormonal, psychological

Changes in the nervous system in a woman’s body during pregnancy

From the very moment of pregnancy, a stream of nerve impulses from the receptors (sensitive nerve endings) of the uterus and the growing fertilized egg begins to enter the mother’s central nervous system.
The impact of this stream of impulses inhibits the cerebral cortex and subcortical structures, which leads to drowsiness in pregnant women. This is not only the result of the influence of receptors, but also the influence of progesterone, aimed at maintaining pregnancy. This is a “hint” to the body that the life that has arisen inside it must be protected. Pregnant women develop a certain detachment, a “look inside themselves.” For some, their intellect is even slightly slowed down, making it difficult to read and solve crossword puzzles. Emotional lability, slight touchiness, tearfulness are also observed, memory and memorization suffer. Therefore, the learning ability of pregnant women deteriorates. These disorders are typical for the 1st-11th trimesters of pregnancy. Then all this gradually goes away. Before childbirth, the entire nervous system is activated, the pregnant woman’s body seems to wake up, the tone of the spinal cord and nervous elements of the uterus increases, which contributes to the onset of labor.

Uterus

Normally it has the shape and size of a pear. As pregnancy begins, the uterus begins to put pressure on the bladder as it grows. This causes it to get rid of even small amounts of urine, so the pregnant woman feels the urge to urinate more often than usual. In the first three months of pregnancy, the size of the uterus does not change very much, but in the fourth month its increase becomes noticeable. By the end of the fifth month, when the length of the fetus is almost 20 cm, the growth of the uterus becomes more intense. The total weight of the uterus, fetus and amniotic fluid at the end of pregnancy is about 8 kg.

Changes in the cardiovascular system in a woman’s body during pregnancy

The mother's blood circulation also undergoes significant changes to ensure the intensity of oxygen and nutrient delivery necessary for the fetus and the removal of metabolic products.

The volume of circulating blood increases, even in the first trimester of pregnancy. Subsequently, it increases, reaching a maximum by the 36th week. The volume of circulating blood during this period is increased by 30-50% of the initial volume before pregnancy. Gradually, there is a predominant increase in the volume of blood plasma and, to a much lesser extent, the cellular elements of the blood. Some blood thinning and hydremia are observed, which ensures its better fluidity. This improves the passage of blood through the vessels of the placenta and other vital organs - kidneys, liver, brain. In this case, so-called physiological anemia occurs - a decrease in hemoglobin from 130 g/l to 110 g/l. At the end of the first and beginning of the second trimester, the uteroplacental circulation is formed. Although the blood of mother and fetus does not mix, mutual influence has been confirmed. Changes in blood circulation in the uterus affect blood circulation in the placenta and the condition of the fetus, and vice versa. The vessels of the uterus and placenta have low resistance to blood flow; blood circulation is regulated passively, due to fluctuations in blood pressure in the mother. The walls of the smallest vessels - the capillaries of the uterus and placenta - become easily permeable to water, salts and light protein chains. This improves the metabolism between blood and tissues.

An increase in the volume of circulating blood loads the heart, and an increase in heart rate occurs - tachycardia. An increase in frequency to 90-96 beats per minute is considered extremely normal.

The fetoplacental system is like a new endocrine gland

After implantation of the zygote in the uterine cavity, a new endocrine gland begins to form in the woman’s body - the placenta (baby place).

The placenta has two parts: fetal and maternal, the blood circulation of which never mixes. These parts of the placenta are as close as possible, which allows for the exchange of substances between the body of the mother and the fetus, i.e., in essence, allows the child to “eat, write and breathe,” and, therefore, grow and develop.

Metabolism between the mother and fetus is the main factor for its development. The exchange is carried out due to the permeability of the placenta, which is disrupted in most acute and chronic complications during pregnancy. Violation of the integrity of parts of the placenta and deterioration of its permeability leads to fetal death and termination of pregnancy.

The death of the fetus and termination of pregnancy is also possible for another reason, when the mother’s body suddenly decides that the fetus is a foreign protein for it. But this is actually true. However, nature has provided a protective mechanism that does not allow the mother's immune system to recognize antigens of paternal origin embedded in the child.

This protective mechanism consists of certain factors that block the mother’s immune system and provide local immunological comfort. With spontaneous abortions, blocking factors in the mother's blood are reduced or absent.

The placenta produces a wide range of hormones and specific proteins that enter the mother's blood and amniotic fluid. They regulate the normal course of pregnancy and fetal development by changing the function of other endocrine glands and life support organs in general.

By the level of hormones and specific proteins of the placenta, determined in the mother’s blood, in the fetal blood or in the amniotic fluid, the condition of the fetus and the function of the placenta can be assessed, which is what obstetric endocrinology deals with. Thus, studying the endocrine function of the fetoplacental complex can significantly improve the diagnosis of the fetal condition at different stages of pregnancy.

The appearance of a new endocrine gland leads to other changes in the female body.

The appearance of a woman changes. Appears:

pigmentation of the skin (forehead, cheeks, chin, upper lip, white line of the abdomen, nipples and parapapillary zones), which is associated with significant stimulation of pigment formation by skin cells. The formation of pigment depends on the melanoform hormone of the adrenal gland, increased production of which occurs during pregnancy;
low-grade body temperature is noted , which can last up to 16-20 weeks of pregnancy and is associated with hormonal fluctuations.

From the moment the placenta begins to produce progesterone, the temperature decreases and returns to normal.

There is engorgement and soreness of the mammary gland due to an increase in its volume as a result of the proliferation of glandular tissue, enlargement of the nipples and protrusion of the areolar glands. In the second half of pregnancy, colostrum may be released;
violation of facial proportions (enlargement of the nose, lips, chin, thyroid gland, especially in the second half of pregnancy), some enlargement of the limbs;
stretching of the tissues of the anterior abdominal wall , mammary gland, thighs and the appearance of striae (“pregnant stripes”) in these areas (stria gravidarum). Their occurrence is associated with excessive stretching of the abdominal wall; this is more often observed in persons with a large abdominal volume (large fetus, polyhydramnios, multiple pregnancy) or with some lack of elastic fibers in the skin;
varicose veins worsen or appear for the first time , especially in the lower extremities;
The “proud posture and gait” of a pregnant woman is caused by a shift in the center of gravity of the body , increased mobility of the pelvic joints and limited mobility of the hip joints.
Progressive increase in body weight , which is caused both by the growth of the fetus and uterus, and by the characteristics of metabolic processes and fluid retention in tissues. The average weight gain during pregnancy is 10-12 kg, of which 5-6 kg is due to the fertilized egg (fetus, placenta, amniotic fluid), 1.5-2 kg for enlarged uterus and mammary glands, 3-3.5 kg - to directly increase a woman’s body weight.

Before childbirth (3-4 days), a pregnant woman’s body weight drops by 1.0-1.5 kg, due to the peculiarities of metabolic processes.

Changes in the respiratory system in a woman’s body during pregnancy

The respiratory system of a pregnant woman changes according to changes in the cardiovascular system. An increase in the volume of circulating blood and an increase in the heart rate entail faster and deeper breathing due to the constant relationship between the amount of blood flowing through the lungs and the volume of air inhaled.

During its life, the developing fetus releases an increased amount of carbon dioxide - CO2. Getting into the mother's blood, carbon dioxide causes increased breathing in order to quickly rid the body of excess carbon dioxide.

Increased breathing also occurs due to an increase in the size of the uterus in the second half of pregnancy, which compresses all internal organs, including the chest, and this reduces lung volume, deepens and increases breathing speed

But the breathing rate should not increase more than 20-22 breaths per minute.

Heart

During pregnancy, the cardiovascular system performs more intense work, as an additional placental circulation appears in the body. Here the blood flow is so great that 500 ml of blood passes through the placenta every minute. The heart of a healthy woman during pregnancy easily adapts to additional loads: the mass of the heart muscle and cardiac blood output increase. To meet the growing needs of the fetus for nutrients, oxygen and building materials, the blood volume in the mother’s body begins to increase, reaching a maximum by the 7th month of pregnancy. Instead of 4000 ml of blood, 5300-5500 ml now circulates in the body. In pregnant women with heart disease, this load can cause complications; that is why, at 27-28 weeks, they are recommended to be hospitalized in specialized maternity hospitals.

Hormonal changes in a woman’s body during pregnancy

The onset and development of pregnancy is accompanied by pronounced changes in the hormonal system of the woman’s body. The complexity of these changes is determined by the influence of placental and fetal hormones on the activity of the mother’s endocrine glands.

The onset and progression of pregnancy is supported by the corpus luteum of pregnancy. This structure in the ovary is formed after ovulation, the release of an egg from the ovary. In an empty follicle, a vesicle in which the egg developed before its final maturation and release into the “light,” the membrane cells quickly transform into luteophores (buttercup is a yellow flower, lutein is a yellow pigment, therefore the structure in the ovary is called the corpus luteum), secreting the hormone progesterone , which ensures the development of the embryo in the first 2-3 months. Progesterone plays a significant role in the process of implantation of the fertilized egg into the endometrium. With the beginning of the development of the trophoblast and then the placenta, the corpus luteum gradually undergoes a reverse process. Further development of pregnancy and growth of the embryo and then the fetus is ensured by the placenta.

Of the hormonal glands of the expectant mother, we will first consider the pituitary gland, the “tear drop” hanging at the lower edge of the cerebral hemispheres. It produces all the hormones that control the activity of the endocrine glands.

They are located in the anterior lobe, which during pregnancy increases 2-3 times, since there is a complete redistribution of all members of this “council”. Prolactin (pro - for, lactis - milk) has increased 5-6 times and blocks follicle-stimulating and luteinizing hormones, so the pregnant woman stops maturing eggs and menstrual cycles do not occur. With the development of the placenta, the function of prolactin in the development of the mammary glands and the production of colostrum and milk in them is taken over by placental lactogen (lactos - milk and genesis - formation), i.e. milk-forming hormone.

The production of thyroid-stimulating hormone, TSH, increases significantly. Accordingly, the production of T3 and T4, thyroid hormones, increases in a pregnant woman. They ensure the proper level of metabolism, optimal for the growth and development of the fetus. Some women even experience some enlargement of the thyroid gland.

But this is followed by an increase in the activity of the thyroxine-binding ability of the blood serum, which is due to the influence of hormones of the feto-placental system.

The function of the parathyroid glands is reduced, because of this the calcium content in the blood of a pregnant woman may be disrupted, which causes painful cramps in the calf muscles and feet.

Therefore, from the first weeks of pregnancy, it is necessary to increase the calcium level in the blood by taking foods rich in calcium or prescribing medications and calcium salts. Soluble Ca is the most effective; it is much more easily absorbed in the stomach and intestines.

The posterior lobe of the pituitary gland does not enlarge. It produces oxytocin, a physiological factor of uterine contraction. It accumulates in the posterior lobe during pregnancy. At the end of pregnancy, all the accumulated oxytocin suddenly enters the mother's bloodstream and triggers the onset of labor - uterine contractions.

Also, an antidiuretic hormone is formed in the posterior lobe of the pituitary gland, which ensures the accumulation of fluid in the pregnant woman’s body.

Significant changes occur in the adrenal glands. Blood flow increases in them, and due to this, excessive growth of adrenal cortex tissue, which produces hormones, occurs. And in the blood the content of a specific protein transcortin increases, which accompanies adrenal hormones into the blood, ensuring their attachment to various sensitive cells - receptors in different organs.

This is exactly how hormones act - they attach to receptors, like inserting a key into a lock, providing their effects. The increased amount of adrenal hormones in the blood of a pregnant woman is explained not only by their increased production in the adrenal glands, but also by the intake of fetal adrenal hormones into the expectant mother’s body after 24 weeks of pregnancy. Adrenal hormones have an adaptive effect, increasing the resistance of membranes and tissues to stress. But there is also a side effect - the formation of brown pigment on the face, nipples, areola, along the white line (middle of the abdomen) of the abdomen of pregnant women. In the 2nd half of pregnancy, bluish-purple striae appear on the chest, hips, and abdomen - stretch marks of the skin with separation of connective tissue fibers. After childbirth, these scars acquire a whitish color and become less noticeable.

The emergence and development of pregnancy is associated with the formation of a new functional mother-fetus system. It has been established that changes in the mother's condition during pregnancy actively affect the development of the fetus. In turn, the condition of the fetus is not indifferent to the mother’s body. During different periods of intrauterine development, numerous signals are emitted from the fetus, which are perceived by the corresponding organs and systems of the mother’s body and under the influence of which their activity changes. The main link connecting the organisms of mother and fetus is the placenta.

During a physiologically occurring pregnancy, in connection with the development of the fetus and placenta, significant changes in the function of all the most important organs and systems are observed in the maternal body. These changes are of a pronounced adaptive nature and are aimed at creating optimal conditions for the growth and development of the fetus.

Endocrine system. The occurrence and development of pregnancy is accompanied by endocrine changes in the maternal body. The complexity of the changes is determined by the fact that the activity of the mother’s endocrine glands is greatly influenced by the hormones of the placenta, as well as the fetus.

The anterior lobe of the pituitary gland increases 2-3 times during pregnancy. Histological examination reveals large acidophilic cells, called “pregnancy cells,” the appearance of which is due to the stimulating influence of sex steroid hormones of the placenta. Morphological changes in the anterior lobe of the pituitary gland affect the function of this organ: a sharp depression in the production of follicle-stimulating hormones (FSH) and luteinizing hormones (LH) and an increase (5-10 times) in the production of prolactin (PRL) during pregnancy, and an increase in FSH and LH along with a decrease Prl products in the postpartum period.

During a physiologically proceeding pregnancy, the content of somatotropic hormone (GH) in the blood is practically unchanged, only at the end of pregnancy is there a slight increase.

Significant changes in thyroid-stimulating hormone (TSH) production are observed. Soon after the onset of pregnancy, an increase in its content is observed in the mother’s blood. Subsequently, as pregnancy progresses, it increases significantly and reaches its maximum before childbirth.

During pregnancy, there is an increased secretion of adrenocorticotropic hormone (ACTH), associated with hyperproduction of corticosteroids by the adrenal glands.

The posterior lobe of the pituitary gland does not enlarge. Oxytocin produced in the hypothalamus accumulates in the posterior lobe of the pituitary gland. Oxytocin synthesis especially increases at the end of pregnancy and childbirth.

The occurrence and development of pregnancy are associated with the function of a new endocrine gland - the corpus luteum of pregnancy. The corpus luteum produces sex hormones (progesterone and estrogens), which play a huge role in implantation and the further development of pregnancy. From the 3-4th month of pregnancy, the corpus luteum undergoes involution and its function is entirely taken over by the placenta. The corpus luteum is stimulated by human chorionic gonadotropin. Blockade of the secretion of FSH and LH from the adenohypophysis is accompanied by a natural inhibition of follicle maturation in the ovaries; the ovulation process also stops.

Thyroid. Most women experience an increase during pregnancy. This is due to its hyperplasia and active hyperemia. The number of follicles increases, and the colloid content in them increases. These morphological changes are reflected in the function of the thyroid gland: the concentrations of protein-bound thyroxine (T4) and triiodothyronine (T3) in the blood increase.

The function of the parathyroid glands is somewhat reduced, which is accompanied by disturbances in calcium metabolism. This, in turn, may be accompanied by the occurrence of convulsive phenomena in the calf and other muscles in some pregnant women.

Adrenal glands. Hyperplasia of the adrenal cortex and increased blood flow in them are observed. This is reflected in increased production of glucocorticoids and mineralocorticoids. Nervous system. This system of the mother plays a leading role in the perception of numerous impulses coming from the fetus. During pregnancy, the uterine receptors are the first to respond to impulses coming from the growing fertilized egg. The uterus contains a large number of different nerve receptors: sensory, chemo-, baro-, mechano-, osmoreceptors, etc. Impact on these receptors leads to changes in the activity of the central and autonomous (autonomic) nervous system of the mother, aimed at ensuring the proper development of the unborn child.

The function of the central nervous system undergoes significant changes. From the moment pregnancy occurs, an increasing flow of impulses begins to flow into the mother’s central nervous system, which causes the appearance in the cerebral cortex of a local focus of increased excitability - a gestational dominant, around which a field of inhibition of nervous processes is created. Clinically, this process manifests itself in a somewhat inhibited state of the pregnant woman, and a predominance of her interests directly related to the birth and health of the unborn child. When various stressful situations occur in the central nervous system, other foci of persistent excitation may arise, which significantly weakens the effect of the gestational dominant and is often accompanied by a pathological course of pregnancy.

During pregnancy, the state of the central nervous system changes. Until the 3-4th month of pregnancy, the excitability of the cerebral cortex is generally reduced, and then gradually increases. The excitability of the underlying parts of the central nervous system and the reflex apparatus of the uterus is reduced, which ensures relaxation of the uterus and the normal course of pregnancy. Before childbirth, the excitability of the spinal cord and nervous elements of the uterus increases, which creates favorable conditions for the onset of labor.

The cardiovascular system. The cardiovascular system functions during pregnancy with an increased load due to increased metabolism, an increase in the mass of circulating blood, the development of the utero-placental circulation, a progressive increase in the body weight of the pregnant woman, etc. As the size of the uterus increases, the mobility of the diaphragm is limited, intra-abdominal pressure increases, and the position of the heart in the chest changes cell (it is located more horizontally), at the apex of the heart in some women a mildly expressed functional systolic murmur occurs.

Already in the first trimester of pregnancy, the blood volume increases significantly and subsequently increases all the time (by about 30-50%), reaching a maximum by the 36th week. Hypervolemia occurs mainly due to an increase in blood plasma volume with the occurrence of physiological anemia in pregnant women.

In the second trimester of pregnancy, a decrease in systolic and diastolic pressure by 5-15 mm Hg is observed. Peripheral vascular resistance also decreases. This is due to the formation of the uterine circulation, which has low vascular resistance, as well as the effect of placental estrogen and progesterone on the vascular wall.

During pregnancy, physiological tachycardia is observed. The heart rate reaches its maximum in the third trimester of pregnancy, when this figure is 15-20 per minute higher than before pregnancy.

The most significant hemodynamic change during pregnancy is an increase in cardiac output (by 30-40%). Cardiac output begins to increase from the earliest stages of pregnancy, with its maximum change observed at 20-24 weeks. On the ECG, a deviation of the EOS can be detected, which reflects a displacement of the heart in this direction. EchoCG shows an increase in myocardial mass and the size of individual parts of the heart. X-ray examination reveals changes in the contours of the heart, reminiscent of the mitral configuration.

Respiratory system. As the size of the uterus increases, the abdominal organs gradually shift, the vertical size of the chest decreases, the excursion of the diaphragm is limited, as a result of which there is a slight increase in breathing (by 10%) and a gradual increase in the tidal volume of the lungs towards the end of pregnancy (by 30-40%) .

As a result, the minute volume of breathing increases from 8 l/min at the beginning of pregnancy to 11 l/min at the end of it.

Digestive system. Many women in the early stages of pregnancy experience nausea, vomiting in the morning, changes in taste, and intolerance to certain foods. As pregnancy progresses, these phenomena gradually disappear.

Pregnancy has an inhibitory effect on the secretion of gastric juice and its acidity. All parts of the gastrointestinal tract are in a state of hypotension, caused by changes in topographic-anatomical relationships in the abdominal cavity due to an enlargement of the pregnant uterus, as well as neurohormonal changes inherent in pregnancy (the effect of placental progesterone on the smooth muscles of the stomach and intestines). This explains the frequent complaints of constipation among pregnant women.

Liver function undergoes significant changes. There is a significant decrease in glycogen reserves in this organ, which depends on the intensive transition of glucose from the mother’s body to the fetus. Increased glycolysis processes are not accompanied by hyperglycemia, therefore, in healthy pregnant women, the nature of the glycemic curves does not change significantly. The intensity of lipid metabolism changes. This is expressed by the development of lipemia and higher levels of cholesterol in the blood. The content of cholesterol esters in the blood also increases significantly, which indicates an increase in the synthetic function of the liver.

The protein-forming function of the liver changes, which is aimed primarily at providing the growing fetus with the necessary amount of amino acids, from which it synthesizes its own proteins. Starting from the second half of pregnancy, the concentration of total protein in the blood plasma begins to decrease slightly. Pronounced changes are also observed in the protein fractions of the blood (decreased albumin concentrations and increased globulin levels).

Urinary system. During pregnancy, the mother's kidneys function with increased load, removing from her body not only the products of its metabolism, but also the products of the fetus's metabolism.

The processes of blood supply to the kidneys undergo significant changes - it increases in the first trimester of pregnancy and gradually decreases thereafter. In parallel with the changes in blood supply, glomerular filtration also changes, which increases significantly in the first trimester of pregnancy (by 30-50%), and then gradually decreases, while tubular reabsorption remains without significant changes throughout pregnancy. This contributes to fluid retention in the pregnant woman’s body, which is manifested by tissue pastiness on the lower extremities at the end of pregnancy. At the end of pregnancy, sodium is retained in the extracellular fluid, which increases its osmolarity.

Some women experience orthostatic proteinuria. This is due to compression of the inferior vena cava liver and the uterine veins of the kidneys. Glucosuria sometimes occurs due to increased glomerular filtration.

During pregnancy, the topography of organs adjacent to the uterus changes. This primarily concerns the bladder and ureters. As the uterus increases in size, compression of the bladder occurs. Towards the end of pregnancy, the base of the bladder moves upward outside the pelvis. The walls of the bladder hypertrophy and are in a state of increased hyperemia. The ureters hypertrophy and lengthen somewhat.

Hematopoietic organs. During pregnancy, hematopoiesis processes intensify. However, due to hypervolemia, by the end of pregnancy there is a decrease in hemoglobin content, the number of red blood cells and the hematocrit number. Activation of the erythropoietic function of the bone marrow during pregnancy is associated with increased production of the hormone erythropoietin, the formation of which is stimulated by placental lactogen.

During pregnancy, not only the number, but also the size and shape of red blood cells changes. The volume of red blood cells increases especially noticeably in the second and third trimesters of pregnancy. The increased volume of red blood cells increases their aggregation and changes the rheological properties of the blood as a whole. Beginning in early pregnancy, an increase in blood viscosity is observed. The concentration of serum iron during pregnancy decreases compared to that in non-pregnant women (at the end of pregnancy to 10.6 µmol/l). Activation of the white blood sprout is observed (the number of leukocytes increases). There is an increase in ESR (up to 40-50 mm/h).

The immune system. During pregnancy, very complex immunological relationships arise and form between the organisms of the mother and the fetus, based on the principle of direct and feedback. These relationships ensure correct, harmonious development of the fetus and prevent rejection of the fetus as a kind of allograft. The most important factor in protecting the fetus is the immunological tolerance of the maternal body to fetal antigens of paternal origin, caused by various mechanisms.

Hemostasis system. During pregnancy, there is a significant (up to 150-200%) increase in the content of all plasma factors (except XIII) of blood coagulation, a decrease in the activity of natural blood clotting inhibitors, inhibition of fibrinolysis activity and a slight increase in the adhesive-aggregation properties of platelets.

Metabolism. With the onset of pregnancy, significant changes occur in metabolism. Significant changes are observed in protein, carbohydrate and lipid metabolism.

As pregnancy progresses, a woman’s body accumulates protein substances, which is necessary to meet the amino acid needs of the growing fetus. Changes in carbohydrate metabolism are characterized by the accumulation of glycogen in the cells of the liver, muscle tissue, uterus and placenta. During the physiological course of pregnancy, a slight increase in the concentration of neutral fat, cholesterol and lipids is observed in the mother’s blood.

Mineral metabolism undergoes various changes: retention of calcium and phosphorus salts is observed.

During pregnancy, the need for vitamins increases significantly. Vitamins are necessary both for the physiological course of metabolic processes in the mother’s body and for the proper development of the fetus. Most vitamins pass through the placenta to one degree or another and are used by the fetus during its growth and development.

Certain adaptive changes during physiological pregnancy are observed in the acid-base state (ABS). It has been established that pregnant women experience a state of physiological metabolic acidosis and respiratory alkalosis.

Musculoskeletal system. During the physiological course of pregnancy, pronounced changes occur in the entire musculoskeletal system of a woman. There is serous impregnation and loosening of the ligaments, cartilage and synovial membranes of the pubic and sacroiliac joints. As a result, there is some divergence of the pubic bones to the sides (0.5-0.6 cm).

The chest expands, the costal arches are positioned more horizontally, and the lower end of the sternum moves somewhat away from the spine. All these changes leave an imprint on the entire posture of the pregnant woman.

Leather. In many pregnant women, brown pigment is deposited on the face, nipples, and areola, which is due to changes in the function of the adrenal glands. As pregnancy progresses, a gradual stretching of the anterior abdominal wall occurs. So-called pregnancy scars appear, which are formed as a result of the divergence of connective tissue and elastic fibers of the skin. Pregnancy scars look like pink or blue-purple stripes in an arched shape. Most often they are located on the skin of the abdomen, less often on the skin of the mammary glands and thighs. After childbirth, these scars lose their pink color and take on the appearance of white stripes.

The navel flattens out in the second half of pregnancy and later protrudes. In some cases, during pregnancy, hair growth is observed on the skin of the face, abdomen, and thighs, which is due to increased production of androgens by the adrenal glands and partly by the placenta.

Reproductive system. The uterus increases in size throughout pregnancy, but this increase is asymmetrical, which largely depends on the site of implantation. During the first few weeks of pregnancy, the uterus is pear-shaped. At the end of the 2nd month of pregnancy, the size of the uterus increases approximately 3 times and it has a rounded shape. During the second half of pregnancy, the uterus retains its round shape, and at the beginning of the third trimester it becomes ovoid. As the uterus grows, due to its mobility, some rotation occurs, often to the right. At the end of pregnancy, the weight of the uterus reaches an average of 1000 g (before pregnancy 50-100 g). The volume of the uterine cavity at the end of pregnancy increases more than 500 times. The increase in the size of the uterus occurs due to the progressive processes of hypertrophy and hyperplasia of muscle elements.

The fallopian tubes thicken, blood circulation in them increases significantly. Their topography also changes (by the end of pregnancy they hang along the ribs of the uterus).

The ovaries increase somewhat in size, although the cyclic processes in them stop. During the first 4 months of pregnancy, a corpus luteum exists in one of the ovaries, which subsequently undergoes involution. Due to the increase in the size of the uterus, the topography of the ovaries, which are located outside the pelvis, changes.

The ligaments of the uterus thicken and lengthen significantly. This is especially true for the round and uterosacral ligaments.

Vagina. During pregnancy, hyperplasia and hypertrophy of the muscle and connective tissue elements of this organ occurs. The blood supply to its walls increases, and pronounced serous permeation of all its layers is observed. As a result, the vaginal walls become easily stretchable. Due to congestive venous congestion, the vaginal mucosa acquires a characteristic bluish color. Transudation processes intensify, as a result of which the liquid part of the vaginal contents increases. A lot of glycogen is deposited in the protoplasm of stratified squamous epithelium, which creates optimal conditions for the proliferation of lactobacilli. The lactic acid secreted by these microorganisms maintains the acidic reaction of the vaginal contents, which is an important deterrent against ascending infection. The external genitalia loosen during pregnancy, and the mucous membrane of the vaginal opening has a distinct bluish coloration. Sometimes varicose veins occur on the external genitalia.

Other internal organs. Along with the urinary system, significant changes due to pregnancy are also observed in the abdominal organs. The jejunum, ileum, cecum, and vermiform appendix are displaced by the pregnant uterus upward and to the right. At the end of pregnancy, the appendix may be located in the right hypochondrium. The sigmoid colon moves upward and may be pressed against the upper edge of the pelvis at the end of pregnancy. At the same time, compression of the abdominal aorta and inferior vena cava is observed, which can lead to varicose veins of the lower extremities and rectum.

Changes in the consumption of various nutrients by the cells and tissues of a pregnant woman

A growing baby requires more and more vitamins and microelements. Due to the increased need of the fetus for glucose, insulin production increases. A healthy woman usually has blood sugar levels within the normal range for a pregnant woman, but if the expectant mother has diabetes, various difficulties may arise.

Also, a doctor’s correction may be required if a woman has anemia. A pregnant woman especially needs vitamins E, C, B vitamins, folic acid, PP, iron, etc. Your nutrition and the prescription of the necessary vitamins and microelements are controlled by a doctor.

Effect of pregnancy on liver function

The liver during pregnancy is in a state of high functional tension. However, in healthy women during the physiological course of pregnancy, the functioning of the liver is not impaired.

Noted:

slight increase in liver size in the absence of pronounced histological changes;
there is a decrease in the antitoxic function of the liver;
the level of protein in the blood serum decreases, by the time of childbirth it can reach 60 g/l;
the result of changes in the composition of serum proteins is an increase in ESR;
blood clotting and fibrinolysis changes. These changes help increase blood clotting ability.

Changes in the immune system in a woman’s body during pregnancy

The embryo receives 50% of the genetic information from the father, which means that half of it consists of material that is immunologically alien to the woman.

Therefore, the fetus is semi-compatible with the mother’s body. During the development of pregnancy, complex immunological direct and feedback connections arise between the mother and fetus. Such relationships ensure the harmonious development of the fetus and prevent its rejection. The earliest barrier to antibodies is the zona pellucida of the fertilized egg, which is impenetrable to immune cells.

Elements of the trophoblast, foreign to the mother’s body, appear in the 5th week of pregnancy, and the same tissues of the fetus appear in the 12th week of pregnancy. From this period, the immune “attack” of the fetus develops and progresses.

Immune protection of the maternal body is provided by several mechanisms. First of all, these are blocking antibodies - protein “reflections” of antigens - foreign proteins, corresponding to each other, like an electron and a positron, and also mutually destroying. Secondly, these are the hormones circulating in the mother’s blood, placental lactogen and chorionic hormone, which inhibit the “meeting” of antigens with antibodies and the manifestation of the antibody-antigen reaction - mutual destruction. The third mechanism is the influence of a specific fruit protein, alpha-fetoprotein, AFP, which suppresses the production of antibodies by maternal lymphocytes.

And the placenta plays a leading role in the immunological protection of the fetus. The trophoblast is resistant to immune rejection because it is surrounded on all sides by a layer of immunologically inert fibrinoid (we talked about it in the chapter on the development of the placenta).

This layer reliably protects the fetus from immunological aggression from the mother.

Internal organs during late pregnancy

The main transformations of internal organs occur in the second half of gestation as the fetus and the uterus in which it is located grow. How do organs move during late pregnancy?

Over nine months, the amount of circulating blood in the female body increases, and a new circulatory system is formed - the placental. The heart works with additional load, the mass of the heart muscle increases. In later stages, the heart rate increases (up to 90 beats per minute). Quite often, pregnancy also affects blood pressure. In the first weeks it may be below normal, and in the later stages it may increase. You need to monitor your blood pressure level, because high levels, especially at the end of pregnancy, can signal pathological processes. For example, about the development of gestosis (late toxicosis).

Expecting a baby also affects the condition of the lungs. They are also working hard. After all, on the one hand, the need for oxygen increases; it is necessary to provide it not only to the mother, but also to the growing fetus. On the other hand, the growing uterus begins to put pressure on the diaphragm. The mucous membrane of the bronchi swells. The woman breathes faster and deeper. Often, pregnant women are recommended special breathing exercises (without holding their breath) to prevent possible inflammation of the respiratory tract. Regular walks in the fresh air are also suitable for this. Before childbirth, the situation becomes a little easier, the pressure on the diaphragm decreases, because the fetus descends towards the birth canal.

The stomach suffers almost more than all other internal organs, especially in recent months. It moves up. The growing uterus constantly puts pressure on it, because of this, gastric juice enters the esophagus - and heartburn occurs.

During pregnancy, the location and intestines change. At first it rises, and at the end of pregnancy it moves apart, giving way to the uterus with the fetus, which descends to the birth canal. Often such intestinal movements provoke constipation. To avoid them, a pregnant woman should drink enough water, eat small portions, include fiber-rich foods in her menu, and have enough gentle physical activity.

The main filter of the body is the liver, which during pregnancy works with double the load, and also shifts upward and sideways. Sometimes this can lead to problems with the flow of bile and the appearance of colic. In such cases, doctors recommend a special diet.

Although the kidneys do not shift, they also work in an enhanced mode, “serving” two organisms - maternal and child.

During pregnancy, the state of the skeletal system also changes. She loses a large amount of calcium, which is used for the full development and growth of the fetus.

Changes in the functioning, as well as the size and location of internal organs during pregnancy are natural. Often such transformations bring physical discomfort to a woman. But all these are temporary phenomena. A little time after birth, the work of all internal organs, their size and location will return to normal.

Especially for nashidetki.net - Ksenia Boyko

Changes in the urinary system in a woman’s body during pregnancy

The kidneys in pregnant women function under increased load, removing from the mother’s body not only the products of her metabolism, but also the waste products of the fetus.

The hormone progesterone weakens the tone of the ureters and bladder. Urination becomes more frequent; not only at the beginning of pregnancy, but throughout pregnancy, the number of bladder emptyings is higher than in non-pregnant women. Increased vascular permeability of the kidneys at the end of pregnancy sometimes leads to the appearance of traces of protein in the urine. Moreover, there is an unproven opinion that these are proteins of the fetus, and not of the expectant mother. Sometimes sugar also appears - physiological glucosuria of pregnant women.

A glucose tolerance test, an analysis of tolerance to sugar load, helps to distinguish this from the manifestations of diabetes.

Effect of pregnancy on kidney function

Renal blood flow increases and glomerular filtration increases (maximum in mid-pregnancy) - associated with the excretion of metabolic products of the woman and the fetus.

The permeability of the kidneys to protein and carbohydrates increases: proteinuria (protein in the urine), glucosuria. The excretion of 140 mg/day of glucose in the urine is considered the upper limit of the physiological norm. Peak glucose secretion was detected at 9 months of pregnancy.

The peristaltic function of the ureters is sharply suppressed, as a result of which they expand and urine is retained in them. Atony of the ureters leads to impaired drainage of urine from the pelvis, which creates favorable conditions for the development of pyelonephritis in pregnant women. In the postpartum period, these phenomena soon disappear.

Changes in the digestive system in a woman’s body during pregnancy

Many women in the first trimester of pregnancy experience nausea, sensitivity to smells, and sometimes vomiting. These phenomena are called toxicosis.

However, no toxins (poisons) are detected. There is a theory that explains these phenomena by the body’s unpreparedness for the development of pregnancy and decreased ovarian function. All these phenomena disappear at the end of the first trimester, when the placenta is formed, replacing hormonal function.

Pregnancy inhibits the secretion of gastric juice and other digestive glands, food stagnates in the stomach and intestines, and constipation occurs at the same time.

The function of the liver changes significantly: glucose depots are emptied, transferring it into the bloodstream and to the fetus, which needs glucose as a highly energy-intensive material.

Fat metabolism also changes. They are “simplified” to glycerol and fatty acids. In this form, fats enter the bloodstream and the fetus. Therefore, neither increased amounts of glucose nor fats are noted in the blood of pregnant women. The amount of cholesterol may be increased - this is the fatty depot of hepatocytes - liver cells. The protein-forming function of the liver also changes, aimed at providing the fetus with a significant amount of protein and its “building blocks” - amino acids necessary for the fetus to nourish and build its own body. The amount of clotting factors produced by the liver increases at the end of pregnancy, causing increased clotting. This is a normal reaction of the body in light of the upcoming birth.

The detoxification function of the liver is weakened during pregnancy, so the use of alcohol, drugs and toxins can be especially harmful. After all, the body is almost naked and unprotected in the face of poisoning.

And in the second half of pregnancy, the growing uterus pushes the intestines to the back wall of the abdominal cavity. Moreover, the hormone testerone, which ensures relaxation of the uterus, simultaneously weakens the intestinal walls, inhibiting peristalsis - the sequential contraction of the intestinal walls that moves the contents through the intestines. Increased fluid retention in the body of a pregnant woman plays a certain role in the formation of constipation. The contents of the intestine are dried out. This can lead to fissures in the anus, which makes defecation extremely painful.

And here the existing constipation is aggravated by conscious inhibition and postponing going to the toilet. Stagnation of feces in the intestines poisons the body of a pregnant woman. And, as already mentioned, it is not protected from toxins.

The pregnant woman’s health worsens, nausea and cramping pain in the abdomen appear.

The way to solve these problems lies in several measures. The first is the drinking regime: if you have nausea in the early stages of pregnancy, you need to literally drink yourself, drink 5-6 glasses of water by spoon, overcoming the tendency for fluid to accumulate.

The second is the introduction of easily digestible foods into food, in small portions and more often.

When the intestines are pushed aside and peristalsis is slowed down, it is necessary to enrich the diet with plant fiber - beets, prunes, apricots or dried apricots, radishes, radishes, pumpkin. Fiber swells in the intestines and, like a broom, sweeps away stagnant contents from the body

You can use laxatives that disrupt the contact of feces with the intestinal wall. Under the influence of gravity, feces move towards the exit. Filling of the rectum is a signal for defecation.

Also effective is the use of eubiotics, drugs of intestinal microflora - Acipol with lactobacilli, Bifiform with bifidobacteria, etc. These drugs have no contraindications either for children or for pregnant and lactating women. Normalization of the intestinal microflora leads to the disappearance of putrefactive bacteria capable of producing toxins.

Hair, skin and nails

Skin changes

Almost always, changes in a woman’s body during pregnancy relate to appearance.
While most changes are temporary, some—like stretch marks—can stay with you for a long time if you don't fight them. Additionally, women who change in appearance during pregnancy are more likely to experience the same changes in future pregnancies or even when taking hormonal contraceptives. Good news for girls and women suffering from acne. As a rule, during pregnancy you will have clear and smooth skin. This is due to high levels of the female hormone estrogen. For some women, such hormonal changes during pregnancy can completely relieve acne caused by hormonal nature.

Hyperpigmentation

The vast majority of pregnant women experience some type of hyperpigmentation during pregnancy. The process involves darkening certain areas of the skin, such as halos, genitals, scars, and the linea alba (dark line) along the middle of the abdomen. Hyperpigmentation can occur in women of any skin tone, although it is more common in women with darker skin.

Additionally, up to 70% of pregnant women experience darkening of the skin on their face. This condition is known as melasma or the “mask” of pregnancy. This can be worsened by sun exposure and radiation, so a broad-spectrum UVA/UVB sunscreen should be used daily during pregnancy.

Stretch marks

Stretch marks (striae gravidarum) are perhaps the most well-known skin change during pregnancy. They are caused by a combination of physical stretching of the skin and the effects of hormonal changes on skin elasticity. Up to 90% of women suffer from stretch marks in the third trimester of pregnancy, often on the chest and abdomen. Although pinkish-purple stretch marks may never completely disappear, they often fade to skin color and decrease in size after childbirth. Stretch marks can be itchy, so use special creams to soothe and reduce the urge to scratch and possibly damage the skin.

Freckles

Hyperpigmentation caused by hormonal changes during pregnancy can lead to discoloration of moles and the appearance of freckles. Some darkening of moles, freckles and birthmarks may be harmless. But it's always a good idea to visit a dermatologist or your primary care physician if there are changes in the size, color, or shape of your birthmarks.

Rash during pregnancy

A small percentage of women may experience skin conditions common to pregnancy, such as PUPPP (pruritic urticaria papules and plaques of pregnancy), folliculitis, and other rashes during pregnancy. Most symptoms include pustules and red bumps along the abdomen, legs, arms, or back. Although most rashes are harmless and resolve quickly after delivery, some skin conditions can cause premature labor or problems for the baby. These include intrahepatic cholestasis and pemphigoid gestation.

Therefore, always report any suspicious rash that appears during pregnancy to your doctor.

Changes in hair condition

High levels of estrogen have a beneficial effect not only on the skin, but also on the condition of the hair. During pregnancy, hair will grow faster and more and fall out less. They will become lush and shiny. But, unfortunately, this cosmetic effect will disappear gradually after childbirth and within a year you will return to the original state of your hair.

However, “pregnant” hormones can cause the opposite effect in some girls and women. Changes in hormones can sometimes cause excessive hair loss. This is especially true for women with familial alopecia.

However, most women do experience hair growth that thickens during pregnancy, not only on the scalp, but also in other places. Hair growth may occur on the face, arms, legs or back.

Changes in nail condition

Many women also experience faster nail growth during pregnancy. Good nutrition and taking prenatal vitamins add many positive effects to the effects of pregnancy hormones. While most women's nails improve, some may complain of increased nail brittleness, breakage, grooves, or keratoses. Eating a healthy diet and applying natural cuticle and nail oils can help prevent nail breakage without using chemical nail products.

Changes in the genital organs in a woman’s body during pregnancy

They are undergoing significant changes. In the chapter on hormonal changes it was already mentioned that prolactin suppresses the maturation of eggs in the ovaries and menstrual cycles.

The external genitalia soften significantly and become bluish in color, as blood circulation in them decreases. The cervix and uterus also soften, especially the isthmus. This is one of the early and probable signs of pregnancy.

As the fetus develops, the uterus grows significantly. Its weight before pregnancy is 50-80 g and increases to 1-2 kg by the end of pregnancy. All ligaments thicken and lengthen, ensuring the uterus is stretched in height and width. They also soften due to soaking in tissue fluid. The joints and joints of the pelvis also soften. All this creates optimal conditions for the birth of the fetus.

Nutrition during pregnancy

It is difficult to overestimate the issue of nutrition during pregnancy. Nutrition during pregnancy is subordinated to two tasks - ensuring the need for the necessary substances for fetal growth and preparing the mother for subsequent lactation. Traditionally, the issue of nutrition during pregnancy is considered in two aspects: what should be the weight gain of a pregnant woman and what amount of energy and necessary elements should come from food during pregnancy.

Pregnancy and weight gain

Weight gain during pregnancy is of great importance due to the fact that the weight of the pregnant woman directly affects the weight and size of the child at birth. Currently, body mass index is used to identify normal weight. Body mass index is the ratio of body weight in kilograms to the square of height in meters. Normal body mass index ranges from 19.8 to 26. Individuals with a body mass index less than 19.8 are underweight. Persons with a body mass index of more than 26 are overweight. A body mass index of more than 29 is a sign of obesity. Morbid obesity is characterized by a body mass index of 35 or higher.

If a pregnant woman has a body mass index of less than 19.8, the baby is underweight at birth. If the body mass index is above 26, the risk of having a large fetus increases. The fetus is considered large if its weight is more than 4000 g. Such children have a higher risk of birth injuries, in particular damage to the brachial plexus. Pregnant women with a body mass index of more than 35 are at high risk of preeclampsia, fetal cardiac dysfunction, fetal death in late pregnancy, and early neonatal death.

Currently, it is believed that acceptable weight gain during pregnancy should be:

With a body mass index of up to 19.8 – from 11.2 to 16 kg
With a body mass index of 19.8-26 – from 10 to 14 kg
With a weight index of 26-29 - from 6 to 10 kg
With a body mass index over 29 – from 4.4 to 8 kg

A strict diet during pregnancy is not recommended. Even if you adhere to a significant caloric restriction in the diet, this will lead to an average decrease in the child’s body weight at birth by 250 grams. Some weight gain is necessary during pregnancy.

If pregnancy weight gain occurs within the above parameters, the number of cesarean sections decreases, the number of birth injuries decreases, and the incidence of postpartum obesity decreases. Unfortunately, only 30% of pregnant women are kept within this framework.

Diet and pregnancy

The body of a pregnant woman needs additional energy for the full growth of the fetus. Energy expenditure increases during pregnancy and amounts to 17% of the energy expenditure of a non-pregnant woman. Approximately a day you need to consume an additional 300 kcal. It should be remembered that in this case it is assumed that the woman ate properly before pregnancy and that her energy expenditure and food intake were balanced. For adequate nutrition in a pregnant woman’s daily diet, protein should make up 20% of the total calorie intake, fats 30% and carbohydrates (complex) 50%. The source of protein is animal food - meat. However, it should be remembered that meat often contains an increased amount of fat, which can lead to unwanted weight gain. In general, the caloric content of a pregnant woman's diet should be about 2500 kcal. When eating, you should adhere to the following rule: if the amount of food consumed per day is divided into equal parts, then 6-11 parts should be cereals, 3-5 parts for vegetables, 2-4 parts for fruits, 3-4 parts for dairy products, 2-3 parts for meat, beans, legumes, nuts and 1 part for simple carbohydrates (sweets).

One study found that eating fish at least three times a week, especially before 22 weeks of pregnancy, reduces the risk of preterm birth.

In our practice, we are, unfortunately, convinced that most pregnant women have a very poor understanding of proper nutrition, therefore, during consultations during pregnancy, increased attention is paid to this aspect

Changes in weight in a woman’s body during pregnancy

Normal weight gain during pregnancy is 7.5-12 kg. Such wide boundaries are explained by the difference in the initial height and weight of a woman before pregnancy. If a woman had an average body mass index of 23-25, then she can gain 8-10 kg during pregnancy. If you had a low body mass index of 17-20, then you are allowed to add 10-12 kg. And if an overweight woman becomes pregnant, then her gain should be limited to 5-7.5 kg. Such restrictions are necessary, since both underweight and excess weight with too much weight gain threaten the occurrence of complications for both the pregnant woman and the fetus.

Massage for back pain during pregnancy

From the second half of pregnancy, the expectant mother's body's center of gravity changes, and she is forced to bend backwards - the load on the lumbar spine increases greatly, and pain appears in it. Severe pain can occur even when lying on your back, and without outside help the woman is often unable to stand up or turn on her side. In this case, massage techniques help.

With the backs of both hands, strokes are performed simultaneously or alternately from the lower back upward. The pressure is increased with each new movement. The technique is repeated 6–8 times.

Using the edge of each hand or fists, simultaneously or alternately, squeeze from the spine to the sides, gradually moving the arms up and increasing the pressure. The technique is repeated 4 to 6 times.

Rubbing is performed simultaneously or alternately with both hands (with the edge of the hand on the side of the thumb). The arms are moved across the body - as if sawing wood, gradually rising up the back. The pressure should be medium. The technique is repeated 5–6 times.

Kneading is performed with fingers gathered into a fist (thumb and index). Make circular movements with the brushes in the direction from the spine up the back. The pressure force should be medium. The technique is repeated 4 to 6 times. You can perform the massage yourself. After childbirth, the pain goes away without treatment.

As the size of the fetus increases, the ligaments in the joints of a woman change, and therefore subluxations and sprains often occur. The joints of the pregnant woman's pelvic bones become especially mobile - this is necessary for the normal passage of the child through the birth canal. But sometimes the pubic bones diverge somewhat. Then pain appears in the womb, it becomes difficult to walk. In this case, you need to consult a doctor.

Increasing importance of uninterrupted functioning of the endocrine system

The uninterrupted operation of a woman’s entire endocrine system is extremely important for bearing a baby. Without the secretion of hormones from the hypothalamus, pituitary gland, thyroid gland, adrenal glands, pancreas, ovaries and their associated joint work, it is impossible to conceive and bear a child. Therefore, any deviation in the functioning of the endocrine glands can create an imbalance in the functioning of the entire endocrine system and make it difficult to realize the dream of motherhood. The most common pathologies of the endocrine organs affect the thyroid gland and gonads.

Thyroid hormones are necessary for the formation of the placenta, control of the process of embryogenesis, growth and development of all organs and systems of the baby, as well as for the formation and formation of brain functions. The thyroid gland, which is actively working during pregnancy, can even increase in size due to the increasing load. This can also occur from a lack of iodine during pregnancy, since most of it passes to the fetus.

The structure of the external (and internal) genital organs changes

The external genitalia become swollen and hyperemic. Cyanosis of the mucous membranes of the vaginal part of the cervix, vagina and its vestibule occurs, which indicates vasodilatation and blood stasis, facilitating serous permeation of the tissues necessary for the deposition of nutrients at the site of attachment of the fertilized egg to the uterine wall.
The vagina expands and lengthens somewhat during pregnancy. The walls of the vagina are swollen and thickened. The discharge becomes more abundant, mucous in nature, milky white or yellowish in color with an acidic reaction. In a healthy pregnant woman, the vagina has I-II degrees of cleanliness.

The uterus changes the most during pregnancy compared to other organs.

Its size increases during pregnancy in all respects:

weight - from 50-100 g to 1-2 kg!!!
length - from 7-9 cm to 50 cm,
volume - 500 times, reaching 2-3,000 cm3 (liters) or more.

Accordingly, changes occur in all tissues, blood supply and innervation of the uterus:

The shape and position of the uterus changes during pregnancy. As the uterus grows, it emerges from the pelvis into the abdominal cavity, rising in the 9th month of pregnancy to the xiphoid process. The shape of the uterus is asymmetrical due to the bulging of the part where the placenta is attached.
Thin arteries and veins of the uterus turn into powerful trunks, which become corkscrew-shaped, tortuous, which allows maintaining normal blood supply during pronounced changes in the uterus during pregnancy and during contraction of its muscles during childbirth.
The volume of blood circulation in the uterus during pregnancy increases tens of times, providing uteroplacental blood flow, which is carried out according to the principle of blood supply to vital organs and remains relatively optimal even under various stresses (blood loss, anemia). This ensures the survival of the fetus in extreme situations.
The receptor system of the uterus changes: during pregnancy, the sensitivity of the uterus to stimulating factors decreases, before childbirth, the excitability of the uterus increases, some of the nervous structures are lost in order to reduce pain information from the uterus during childbirth.

With the appearance of the placenta, a pregnancy dominant arises in the cerebral cortex, which ensures clear coordination of the functions of all organs and systems in the interests of the developing fetus.

Women note a decrease in performance, increased drowsiness, or vice versa, they are irritated, they have nausea, drooling, periodic vomiting, which is classified as mild and the occurrence of which corresponds to the phase of functional changes in the nervous system.

Pregnant women have increased suggestibility and self-hypnosis, which is taken into account when conducting psychoprophylactic preparation for childbirth.

Phenomena of paresthesia, neuralgic pain, spasms of muscle groups, numbness of the fingers and other disorders may occur. Increased excitability of peripheral nerves is also manifested by increased knee reflexes.

With all this, sexual excitability decreases , and you, dear husbands, must be prepared for this. No need, under no circumstances!!! (remember about increased suggestibility and self-hypnosis) do not show your grievances that your wife is cold and inattentive to you, which means she has stopped loving you. She still loves you, she is already carrying your child and she has a dominant in her cerebral cortex - to endure pregnancy at all costs. And there is no escape from this.

In a pregnant woman, the functions of some analyzers change - hearing, vision, smell!!! A pregnant woman's sense of smell can become so strong that the woman will react to the lightest (hardly perceptible) odors.

Please keep in mind, dear men, when a woman feels bad, feels sick, and the world is generally in shades of grey, for some reason unhappy thoughts come into her head, which can lead to a deterioration in her condition and, as a consequence, to termination of pregnancy.

During pregnancy, changes affect other organs as well.

The adrenal glands increase in size during pregnancy due to cortical hyperplasia, and the glucocorticoid and mineralocorticoid function of the adrenal glands increases accordingly.

Strengthening the function of the adrenal cortex during pregnancy is aimed at increasing protective and adaptive mechanisms, including during childbirth.

The thyroid gland increases in volume and function increases. Goiter in pregnant women is observed, especially in areas endemic for goiter (little iodine in soil and water) and hyperthyroidism without thyrotoxicosis. Strengthening the function of the thyroid gland is associated with the influence of placental hormones on it. Clinical thyrotoxicosis does not develop due to increased binding of free hormones by plasma proteins. The protein-bound form of the hormone is subsequently utilized by the fetus and the mother’s body, since the need for it increases with the development of pregnancy, before the onset of fetal thyroid function.

The parathyroid glands (calcium metabolism) undergo hypertrophy, their functional activity increases due to the increased need for calcium, which is a plastic material for the formation of the musculoskeletal system of the fetus. If there is insufficient intake or impaired absorption, the fetus receives calcium from the tissues of the mother’s body (bones, teeth), which can manifest itself as osteoporosis, fragility and dental caries. During pregnancy, the concentration of calcium in the blood increases. The content of phosphorus compounds, iron and a number of microelements (cobalt, iodine, manganese, copper) also decreases in the blood plasma. The deficiency of these substances is due to the needs of the fetus and increased metabolic reactions, the enzyme systems of which include some of the micro- and macroelements.

Pancreas – strengthening the function of the insulin-producing apparatus. As a result, carbohydrates are absorbed very well and are deposited in the mother’s liver and in the tissues of the fetus. Women with diabetes always give birth to large children due to the utilization of excess carbohydrates by the fetus. Some pregnant women experience glucosuria (sugar in the urine), which is not pathological and manifests itself with normal or even low carbohydrate levels in the blood.

The pituitary gland in pregnant women increases in volume and is difficult to fit in the sella turcica; hyperproduction of growth hormone (GH) is observed, which, penetrating the placenta, stimulates the growth of the embryo. This hormone also affects the lactogenic function of the mammary gland, causing in some cases an enlargement of the nose, lips, and fingers.

Changes in the load on the musculoskeletal system

Under the influence of hormones, the ligamentous apparatus of the joints becomes more relaxed, and increasing body weight creates additional stress on them, so unpleasant and painful sensations in the joint area may occur.

Due to the growing belly, the load on the spine, especially on the lumbosacral region, increases greatly. In this regard, the expectant mother may experience pain in the spine.

If a woman had problems with posture, joints, and muscles before pregnancy, then with an increased load on them, she may need to consult an appropriate specialist. Physical exercises and wearing a bandage usually help solve such problems.

Heart, blood vessels and blood

The cardiovascular system, without exaggeration, bears the main burden while waiting for a child. To deliver all the necessary nutrients to the uterus, hypertrophy occurs, that is, an enlargement of the left ventricle, increased heart rate and an increase in minute blood volume.

Blood pressure in the 1st trimester may even decrease slightly, which causes lethargy, weakness and drowsiness (pregnant women often complain about them at the beginning of their journey). Somewhere in the middle of the second trimester, every woman's blood pressure increases by an average of 10 mm. Hg Art. However, in pathological cases these numbers can increase significantly. In such situations, we are talking about gestosis - a complication of the second half of pregnancy, fraught with such dangerous conditions as eclampsia. Jumps in blood pressure to high levels are known to cause miscarriage or premature birth.

The expectant mother provides food not only for herself, but also for the baby. And despite the fact that the blood of the mother and fetus does not mix for 9 months, the woman requires increased volumes of this fluid. As a result, during the period of waiting for a child, hematopoiesis increases, the number of red blood cells and hemoglobin increases. By the end of pregnancy, the total amount of blood increases by 40%.

Progesterone

During pregnancy, a significant increase in the level of steroid hormones, especially progesterone, is observed in the blood plasma. This leads to numerous clinical manifestations. The concentration of progesterone and its metabolites, produced mainly by the placenta, increases more than 20 times during pregnancy.

Progesterone has a number of effects, but the most important is its effect on smooth muscle. It is capable of causing hyperpolarization of smooth muscle cell membranes, which reduces their excitability. As a result, the smooth muscles relax. This affects all homeostasis processes, in which smooth muscle structures play a key role. The uterus, the normal tone of which ensures gestation, and even the smallest peripheral arterioles are also affected by progesterone.

Due to the influence of progesterone on vascular smooth muscle, the reactivity of the vascular bed to various stress factors changes, and the overall peripheral resistance decreases. The motility of the gastrointestinal tract, bronchial tone, and the functions of the excretory system also undergo changes. The effects of progesterone are listed in table. 2-1.