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Review
. 2014 Mar 15;101(4):545-53.
doi: 10.1093/cvr/cvu009. Epub 2014 Jan 20.

Maternal cardiac metabolism in pregnancy

Laura X Liu  1 , Zolt Arany
Affiliations
Review

Maternal cardiac metabolism in pregnancy

Laura X Liu et al. Cardiovasc Res. .

Abstract

Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal 'invasion' profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology.

Keywords: Heart; Metabolism; Peripartum cardiomyopathy; Pregnancy.

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Figures

Figure 1
Figure 1
Metabolic changes during late pregnancy. Late pregnancy is marked by maternal catabolism that serves to support the dramatic anabolic growth of the foetus. The liver uses glycerol and (less so) amino acids to make glucose for the foetus and consumes fats, generating in the process ketones that are usable by the brain, muscle, and foetus. Adipose tissue releases fatty acids for consumption by both the liver and muscle. The foetus uses amino acids, fats, and roughly half of incoming glucose for anabolic growth, while largely relying on the other half of glucose for energetic needs.
Figure 2
Figure 2
Cardiac metabolism. Cardiomyocytes are 95% oxidative, consuming fuels in mitochondria to generate ATP. Under normal conditions, >70% fuel consumed are fatty acids, but cardiomyocytes are omnivorous and can consume any number of other fuels. Under pregnancy conditions, cardiomyocytes increase utilization of fatty acids while decreasing glucose utilization. PDH, pyruvate dehydrogenase; CPT1, carnitine palmitoyltransferase; TCA, tricarboxylic acid cycle.
Figure 3
Figure 3
Haemodynamics changes during pregnancy. Cardiac output, heart rate, stroke volume, and blood volume all increase between 5 and 8 weeks of gestation, peak by mid-pregnancy, and is sustained until the end of pregnancy. These parameters are reversed by 6 months postpartum. 1, Clark et al.; 2, Hytten and Paintin.
See this image and copyright information in PMC

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