Physiologic Changes During Pregnancy
| Organ System | Changes During Pregnancy | Effects on a Patient with Autoimmune Disease |
|---|---|---|
| Cardiovascular | Increased plasma volume Increased heart rate Increased stroke volume Vasodilation | Can place strain on the heart if affected by CTD Raynaud’s phenomenon can improve |
| Pulmonary | Increased minute ventilation Respiratory alkalosis | Can stress patients with underlying pulmonary disease such as ILD Avoid pregnancy in PHTN |
| Renal | Increased glomerular filtration rate (renal blood flow increases by 50%) Increased urinary excretion of protein | Baseline proteinuria increases: can be difficult to differentiate from a flare of glomerular disease |
| Laboratory values | Acute-phase reactants can rise during pregnancy including ESR and alkaline phosphatase (secreted by the placenta) | Can make it difficult to distinguish a disease flare from normal physiologic pregnancy changes |
| Hepatic | Increased hepatic protein synthesis, complement, fibrinogen | Elevated ESR and complement May be hard to follow ESR |
| Hematologic | Leukocytosis Hemodilution | Can be confused with infection Anemia Thrombocytopenia |
| Muscle | Relaxation of skeletal muscle | Worsening GERD |
| Dermatologic | Hypervascular changes Melasma | Can mimic a lupus rash |
CTD, Connective tissue disease; ILD, interstitial lung disease; PHTN, pulmonary hypertension; GERD, gastroesophageal reflux disease; ESR, erythrocyte sedimentation rate.
