Pregnancy

Physiological Changes with Pregnancy

Musculoskeletal

• ↑ BMR

• Weight gain of 20–25 lbs

• ↑ Rib cage circumference

• ↓ Spinal curves

• ↑ Ligamentous laxity

• Postural changes

• Change in center of gravity

Cardiovascular

• ↑ Blood volume

• ↑ RBC mass

• Iron deficiency

• ↑ Leukocyte count

• ↑ Coagulation factors

• ↑ Cardiac capacity

• ↑ Size of heart

• ↑ Cardiac output & ↑ HR

Pulmonary

• Voice changes

• Difficulty breathing through the nose

• ↑ Pulmonary dead space

• ↓ Residual volume

• ↑ Tidal volume

• ↑ Alveolar ventilation

• ↑ Respiratory rate

• ↑ O₂ consumption

• ↑ CO₂ output

Integumentary

• Vascular spiders

• Palmar erythema

• ↑ Sweating

• Striae gravidarum (stretch marks)

• Hyperpigmentation

Gastrointestinal

• ↓ pH of oral cavity with ↑ risk of tooth decay

• Tender/bleeding gums

• Gastric reflux

• ↓ GI motility

• ↑ Water absorption resulting in constipation

• ↓ Risk of gallstones

Endocrine

• Enlarged adrenal & thyroid glands

• Enlarged parathyroid & pituitary glands

Urogenital

• ↑ Urinary stasis with ↑ risk of infection

• ↑ Glomerular filtration rate

• Obstruction of uterus on inferior vena cava resulting in LE edema

• ↑ Urinary output

Source: Boissonnault WG (2005).

Precautions During Pregnancy

• Avoid x-ray exposure in 1st trimester

• Avoid supine for more than a few minutes after 4th month

• Avoid rapid, uncontrolled bouncing mov'ts

• Avoid overheating

• Avoid electrical stimulation & heating modalities to the abdominal region

• Avoid prone lying in the 3rd trimester

• Avoid taking aspirin, NSAIDs, & decongestants

Red Flags When Exercising During Pregnancy

• Calf swelling or pain

• Chest pain

• Leakage of amniotic fluid

• Premature labor

• ↓ Fetal mov't

• Dizziness/headache

• Vaginal bleeding

Musculoskeletal Complications

• LBP, SI px, nerve entrapment due to ↑ fluid volume (CTS)

• Mm cramps secondary to uterine pressure resulting in LE ischemia

• Pubic symphysis dysfunction

• Diastasis recti abdominis

• Restless leg syndrome (iron deficiency)

Cardiovascular & Pulmonary Complications

• Preeclampsia = rapidly progressive disorder that occurs after 20 weeks of pregnancy-h/a, blurred vision, edema, ↑ BP, proteinuria

• DVT

• Dyspnea

• Pregnancy-induced hypertension = h/a, blurred vision

• LE edema & varicose veins

Integumentary Complications

• Hyperpigmentation

• Palmar erythema

• Dermatoses

Gastrointestinal Complications

• GI px = nausea & vomiting may lead to dehydration, hypokalemia, & wt loss

• ↓ Motility may result in constipation

• Heartburn/gastric reflux

• Hemorrhoids

• ↑ Risk of gallstones

• Toxoplasma gondii (toxoplasmosis)-parasite-can be transmitted across the placenta

Hepatic Complications

• Although the liver is affected by physiological changes during pregnancy & the bilirubin excretion may be challenging in the 2nd ...