Changes in Maternal Weight and Breast, Skin during Pregnancy

Subject: Midwifery I (Theory)

Overview

A varying amount of weight gain is a constant throughout normal pregnancy. During the first several weeks, the woman may lose weight due to nausea or vomiting. During the following months, the weight gain is progressive until the last one or two weeks, when it becomes stagnant or even falls. A singleton pregnancy results in an average weight gain of 11-12.5 kg. During pregnancy, estrogen stimulates ductal proliferation and progesterone causes alveolar expansion, thus the breast enlarges to meet projected lactational demands. As pregnancy progresses, the breast, areola, nipple, and Montgomery tubercles increase.

A varying quantity of weight gain is a continual phenomenon in a normal pregnancy. The mother may lose weight in the early weeks due to sickness or vomiting. During the succeeding months, the weight gain is progressive until the last one or two weeks, when it remains static or occasionally declines. The average weight gain during a singleton pregnancy is 11-12.5 kg. Weight gain is expected to be 2-4 g in the first 20 weeks. 8,5 kg in the second 20 weeks (0.4 kilogram/week in the third trimester). It is also suggested that multigravidae grow approximately 1kg less than primigravidae.

Many factors influence weight increase, including the degree of maternal edema, maternal metabolic rate, nutritional intake, vomiting or diarrhea, smoking, the amount of amniotic fluid, and the size of the fetus. According to a recent study, maternal age, pre-pregnancy body size, parity, race, ethnicity, hypertension, and diabetes all have an impact on the pattern of maternal weight gain.

Changes in Breast and Skin

Estrogen stimulates ductal proliferation while progesterone stimulates alveolar growth, causing the breast to enlarge to satisfy lactational demands.
The patient suffers breast soreness early in pregnancy, and the discomfort continues throughout the pregnancy.
The breast, areola, nipple, and Montgomery tubercles expand as a pregnant woman progresses. A clear secretion is usually released at the nipple.
Pigmentation is enhanced across the skin, but mainly in the nipples, areola, axilla, umbilicus, linea nigra, and perineum. Similarly, the areola can be seen. This is due to an increase in the melanocyte-stimulating hormone, estrogen, and progesterone levels.
Naevi that are pigmented may darken.
Vascular alterations cause planar hyperemia and the formation of spider naevi. It is usual to notice an increase in hair loss during the puerperium. Stretch marks, also known as striae gravidarum, are widespread on the abdomen, breasts, and thighs and appear as silver – pink -violaceous linear or zigzag scratches.

References

Kovacs CS. Calcium metabolism during pregnancy and lactation. NCBI Bookshelf. http://www.ncbi.nlm.nih.gov/books/NBK279173/
HealthLine. 2005. 2017 http://www.healthline.com/health/pregnancy/bodily-changes-during
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
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

A varying quantity of weight gain is a continual phenomenon in a normal pregnancy.
The mother may lose weight in the early weeks due to sickness or vomiting.
During the succeeding months, the weight gain is progressive until the last one or two weeks, when it remains static or occasionally declines.
The average weight gain during a singleton pregnancy is 11-12.5 kg.
Weight gain is expected to be 2-4 g in the first 20 weeks. 8,5 kg in the second 20 weeks (0.4 kilogram/week in the third trimester).
During pregnancy, estrogen stimulates ductal proliferation and progesterone causes alveolar expansion, causing the breast to enlarge to fulfill predicted lactational demands.
The breast, areola, nipple, and Montgomery tubercles expand as a pregnant woman progresses. A clear secretion is usually released at the nipple.

Questions and Answers

What are the changes that occur in breast and skin ?

The breast grows to accommodate anticipated lactational needs as a result of progesterone- and estrogen-induced ductal proliferation.
The patient complains of breast discomfort early on in pregnancy, and it gets heavier as the pregnancy goes on.
The breast, areola, nipple, and Montgomery tubercles all expand as the pregnancy progresses. Usually, the nipple can be used to express a clear secretion.
Increased pigmentation is seen across the skin, but it is particularly noticeable in the nipples, areola, axilla, umbilicus, linea nigra, and perineum. Similar to this, the areola is evident. Increased amounts of progesterone, estrogen, and melanocyte stimulating hormone are to blame for this.
Naevi that are pigmented may get darker.
Hyperemia of the plans and the emergence of spider naevi are the results of vascular alterations. It's usual to notice an increase in hair loss throughout the puerperium. Stretch marks, also known as striae gravidarum, often show as silvery, pink, or violet-colored linear or zigzag scratches on the thighs, breasts, and abdomen.

What are the changes in maternal weight during pregnancy ?

Changes in Maternal Weight

A fluctuating weight gain is a common occurrence in a healthy pregnancy. Early on in the pregnancy, the woman could lose weight as a result of sickness or vomiting. The weight growth continues to increase throughout the following months until the last one or two weeks, after which it stabilizes or occasionally decreases. A singleton pregnancy often results in an average weight gain of 11–12.5 kg. In the first 20 weeks, a weight gain of 2-4 g is anticipated. 8,5 kg in the next 20 weeks (0.4 kilogram every week in the third trimester).

The average multigravidae is said to grow roughly 1 kg less than the primigravidae on average.

The degree of maternal edema, maternal metabolic rate, nutritional intake, vomiting or diarrhea, smoking, the amount of amniotic fluid, and the size of the fetus must all be taken into consideration when calculating weight increase. According to a recent study, the pattern of maternal weight growth may also be influenced by the mother's age, pre-pregnancy body size, parity, race, ethnicity, hypertension, and diabetes.