Hormones of Pregnancy
| Primary Effects | Clinical Implications for Nursing Actions |
|---|---|
|
Estrogen Level rises in serum and urine |
Basis of test for maternal/placental/fetal well-being |
| Uterine enlargement | Probable sign of pregnancy |
| Breast enlargement | Probable sign of pregnancy; increased tingling, tenderness |
| Genital enlargement: increased vascularization, hyperplasia | Vaginal growth facilitates vaginal birth |
| Softens connective tissue | Results in backache and leg ache; relaxes joints to increase size of birth canal and rib cage |
| Alters nutrient metabolism: | |
| Decreases HCI and pepsin |
Gastrointestinal and metabolic changes: Digestive upsets |
| Antagonist to insulin - makes glucose available to fetus | Anti-insulin effect challenges maternal pancreas to produce more insulin; failure of β-cells to respond leads to “gestational” diabetes. For the insulin-dependent woman, insulin requirements increase by an average of 67% during the second half of pregnancy. |
| Supports fat deposition | Protect source of energy for fetus |
| Sodium and water retention; edema of lower extremities (nonpitting) | Meet increased plasma volume needs and maintain fluid reserve |
|
Hematological changes: Increased coagulability |
Increased tendency to thrombosis |
| Increased sedimentation rate (SR) | SR loses diagnostic value for heart disease |
| Vasodilation: spider nevi; palmar erythema | Resolves spontaneously after birth |
| Increased production of melanin-stimulating hormone | Resolves spontaneously after birth; causes chloasma and linea negra |
|
Progesterone Development of decidua |
High levels result in tiredness, listlessness, and sleepiness |
| Reduces uterine excitability | Protection against abortion/early birth |
| Development of mammary glands | Prepares breasts for lactation |
| Alters nutrient metabolism: | Nutritional significance: |
| Antagonist to insulin | Diabetogenic |
| Favors fat deposition | Energy reserve |
| Decreases gastric motility and relaxes sphincters | Favors heartburn and constipation |
| Increased sensitivity of respiratory center to CO2 | Increased depth, some dyspnea, increased sighing |
| Decreased smooth-muscle tone: | Decreased tone can lead to: |
| Colon | Constipation |
| Bladder, ureters | Stasis of urine with T chance of infection |
| Veins | Dependent edema; varicosities |
| Gallbladder | Gallbladder disease |
| Increased basal body temperature (BBT) by 0.5°C | Discomfort from hot flashes and perspiration |
|
Human Chorionic Gonadotropin Maintains corpus luteum during early pregnancy |
Placenta must “take over” after a few weeks |
| Stimulates male testes | Increased testosterone in male fetuses |
| May suppress immune response | May inhibit response to foreign protein, for example, fetal portion of placenta |
Diagnostic value:
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Human Placental Lactogen Antagonizes insulin |
Diabetogenic; may —> gestational diabetes or complicate management of existing diabetes |
| Mobilizes maternal free fatty acids | Increased tendency to ketoacidosis in pregnant diabetic |
|
Prolactin Suppressed by estrogen and progesterone |
No milk produced before birth |
| Increased level after placenta is delivered | Milk production 2-3 days after birth |
|
Follicle Stimulating Hormone Production suppressed during pregnancy; level returns to prepregnant levels within 3 weeks after birth |
No ovulation during pregnancy; ovulation usually returns within 6 weeks for 15%, within 12 weeks for 30% |
|
Oxytocin Causes uterus to contract when the oxytocin levels exceed those of estrogen and progesterone |
Labor induction or augmentation; treatment for postpartum uterine |