Physiology psychology
Download
1 / 61

Physiology & Psychology - PowerPoint PPT Presentation


  • 175 Views
  • Updated On :

Physiology & Psychology. Maternal physiological adaptations to pregnancy The placenta Psychology of pregnancy. Physiology of Pregnancy. Systematic Adjustments to Pregnancy. Cardiovascular Respiratory Urinary.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Physiology & Psychology' - orde


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Physiology psychology l.jpg
Physiology & Psychology

  • Maternal physiological adaptations to pregnancy

  • The placenta

  • Psychology of pregnancy



Systematic adjustments to pregnancy l.jpg
Systematic Adjustments to Pregnancy

  • Cardiovascular

  • Respiratory

  • Urinary


Slide4 l.jpg

Cardiac output during three stages of gestation, labor, and immediately postpartum compared with values of nonpregnant women. All values were determined with women in the lateral recumbent position.


Slide6 l.jpg

Mean glomerular filtration rate in healthy women over a short period with infused inulin (solid line), simultaneously as creatinine clearance during the inulin infusion (broken line), and over 24 hours as endogenous creatinine clearance (dotted line).


King j physiology of pregnancy and nutrient metabolism am j clin nutr 2000 71 suppl 1218s 25s l.jpg
King J. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71 (suppl):1218S-25S


Adjustments in nutrient metabolism l.jpg
Adjustments in Nutrient Metabolism Am J Clin Nutr 2000;71 (suppl):1218S-25S

  • Goals

    • support changes in anatomy and physiology of mother

    • support fetal growth and development

    • maintain maternal homeostasis

    • prepare for lactation

  • Adjustments are complex and evolve throughout pregnancy


General concepts l.jpg
General Concepts Am J Clin Nutr 2000;71 (suppl):1218S-25S

1. Alterations include:

  • increased intestinal absorption

  • reduced excretion by kidney or GI tract

    2. Alterations are driven by:

  • hormonal changes

  • fetal demands

  • maternal nutrient supply


Slide10 l.jpg

3. There may be more than one adjustment for each nutrient. Am J Clin Nutr 2000;71 (suppl):1218S-25S

4. Maternal behavioral changes augment physiologic adjustments

5. When adjustment limits are exceeded, fetal growth and development are impaired.


Slide11 l.jpg

Birth weight of 11 children born to a poor woman in Montreal; 8 children were born before receiving nutritional counseling and food supplements from the Montreal Diet Dispensary and 3 children were born afterward.


Slide12 l.jpg

6. The first half of pregnancy is a time of preparation for the demands of rapid fetal growth in the second half



Nitrogen balance g day l.jpg
Nitrogen Balance (g/day) nutrients to the fetus.


Hormonal adjustments l.jpg
Hormonal Adjustments nutrients to the fetus.

  • Changes in over 30 different hormones have been detected in pregnancy

  • Estrogens: increase significantly in pregnancy, influence carbohydrate, lipid, and bone metabolism

  • Progesterone: relaxes smooth muscle and causes atony of GI and urinary tract

  • Human Placental Lactogen (hPL): stimulates maternal metabolism, increases insulin resistance, aids glucose transport across placenta, stimulates breast development


Late gestation is characterized by l.jpg
Late gestation is characterized by: nutrients to the fetus.

  • Anti-insulinogenic and lipolytic effects of Human chorionic somatomammotropin, prolactin, cortisol, glucagon)

    Which Results in:

  • Glucose intolerance, insulin resistance, decreased hepatic glycogen, mobilization of adipose tissue


Maternal nutrient levels l.jpg
Maternal Nutrient Levels nutrients to the fetus.

  • Increased triglycerides

  • Increased cholesterol

  • Decreased plasma amino acids & albumin


Lipids l.jpg
Lipids nutrients to the fetus.


Maternal albumin l.jpg
Maternal Albumin nutrients to the fetus.


Maternal plasma volume increases 40 l.jpg
Maternal Plasma volume increases ~ 40% nutrients to the fetus.

  • range 30-50%

  • nutrient concentration declines due to increased volume, but total amount of vitamins and minerals in circulation actually increases.


Slide24 l.jpg

Mean hemoglobin concentrations (  —  ) and 5th and 95th (  —  ) percentiles for healthy pregnant women taking iron supplements


Embryonic development l.jpg
Embryonic Development 95th (  —  ) percentiles for healthy pregnant women taking iron supplements

  • In early gestation Embryo is nourished by secretions of the oviduct and uterine endometrial glands

  • Uterine secretions include growth factors (e.g. TNFa, epidermal growth factor) that promote placental growth

  • Poorly nourished women and obese women at risk for aberrations in embryonic and placental development

    • Congenital anomalies

    • Adverse outcomes later in pregnancy (e.g. PIH)

  • Before implantation, blastocyst divides into embryonic cells and placental cells



The placenta l.jpg
The Placenta seventh week of pregnancy.

  • 10-12 weeks is the period of placentation

  • Rapid early growth prepares way for fetal growth

  • Trophoblast cells use same molecular mechanisms as tumors, but are highly regulated and controlled


Placental functions l.jpg
Placental Functions seventh week of pregnancy.

  • Maintains immunological distance between mother and fetus

  • Special endocrine organ: “transient hypothalamo-pituitary-gonadal axis”

  • Responsible for exchange of nutrients, gases & metabolic waste products between maternal and fetal circulation


Placental architecture l.jpg
Placental Architecture seventh week of pregnancy.

  • Maternal and fetal blood do not mix: “placental barrier”

    • Fetal blood flows through capillary networks within highly branched terminal chorionic villi

    • Maternal blood flows through intervillous space

      • Uterine arteriols bring blood in

      • Uterine venules drain blood


Slide30 l.jpg

©2007 UpToDate seventh week of pregnancy.®

 e-mail this to a colleague


Placental capacity increases during gestation l.jpg
Placental Capacity Increases During Gestation seventh week of pregnancy.

  • Expression of transporters increases

  • The “brush border” microvilli develop to:

    • increase surface area

    • impede maternal blood flow

  • Flow through the placenta at term is 500 ml/minute




Fetal to maternal transport l.jpg
Fetal to Maternal Transport Placenta

  • Carbon dioxide

  • Water & urea

  • Signaling Molecules: Hormones, cytokines, others


Factors affecting placental transfer l.jpg
Factors Affecting Placental Transfer Placenta

  • Placental size

  • Diffusion distance –

    • diabetes and infection cause edema of the villi

    • distance decreases as pregnancy progresses and fetal needs increase

  • Maternal-placental blood flow

  • Blood saturation with gases and nutrients


Factors affecting placental transfer cont l.jpg
Factors Affecting Placental Transfer (cont) Placenta

  • Maternal-placental metabolism of the substance

  • Disorders in expression or activity of nutrient transporters

  • Maternal use of tobacco, cocaine, alcohol


Metabolic functions of the placenta l.jpg
Metabolic Functions of the Placenta Placenta

  • Glycogen synthesis: from maternal glucose & stored

  • Cholesterol synthesis: placental cholesterol is precursor for placental progesterone and estrogens

  • Protein production: rises to 7.5 g per day at term

  • Lactate: produced in large quantities and needs to be removed


Endocrine functions l.jpg
Endocrine Functions Placenta

  • Placenta Produces Peptide hormones

    • Human Chorionic gonodotrophin (hCG) - secreted early and helps to maintain synthesis of progesterone

    • Human placental lactogen (hPL): increase supply of glucose to future by decreasing maternal stores of fatty acids by altering maternal secretion of insulin

    • Insulin-like growth factors (IGF): IGF signaling system is a major regulator of growth in fetus and infant


Endocrine functions41 l.jpg
Endocrine Functions Placenta

  • Steroid hormones

    • Progesterone: produced by placenta, needed to maintain non-contractile uterus

    • Estrogen: produced by placenta drives many processes in pregnancy

  • Glucocorticoids: placenta regulates fetal exposure


Emerging understandings l.jpg
Emerging Understandings Placenta

  • Cytokines & Inflammatory molecules are produced by the placenta as well as adipocytes

  • Adverse outcomes in obese women may be associated with imbalances due to overproduction from both sources

  • “In pregnancy complicated with obesity or DM, continuous adverse stimulus is associated with dysregulation of metabolic, vasular and inflammatory pathways.”


The known and unknown of leptin in pregnancy hauguel de mouzon am j obstet gynecology 2006 l.jpg
The Known and Unknown of Leptin in Pregnancy Placenta(Hauguel-de-Mouzon, Am J Obstet Gynecology, 2006)

  • Maternal plasma leptin levels rise in pregnancy

  • Leptin is produced by placenta

  • Overproduction of placental leptin is seen with diabetes and htn in pregnancy

  • Umbilical leptin levels are biomarker of fetal adiposity

  • “Leptin may be sensitive to maternal energy status and coordinate metabolic response accordingly.” (King, Ann Rev Nutr, 2006)


Psychology of pregnancy l.jpg
Psychology of Pregnancy Placenta

  • Psychosocial tasks

    • Rubin

    • Leaderman’s tasks

  • Fathers

  • Stress and Depression


Developmental tasks of pregnancy rubin 1984 l.jpg
Developmental Tasks of Pregnancy (Rubin, 1984) Placenta

  • Seeking safe passage for herself and her child through pregnancy, labor, and delivery.

  • Ensuring the acceptance by significant persons in her family of the child she bears.

  • Binding-in to her unknown baby.

  • Learning to give of herself.


Maternal focus l.jpg
Maternal Focus Placenta


Lederman rp psychosocial adaptation in pregnancy 2nd ed 1996 l.jpg
Lederman, RP. Psychosocial Adaptation in Pregnancy, 2nd Ed. 1996

  • Developmental Tasks of Pregnancy

    • acceptance of pregnancy

    • identification with motherhood role

    • relationship to the mother

    • relationship to the husband/partner

    • preparation for labor

    • processing fear of loss of control & loss of self esteem in labor


Psychosocial adjustment during pregnancy the experience of mature gravidas stark jognn 1997 l.jpg
Psychosocial adjustment during pregnancy: the experience of mature gravidas(Stark, JOGNN, 1997)

  • N=64 older gravidas (> 35), 46 younger gravidas (< 32) in third trimester

  • Lederman prenatal self evaluation questionnaire - examines conflicts for 7 steps

  • In general conflicts about maternal role were similar in both groups

  • Older gravidas had less concern about fear of helplessness and loss of control in labor - regardless of parity


Adolescents psychosocial factors that influence transition to motherhood kaiser 2004 l.jpg
Adolescents: PSYCHOSOCIAL FACTORS THAT INFLUENCE TRANSITION TO MOTHERHOOD (kaiser, 2004)

  • Gaining acceptance of the pregnancy in the family system

  • Awareness of the need to develop a sense of responsibility

  • Planning for a future that includes the baby

  • Viewing self as a mother


Laboring for relevance expectant and new fatherhood jordan nursing research 1990 l.jpg
Laboring for Relevance: Expectant and New Fatherhood TO MOTHERHOOD (Jordan, Nursing Research, 1990)

  • N=56 expectant fathers followed prospectively

  • Fathers reported:

    • grappling with the reality of the pregnancy and child

    • struggling for recognition as a parent from mother, coworkers, friends, family baby and society

    • plugging away at the role-making of involved fatherhood


Jordan cont l.jpg
Jordan, cont. TO MOTHERHOOD

  • Identified concerns:

    • Men not recognized as parents but as helpmates and breadwinners

    • Men felt excluded from childbearing experience by mates, health care providers, and society

    • Fathers felt that they had no role models for active and involved parenthood


Jordon s developmental tasks of fatherhood l.jpg
Jordon’s Developmental Tasks of Fatherhood TO MOTHERHOOD

  • Accepting the pregnancy

  • Identifying the role of father

  • Reordering relationships

  • Establishing relationship with his child

  • Preparing for the birth experience


Slide53 l.jpg
What about Dad? Psychosocial and mental health issues for new fathers. (Condon, 2006. The Australian First Time Fathers Study)

Tasks:

  • Developing an attachment to the fetus

  • Adjusting to the dyad becoming a triad

  • Conceptualizing the self as “father”

  • What type of father?


Slide54 l.jpg
Effects of pregnancy planning status on birth outcomes and infant care (Kost et al. Family Planning Perspectives, 1998)

  • Analysis of 1988 NMIHS (n=9122) and NSFG (n=2548) data.


Slide55 l.jpg
Effects of pregnancy planning status on birth outcomes and infant care (Kost et al. Family Planning Perspectives, 1998)


Slide56 l.jpg
Effects of pregnancy planning status on birth outcomes and infant care (Kost et al. Family Planning Perspectives, 1998)

  • “Knowing the planning status of a pregnancy can help identify women who may need support to engage in prenatal behaviors that are associated with healthy outcomes and appropriate infant care.”





Slide61 l.jpg

WA State PRAMS infant care


ad