Open AccessAnatomical and physiological alterations of pregnancy
Author(s) -
Jamil Kazma,
John van den Anker,
Karel Allegaert,
André Dallmann,
Homa K. Ahmadzia
Publication year - 2020
Publication title -
journal of pharmacokinetics and pharmacodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.827
H-Index - 60
eISSN - 1573-8744
pISSN - 1567-567X
DOI - 10.1007/s10928-020-09677-1
Subject(s) - pregnancy , medicine , physiology , intensive care medicine , population , eclampsia , drugs in pregnancy , drug , clinical trial , bioinformatics , organ system , placenta , fetus , pharmacology , disease , biology , genetics , environmental health
The extensive metabolic demands of pregnancy require specific physiological and anatomical changes. These changes affect almost all organ systems, including the cardiovascular, respiratory, renal, gastrointestinal, and hematologic system. The placenta adds another layer of complexity. These changes make it challenging for clinicians to understand presenting signs and symptoms, or to interpret laboratory and radiological tests. Furthermore, these physiological alterations can affect the pharmacokinetics and pharmacodynamics of drugs. Drug safety in lactation is only supported by limited evidence. In addition, the teratogenic effects of medications are often extrapolated from animals, which further adds uncertainties. Unfortunately, pregnant women are only rarely included in clinical drug trials, while doses, regimens, and side effects are often extrapolated from studies conducted in non-pregnant populations. In this comprehensive review, we present the changes occurring in each system with its effects on the pharmacokinetic variables. Understanding these physiological changes throughout normal pregnancy helps clinicians to optimize the health of pregnant women and their fetuses. Furthermore, the information on pregnancy-related physiology is also critical to guide study design in this vulnerable 'orphan' population, and provides a framework to explore pregnancy-related pathophysiology such as pre-eclampsia.