Physiologic and pharmacokinetic changes in pregnancy.
Physiologic and pharmacokinetic changes in pregnancy.
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DOI：
10.3389/fphar.2014.00065
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发表时间：
2014
影响因子：
5.6
通讯作者：
Costantine MM
中科院分区：
文献类型：
--
作者：
Costantine MM
怀孕期间的生理变化会导致许多药物的药代动力学特性发生深刻的变化。这些变化影响药物的分布、吸收、代谢和排泄，从而可能影响它们在怀孕期间的药效学特性。孕妇在许多器官系统中经历了几次适应。有些适应是怀孕期间荷尔蒙变化的次要因素，而另一些适应则是为了支持怀孕妇女及其发育中的胎儿。例如，孕期母体生理的一些变化包括：母体脂肪和全身水分增加，血浆蛋白浓度降低，特别是白蛋白，母体血容量、心输出量和流向肾脏和子宫胎盘单位的血液增加，血压下降。母体血容量膨胀的比例大于红细胞质量的增加，从而导致生理性贫血和血液稀释。其他生理变化包括潮气量增加，部分代偿性呼吸性碱中毒，胃排空和胃肠动力延迟，肝脏药物代谢酶活性改变。低估这些变化及其对药物在怀孕期间的药代动力学特性的深刻影响，对于优化孕产妇和胎儿健康至关重要。
Physiologic changes in pregnancy induce profound alterations to the pharmacokinetic properties of many medications. These changes affect distribution, absorption, metabolism, and excretion of drugs, and thus may impact their pharmacodynamic properties during pregnancy. Pregnant women undergo several adaptations in many organ systems. Some adaptations are secondary to hormonal changes in pregnancy, while others occur to support the gravid woman and her developing fetus. Some of the changes in maternal physiology during pregnancy include, for example, increased maternal fat and total body water, decreased plasma protein concentrations, especially albumin, increased maternal blood volume, cardiac output, and blood flow to the kidneys and uteroplacental unit, and decreased blood pressure. The maternal blood volume expansion occurs at a larger proportion than the increase in red blood cell mass, which results in physiologic anemia and hemodilution. Other physiologic changes include increased tidal volume, partially compensated respiratory alkalosis, delayed gastric emptying and gastrointestinal motility, and altered activity of hepatic drug metabolizing enzymes. Understating these changes and their profound impact on the pharmacokinetic properties of drugs in pregnancy is essential to optimize maternal and fetal health.