Physiological Changes in Urinary and Gastro- Intestinal System during Pregnancy

Subject: Midwifery I (Theory)

Overview

Both the gastrointestinal system and the urine system underwent various alterations. The glomerular filtration rate increases by 50% during pregnancy, and renal plasma flow is raised by 25–50% in the urinary system, with a maximal rise in the first trimester. The kidney gets bigger. Between 20 and 24 weeks, there is a pronounced urine stasis because the tone of the ureter and bladder is diminished. The effective renal perfusion has improved by 75% by mid-pregnancy as a result of increased cardiac output and decreased renovascular resistance. Different changes occur in the gastrointestinal system, such as alterations to the mouth cavity and increased salivation (ptyalism). Acidic saline may make tooth decay more common. Around 70% of women experience nausea and vomiting in the first few weeks of pregnancy, usually beginning a few days after a missed period and lasting until 14 to 18 weeks of gestation. The high levels of progesterone during pregnancy cause the tone of the body's smooth muscles to relax. This has an impact on every part of the digestive system, resulting in gastroesophageal reflux disease, esophagitis, and slow peristalsis that delays stomach emptying.

Changes in Urinary System

  • Maximum increase in renal plasma flow, 25–50%, occurs in the first trimester.
  • Throughout pregnancy, glomerular filtration rate increases by 50%.
  • A test of renal function is enhanced. Water-soluble vitamins, amino acids, glucose, and uric acid cannot be fully reabsorbed by the renal tubules. GFR is mostly to blame.
  • The kidney gets bigger. Due to the influence of maternal progesterone, the pelvicalyceal system relaxes and enlarges, and the peristaltic activity of the ureter uterus is reduced. Between 20 and 24 weeks, there is a pronounced urine stasis because the tone of the ureter and bladder is diminished. The ureter is stretched out, kinked, and moved outward. Due to the ovarian vessel's compression and the gravid uterus' dextro-rotation, the pelvic-calyceal system is more dilated on the right side.
  • The effective renal perfusion has increased by 75% by mid-pregnancy as a result of increased cardiac output and decreased renovascular resistance. The renal glucose threshold is lowered, allowing an euglycemic woman to experience "physiological glycosuria."
  • The levels of urea, nitrogen, and creatinine in the serum are reduced as a result of improved renal clearance and higher glomerular filtration.
  • Circulating steroid hormones have an impact on salt and water metabolism. Increased glomerular filtration and sodium plasma clearance levels, along with progesterone's antagonistic effects, encourage sodium excretion. Aldosterone and deoxycorticosterone have this effect, which contributes to sodium retention. Overall, sodium retention results.

Changes in Gastrointestinal System

  • Estrogen causes the gums to swell and become spongy, which can cause gingivitis and bleed when touched.
  • Salivation rises as a result of many changes in the oral cavity (ptyalism). Acidic saline may make tooth decay more prevalent.
  • Appetite: The total daily calorie need rises by 200 to 300 kcal during pregnancy, which causes an increase in appetite.
  • About 70% of women experiences nausea and vomiting during early pregnancy, usually starting within few days after the missed period and going on up to about 14 to 18 weeks of gestation. Relaxation of the smooth muscles of the stomach and hypomotility in addition to raised levels of estrogen or human chorionic gonadotropin hormone (HCGH) may all contribute to the problem. Occasionally excessive vomiting (Hyperemesis gravidarum) may occur.
  • The high level of progesterone during pregnancy produces relaxation in the tone of smooth muscles on the body. This affects the entire gastrointestinal tract leading to sluggish peristalsis causing delayed stomach emptying, relaxation of the esophageal sphincter causing gastroesophageal reflux and esophagitis. Delayed small bowel transit time, increased water reabsorption predisposing to constipation and passage of hard stools, gallbladder distension, and biliary stasis predispose to a propensity for stone in susceptible subjects.
  • Hepatic function changes are reflected in the form of increased level of alkaline phosphate, a rise in fibrinogens, cholesterol, and lipids.

Reference

BC Open Textbook. https://opentextbc.ca/anatomyandphysiology/chapter/28-4-maternal-changes-during-pregnancy-labor-and-birth/

Hadassah Medical Center. http://www.hadassah-med.com/giving-birth/hadassah-birthing-club/throughout-pregnancy/physiological-changes-during-pregnancy

HealthLine. 2005. 2017 http://www.healthline.com/health/pregnancy/bodily-changes-during

Kovacs CS. Calcium metabolism during pregnancy and lactation. NCBI Bookshelf. http://www.ncbi.nlm.nih.gov/books/NBK279173/

Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu

Tuitui R. 2002, A textbook of Midwifery B (Intranatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
Things to remember
  • Both the gastrointestinal system and the urine system underwent various alterations.
  • The glomerular filtration rate increases by 50% throughout pregnancy, and renal plasma flow is increased by 25–50% in the urinary system, with a maximum increase in the first trimester.
  • The kidney gets bigger.
  • Between 20 and 24 weeks, there is a pronounced urine stasis because the tone of the ureter and bladder is diminished.
  • The effective renal perfusion has improved by 75% by mid-pregnancy as a result of increased cardiac output and decreased renovascular resistance.
  • Different changes occur in the gastrointestinal system, such as changes to the oral cavity and increased salivation.
  • Acidic saline may make tooth decay more prevalent. In the first trimester of pregnancy, about 70% of women experience nausea and vomiting, which typically begins a few days after the missed period and lasts until the baby is between 14 and 18 weeks gestation.
  • The pregnancy-induced high levels of progesterone cause the tone of the body's smooth muscles to relax. This has an impact on every part of the digestive system, resulting in gastroesophageal reflux disease, esophagitis, and sluggish peristalsis that delays stomach emptying.
Questions and Answers
  • Maximum increases in renal plasma flow, of 25–50%, occur in the first trimester.
  • Throughout pregnancy, glomerular filtration rate increases by 50%.
  • A test of renal function is enhanced. Glucose, uric acid, amino acids, water-soluble vitamins, and other compounds are not totally reabsorbable by renal tubules. GFR is primarily to blame.
  • The kidney gets bigger. Due to the influence of maternal progesterone, the pelvi-calyceal system does not undergo relaxation and dilatation, and the peristaltic activity of the ureter uterus is decreased. Between 20 and 24 weeks, there is a pronounced urine stasis because the tone of the ureter and bladder is diminished. The ureter is stretched out, kinked, and moved outward. Due to the ovarian vessel's compression and the gravid uterus' dextro-rotation, the pelvi-calcyeal system is more dilated on the right side.
  • The effective renal perfusion has improved by 75% by mid-pregnancy as a result of increased cardiac output and decreased reno-vascular resistance. Lowered renal glucose tolerance allows euglycemic women to have "physiological glycosuria."
  • The levels of urea, nitrogen, and creatinine in the serum are reduced as a result of improved renal clearance and higher glomerular filtration.
  • Circulating steroid hormones have an impact on salt and water metabolism. Increased glomerular filtration and sodium plasma clearance levels, along with progesterone's antagonistic effects, improve sodium excretion. Aldosterone and deoxycorticosterone, which flavor salt retention, have this effect. Overall, sodium retention results.
  • Estrogen causes gums to become clogged and spongy, which can cause bleeding when touched and gingivitis.
  • Salivation increases as a result of many changes in the oral cavity (ptyalism). Acidic saline may make tooth decay more prevalent.
  • Appetite: The total daily calorie need rises by 200 to 300 kcal during pregnancy, which causes an increase in appetite.
  • In the first trimester of pregnancy, over 70% of women suffer nausea and vomiting, which often begins a few days after the missed period and lasts until the baby is between 14 and 18 weeks gestation. Raised estrogen or human chorionic gonadotropin hormone (HCGH) levels, hypomotility, and relaxation of the stomach's smooth muscles are all potential causes of the issue. Hyperemesis gravidarum, or extreme vomiting, can occasionally happen.
  • The pregnancy-induced high levels of progesterone cause the tone of the body's smooth muscles to relax. The entire gastro intestinal system is impacted, resulting in sluggish peristalsis, which delays stomach emptying, relaxed esophageal sphincter, gastroesophageal reflux, and esophagitis. Gall bladder distension, increased water reabsorption, biliary stasis, and delayed small bowel transit time all increase the risk of constipation and the passage of hard stools in susceptible individuals.
  • Changes in hepatic function can be seen in the levels of alkaline phosphate, fibrinogens, cholesterol, and lipids.

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