| 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: | Gastrointestinal and metabolic changes: |
| |
- Antagonist to insulin—makes glucose available to fetus
| - Anti-insulin effect challenges maternal pancreas to produce more insulin; failure of beta cells to respond leads to “gestational” diabetes. For the woman who is insulin dependent, insulin requirements increase by an average of 67% during the second half of pregnancy
|
| - 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 nigra |
| Progesterone |
| Development of decidua | High levels result in tiredness, listlessness, and sleepiness |
| Reduces uterine excitability | Protection against abortion/early birth (i.e., maintains pregnancy ) |
| Development of mammary glands | Prepares breasts for lactation |
| Alters nutrient metabolism: | Nutritional significance: |
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| |
- 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: |
| |
| - Stasis of urine with ↑ chance of infection
|
| - Dependent edema; varicosities
|
| |
- 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 (e.g., fetal portion of placenta) Diagnostic value:
- Basis for pregnancy test
- Decreased level with threatened abortion
- Increased level with multiple pregnancy
- Very high level with hydatidiform mole
|
| Human Placental Lactogen |
| Antagonizes insulin | Diabetogenic; may → gestational diabetes or complicate management of existing diabetes |
| Mobilizes maternal free fatty acids | Increased tendency of ketoacidosis in pregnant diabetic |
| Prolactin |
| Suppressed by estrogen and progesterone | No milk produced before birth |
| Increased level after placenta is delivered | Milk production (lactation) 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 atony |