Physiological Changes in Musculo-skeletal and Metabolism during Pregnancy

Subject: Midwifery I (Theory)

Overview

The physiological changes in a Musculoskeletal system include the effect of progesterone and relaxin on ligament and muscle relaxation, with the effect peaking during the last week of pregnancy. The pelvic relaxation increases the pelvic capacity to accommodate the fetal presenting part at the end of the pregnancy and labor. Backache and waddling gait are caused by greater pelvic joint motion due to ligament loosening and increased lordosis during the later months of pregnancy. Changes in metabolism include an increase in basal metabolic rate that is 30% higher than the average of non-pregnant women. Approximately 1000 gm of protein is stored during a normal pregnancy. The conversion of amino acids to urea is inhibited. Total body fat increases during pregnancy, and plasma lipid levels rise in the latter half of the pregnancy but fall quickly after delivery.

Changes in Musculoskeletal System

The action of progesterone and relaxin enhances ligament and muscle relaxation, reaching a peak during the penultimate week of pregnancy. The pelvic relaxation increases the pelvic capacity to accommodate the fetal presenting part at the end of the pregnancy and labor.
All of the joints release, allowing the coccyx to go backward. An unstable pelvic joint causes rolling gait.
Backache and waddling gait are caused by increased pelvic joint mobility due to ligament softening and increased lordosis during the later months of pregnancy.
During pregnancy, the daily calcium need is considerable (average 1-1.5 gm). Calcium deficiency in the diet causes calcium mobilization from the bone, resulting in osteomalacia, osteoporosis, or both.

Changes in Metabolism

The developing uterus and fetus require an increase in total metabolism. The basal metabolic rate is elevated to be 30% greater than the non-pregnant women's average.
Approximately 1000 gm of protein is stored throughout a normal pregnancy (450 gm in a fetus, 450 gm in a uterus, other are in a breast, plasma protein, and hemoglobin). The conversion of amino acids to urea is inhibited.
Metabolism of carbohydrates: Fasting, hypoglycemia, and postprandial hyperglycemia in a non-diabetic woman cause a diabetic type state, which resolves after delivery.
Total body fat increases during pregnancy, and plasma lipid levels rise in the latter half of the pregnancy but fall quickly following delivery.

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

The physiological changes in a Musculoskeletal system include the effect of progesterone and relaxin on ligament and muscle relaxation, with the effect peaking during the last week of pregnancy.
The pelvic relaxation increases the pelvic capacity to accommodate the fetal presenting part at the end of the pregnancy and labor.
Backache and waddling gait are caused by greater pelvic joint motion due to ligament loosening and increased lordosis during the later months of pregnancy.
Changes in metabolism include an increase in basal metabolic rate that is 30% higher than the average of non-pregnant women.
Approximately 1000 gm of protein is stored throughout a normal pregnancy (450 gm in a fetus, 450 gm in a uterus, other are in a breast, plasma protein, and hemoglobin). The conversion of amino acids to urea is inhibited.
Total body fat increases during pregnancy, and plasma lipid levels rise in the latter half of the pregnancy but fall quickly following delivery.

Questions and Answers

What are the physiological changes in musculo skeletal system ?

The relaxation of ligaments and muscles is increased by the effects of progesterone and relaxin, reaching their peak effect during the final week of pregnancy. The pelvis' capacity to hold the fetal component that will present at the conclusion of the pregnancy and during labor can be increased thanks to the pelvis' relaxation.
The coccyx might go rearward when all joints become free. Instable pelvic joint is the cause of rolling gait.
Back pain and a waddling gait are brought on by greater pelvic joint mobility brought on by ligament loosening and increased lardosis in the later months of pregnancy.
The daily demand for calcium during pregnancy is significant (average 1-1.5 gm). Dietary calcium deficiency results in calcium being mobilized from the bones, which can lead to osteomalacia, osteoporosis, or both.

What are the physiological changes that occurs in metabolism during pregnancy ?

The requirements of the developing uterus and the fetus result in an increase in total metabolism. The average basal metabolic rate of non-pregnant women is 30% higher than it is in pregnant women.
A normal pregnancy stores roughly 1000 g of protein (450 gm in a fetus, 450 gm in a uterus, other are in a breast, plasma protein, and hemoglobin). There is a suppression of amino acid to urea conversion.
Metabolizing carbohydrates Fasting, hypoglycemia, and postprandial hyperglycemia during a normal pregnancy cause a non-diabetic woman to experience a diabetic-like state, which resolves after delivery.