ENDOCRINE SYSTEM

IN PREGNANCY

Dwi Cahya Febrimulya

 ENDOCRINE SYSTEM
GH
Prolactine
Pituitary Oxytocin
Gland ADH

Thyroid Thyroid Hormone

Gland

Parathyroid Hormone and Calcium

Parathyro Calcitonin and calcium

id Gland Vitamin D and calcium

Cortisol
Adrenal Aldosterone
Gland Deoxycorticosterone
 PITUITARY GLAND

Pituitary gland become enlarge by 135%

when pregnancy

Reduc compress the

e optic chiasma
vision
 PITUITARY GLAND

GH
TSH
Anterior LH
FSH
Prolactin

Oxytocin
Posterior
ADH
4
 GROWTH HORMONE
Time Maternal Fetal
First Trimester GH secreted predominantly
from maternal pituitary
gland
8 weeks GH from placenta
pregnancy becomes detectable

10 weeks Maternal serum values

pregnancy increase slowly from
approximately 3.5 ng/mL
14 to 15 weeks Growth hormone peaks
in amnionic fluid
17 weeks Placenta is the
pregnancy principal source of GH

after 28 weeks plateau at approximately 14

ng/mL
PROLACTIN HORMONE

Non
Pregnant
Pregnant

prolacti
n
prolacti prolacti
n n
prolacti prolacti
n n
PROLACTIN

To ensure lactation

Initiate DNA synthesis and mitosis of glandular

epithelial cells and the presecretory alveolar cells of
the breast (in early pregnancy)

increases the number of estrogen and prolactin

receptors in these same cells

Promotes mammary alveolar cell RNA synthesis,

galactopoiesis, and production of casein and
lactalbumin, lactose, and lipids
 Up
to
10.0
00
ng/
At 20-
mL
(in
26
Lev
els
amn
iotic
weeks
decr fluid
eas
After 34 e
)

and
weeks reac Prol
ha acti
nadi n
r con
Puls cent After
ratio
atil
e n delivery
decr
bur eas
st e

Res
pon
se
to
 THYROID GLAND

Thyroid volume
increased from
12.1 mL in the first
trimester to 15.0
mL at delivery

Enlargement
caused by
Are not
glandular pathologic
hyperplasia and al
increased
vascularity
 IODINE STATUS

Iodine
Increase in
requireme
Pregnancy
nts

Iodine Leads to
Deficien Cretinis
cy m
Parathyroid Glands - Vitamin D and Calcium

Vitamin D,
(a hormone that is
synthesized
in the skin or ingested)

the liver

25-hydroxyvitamin
D3
Facilitated by parathyroid hormone and by kidney, decidua,
low calcium and phosphate plasma levels and placenta
and opposed by calcitonin

1,25-dihydroxyvitamin D3
(increased during normal
pregnancy)

stimulates resorption of calcium from bone

and absorption from the intestines
13
ADRENAL GLANDS

14
ADRENAL GLANDS

ADRENAL GLAND -
CORTISOL
ACTH decrease early
pregnancy

Pregnan
cy
ACTH & free cortisol progress
1. Resetting maternal
feedback mechanism
2. Tissue refractoriness to
cortisol
3. Progesteron (antagonis
mineralo corticoids)
15
MATERNAL PHYSIOLOGY
WILLIAMS OBSTETRICS 22ND
PAGE 143-145
16
ADRENAL GLANDS

ALDOSTERONE

Aldosterone at 15th weeks

Limited
(1mg/day at 3rd trisemester) sodium
intake

Substrat
e

Angioten
sin II

17
http://www.webalice.it/alberto.frangini/Potassium-Sparing%20
Diuretics.jpg

18
ADRENAL GLANDS

DEOXYCORTICOSTERONE
Increase in pregnancy
(1500 g/ml, more than 15th fold)

Increased
kidney Estrogen
production stimulation

19
ADRENAL GLANDS

DEOXYCORTICOSTERONE
Concentration at fetus is bigger than it at mother

Transfer
deoxycorticosterone from
fetus to mother

20
ADRENAL GLANDS

ANDROSTENEDION & TESTOSTERON

Production increase unknown source (likely

originates in the ovary)
Clearance increase converted to estradiol in the
placenta
Retardation testosteron clearance increase sex
hormon binding globulin
Testosteron is undetectable in umbilical cord venous
plasma conversion of testosterone to 17-estradiol
by trophoblast

21
TERIMA KASIH