Alterations in Physiology and Anatomy during Pregnancy
Abstract
Pregnant women undergo profound anatomical and physiological changes so that they can cope with the increased physical and metabolic demands of their pregnancies. The cardiovascular, respiratory, haematological, renal, gastrointestinal and endocrine systems all undergo important physiological alterations and adaptations needed to allow development of the fetus and to allow the mother and fetus to survive the demands of childbirth. Such alterations in anatomy and physiology may cause difficulties in interpreting signs, symptoms, and biochemical investigations, making the clinical assessment of a pregnant woman inevitably confusing but challenging. Understanding these changes is important for every practicing obstetrician, as the pathological deviations from the normal physiological alterations may not be clear-cut until an adverse outcome has resulted. Only with a sound knowledge of the physiology and anatomy changes can the care of an obstetric parturient be safely optimized for a better maternal and fetal outcome.
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Pregnancy is marked by a progressive increase in circulating cortisol and altered hypothalamic-pituitary-adrenal axis with reduced negative feedback.
“Moreover, pregnancy is marked by a progressive increase in the level of circulating cortisol; the hypothalamic–pituitary–adrenal axis is altered, and the normal negative feedback loop that suppresses the production of corticotrophin-releasing (CRH) and adrenocorticotropic hormone (ACTH) release in response to high cortisol is reduced.”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [24]
Physiological insulin resistance in pregnancy allows a state of hyperglycemia that increases fetal glucose absorption while preventing glucose use by maternal tissue.
“Physiological insulin resistance allows for a state of hyperglycemia that allows a higher glucose absorption by the fetus, preventing glucose from being used by maternal tissue [24].”
From Maternal Overnutrition and Fetal Programming: Long-Term Metabolic, Cognitive, and Epigenetic Consequences (2026) · cites this paper as [24]
Cites
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Gender differences in autoimmune disease
Ngo, S. T., Steyn, F. J., & McCombe, P. A. (2014) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2014.04.004 · Cited by 1,074 · see citing works
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- Authors
- Tan, E. K., & Tan, E. L.
- Affiliations
- National University Hospital (SG)
- Singapore General Hospital (SG)
- Corresponding author
- Tan, Eng Kien
- Venue
- Best Practice & Research Clinical Obstetrics & Gynaecology
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 27
- Issue
- 6
- Pages
- 791-802
- ISSN
- 1521-6934 (ISSN-L)
- OpenAlex
- W2007714044
- Cited by
- 484
- References
- 2
- Citations by year
- 2026: 31 · 2025: 54 · 2024: 68 · 2023: 73 · 2022: 50 · 2021: 51 · 2020: 39 · 2019: 28 · 2018: 30 · 2017: 13 · 2016: 17 · 2015: 23 · 2014: 7
- FWCI
- 2.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Best Practice & Research Clinical Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- pregnancy, physiological changes, anatomical changes, cardiovascular changes, respiratory changes, hematological changes, renal changes, gastrointestinal changes, endocrine changes, obstetric care
- MeSH terms
- Cardiovascular System, Cardiovascular Physiological Phenomena, Digestive System, Digestive System Physiological Phenomena, Endocrine System, Female, Hemodynamics, Humans, Pregnancy, Pregnancy Complications, Respiratory System, Respiratory Physiological Phenomena, Stroke Volume, Urogenital System
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