Physiologic Changes During Pregnancy

Physiologic Changes During Pregnancy

Organ SystemChanges During PregnancyEffects on a Patient with Autoimmune Disease
CardiovascularIncreased plasma volume
Increased heart rate
Increased stroke volume
Vasodilation
Can place strain on the heart if affected by CTD
Raynaud’s phenomenon can improve
PulmonaryIncreased minute ventilation
Respiratory alkalosis
Can stress patients with underlying pulmonary disease such as ILD
Avoid pregnancy in PHTN
RenalIncreased 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 valuesAcute-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
HepaticIncreased hepatic protein synthesis, complement, fibrinogenElevated ESR and complement
May be hard to follow ESR
HematologicLeukocytosis
Hemodilution
Can be confused with infection
Anemia
Thrombocytopenia
MuscleRelaxation of skeletal muscleWorsening GERD
DermatologicHypervascular 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.

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