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Questions and Answers
Which of the following changes occur during the first trimester of pregnancy? (Select all that apply)
What significant muscle changes occur during pregnancy?
Melasma is also known as the mask of pregnancy.
True
What is the linea nigra?
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Which of the following are potential injuries related to pregnancy?
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Diastasis recti refers to the separation of the __________.
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What is a common breast change experienced early in pregnancy?
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What role do pelvic floor muscles play during pregnancy?
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Thyroid hormone levels increase significantly during pregnancy.
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Match the following pregnancy-related conditions with their descriptions:
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What happens to the gallbladder's function during pregnancy?
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Study Notes
Combat Effects of Gravity/Hormones
- Perform pelvic tilts to stabilize the pelvis
- Adjust stance, shorten jog stride, and lower or eliminate steps in aerobics to accommodate changes in balance and center of gravity
- Avoid rapid leg abduction and breaststroke kick in swimming due to increased joint laxity
- Recognize that exercise tolerance varies throughout pregnancy
- Engage in pelvic floor exercises to prevent trauma and strengthen muscles
- Emphasize strengthening and stretching exercises to address muscle imbalances
- Wear abdominal support or sports bra for added support during exercise
Changes To Body System
- First Trimester: Baby begins to grow, leading to increased urination, changes in skin and hair, thickening waistline, and potential for nausea and fatigue.
- Second Trimester: Baby's weight increases, contributing to improved energy levels. Heartburn, leg cramps, and pelvic relaxation causing SI discomfort may occur.
- Third Trimester: Baby experiences rapid growth and weight gain leading to backaches, swelling of hands, legs, and feet, breathlessness, and more frequent urination.
Muscles Affected
- Gluteal muscles and hamstrings: Overstretching and weakening
- Abdominal muscles and pelvic floor: Overstretching and weakening
- Upper back muscles: Overstretching and weakening
- Low back and hip flexor muscles: Shortening and tightening
- Upper back flexors and pectoral muscles: Shortening
Neurological and sensory
- Decreased intraocular pressure
- Corneal thickening
- Altered sense of smell
- Decreased attention span and memory problems
- Altered central nervous system physiology leading to mood disturbances
Biomechanical Changes
- Weight distribution shifts due to the growing fetus
- Joint movement becomes more restricted
- Balance of muscle strength is altered
- Spinal curves increase, particularly lumbar lordosis
- Joint laxity increases, making joints more susceptible to injury
- Structural discomfort increases as the body adapts to changing biomechanics
- Increased potential for nerve compression
Potential for Injury
- Nerve compression syndromes caused by altered posture and muscle imbalances
- Low back discomfort or pelvic pain due to increased weight and strain on the spine
- Upper back fatigue from postural changes
- Lower extremity pain due to increased weight and altered biomechanics
- Pelvic floor dysfunction affecting urinary and fecal control
MS system
- Joint relaxation throughout the body
- Posture changes like increased lumbar lordosis and shifting center of gravity leading to backache
- Diastasis recti: Separation of the rectus abdominus muscle
- Leg cramps due to calcium depletion and muscle stretching
Pelvic Floor Muscle Functions
- Maintain alignment and support of internal organs
- Control of urine flow
- Sexual enhancement
- Eliminate waste from the rectum
- Improve recovery from episiotomy
Hyperpigmentation
- Melasma and linea nigra are common pigmentation changes
- Estrogen and progesterone contribute to the increase in melanin production
- Melasma is more prevalent in dark-skinned individuals and may be more pronounced in summer
Breast Changes
- Early in pregnancy, tenderness and tightness in the breasts are common
- From week 8 onwards, breasts grow significantly, blood vessels are more visible, nipples become larger and darker, and a thick yellowish fluid known as colostrum can be expressed
Striae
- Reddish slightly depressed lines appear on the breasts, thighs, and abdomen
- In future pregnancies, they appear as glistening, silver lines
Linea nigra
- A dark line that appears down the middle of a pregnant woman's abdomen
Melasma
- Also known as the mask of pregnancy
- More common in dark skin people
- More pronounced in the summer
- Fades a few months after delivery
- Repeated pregnancy can intensify
- Can occur in non-pregnant women with harmless hormonal imbalances or women on OCPs or depo
Skin Changes
- Stretch marks (striae)
- Dark pigmented line on the abdomen (linea nigra)
- Pigment changes on the face and neck
- Small blood vessels in the face, neck, and upper chest
- Most of these skin changes resolve after pregnancy
Physiologic changes - INTEGUMENTARY SYSTEM
- These result from stretching of the skin and hormonal changes
- Linea nigra: Pigmentation down the middle line of the abdomen
- Chloasma – "mask of pregnancy": Pigmentation on the face
- Striae: Stretch marks on the abdomen, breasts, thighs, and buttocks
- Sweating: Increased sweating
Skin Changes
- Chloasma or melasma gravidarum
- Striae
- Linea nigra
Liver
- Liver morphology remains unchanged
- Lab tests show similar results to liver disease
- Alkaline phosphatase levels double
- AST, ALT, GGT, and bilirubin levels are slightly lower
- Decreased plasma albumin
Gallbladder
- Impaired contraction of the gallbladder
- High residual volumes of bile
- Promotion of stasis (stagnation of bile)
- Stasis contributes to increased cholesterol saturation in pregnancy, supporting the predisposition to gallstones
- Intrahepatic cholestasis: Retention of bile salts in the liver, contributing to pruritus gravidarum (itching)
Physiologic changes - INTEGUMENTARY SYSTEM
- These result from stretching of the skin and hormonal changes
- Linea nigra: Pigmentation down the middle line of the abdomen
- Chloasma – "mask of pregnancy"
- Striae: Stretch marks on the abdomen, breasts, thighs, and buttocks
- Sweating: Increased sweating
Insulin resistance
- Anti-insulin environment is aided by:
- Placental lactogen: Hormone similar to growth hormone, increases lipolysis and free fatty acids, increases tissue resistance to insulin
- Increased unbound cortisol: Contributes to insulin resistance
- Estrogen and progesterone may also exert some anti-insulin effects
Thyroid
- Estrogen stimulates an increase in thyroxine-binding globulin (TBG)
- Total T3 and T4 levels are increased, but active hormone levels remain unchanged
- hCG stimulates the thyroid
- TSH levels are reduced
- Iodine-deficient state occurs due to increased renal clearance
- To rule out pathological changes, early in pregnancy TSH can be used, and later free T4 can be monitored
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Description
This quiz covers key concepts related to the effects of gravity and hormonal changes on the body during pregnancy. It highlights recommended exercises, adjustments in physical activity, and the evolving requirements of the body through the trimesters. Understand how to effectively manage exercise routines throughout this transformative time.
