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.

中文翻译：

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妊娠的解剖学和生理学变化。

怀孕期间广泛的代谢需求需要特定的生理和解剖学变化。这些变化几乎影响所有器官系统，包括心血管、呼吸、肾脏、胃肠道和血液系统。胎盘又增加了一层复杂性。这些变化使临床医生难以理解出现的体征和症状，或解释实验室和放射学测试。此外，这些生理变化可以影响药物的药代动力学和药效学。哺乳期药物安全性仅得到有限的证据支持。此外，药物的致畸作用常常是从动物身上推断出来的，这进一步增加了不确定性。不幸的是，孕妇很少参与临床药物试验，而剂量、治疗方案和副作用通常是从非怀孕人群中进行的研究推断出来的。在这篇综合综述中，我们介绍了每个系统中发生的变化及其对药代动力学变量的影响。了解正常怀孕期间的这些生理变化有助于临床医生优化孕妇及其胎儿的健康。此外，与妊娠相关的生理学信息对于指导这一弱势“孤儿”人群的研究设计也至关重要，并为探索先兆子痫等与妊娠相关的病理生理学提供了框架。