Abstract
Exposures to environmental contaminants can pose risks to pregnant women’s health, their developing fetuses, children, and adults later in their lives. Assessing risks to this potentially susceptible population requires a sound understanding of the physiological and behavioral changes that occur during pregnancy and lactation. Many physiological and anatomical changes occur in a woman’s organ systems during the course of pregnancy and lactation. For example, blood volume and cardiac output increase during pregnancy, and other metabolic functions are altered to provide for the demands of the fetus. During lactation, nutritional demands are greater than during pregnancy. There are also changes in behavior during both pregnancy and lactation. For example, water consumption during pregnancy and lactation increases. These behavioral and physiological changes can lead to different environmental exposures than these women might otherwise experience in the absence of pregnancy or lactation. This paper provides a summary of information from the published literature related to behavioral and physiological changes in pregnant and lactating women that may affect their exposure or susceptibility to environmental contaminants, provides potentially useful exposure factor data for this population of women, and highlights data gaps.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 6 print issues and online access
£169.00 per year
only £28.17 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ventura SJ, Curtin SC, Abma JC . Estimated pregnancy rates by outcome for the United States, 1990-2008. National Center for Health Statistics. Natl Vital Stat Rep 2012; 60: 1–22.
Kahn HH, Stralka KK . Estimates of water ingestion for women in pregnant, lactating, and non-pregnant and non-lactating child-bearing age groups based on USDA’s 1994–96, 1998 continuing survey of food intake by individuals. Hum Ecol Risk Assess 2008; 14: 625–633.
AAP (American Academy of Pediatrics). Breast feeding and the use of human milk. Policy statement. Pediatrics 2012; 129: e827–e841.
AAP (American Academy of Pediatrics). Breast feeding and the use of human milk. Policy statement. Pediatrics 2005; 115: 496–506.
CDC (Centers for Disease Control). Breastfeeding Report Card–United States 2012. CDC: Atlanta, GA. 2012a.
CDC (Centers for Disease Control) Breastfeeding Among U.S. Children Born 2009–2010. CDC National Immunization Survey. Accessed: 20 February 2013; http://www.cdc.gov/breastfeeding/data/nis_data/2012b.
Gabbe SG, Niebyl JR, Simpson JL (eds). Obstetrics: Normal and Problem Pregnancies 5th edn. Churchill Livingstone: New York). 2007.
Anderson GD . Pregnancy-induced changes in pharmacokinetics: a mechanistic-based approach. Clin Pharmacokinet 2005; 44: 989–1008.
Loebstein RR, Lalkin AA, Koren GG . Pharmacokinetic changes during pregnancy and their clinical relevance. Clin Pharmacokinet 1997; 33: 328–343.
Dawes MM, Choweinczyk PJ . Pharmacokinetics in pregnancy. Best Practice Res Clin Obstetr Gynaecol 2001; 15: 819–826.
Abduljalil KK, Furness PP, Johnson TN, Rostami-Hodjegan AA, Soltani HH . Anatomical, physiological and metabolic changes with gestational age during normal pregnancy: a database for parameters required in physiologically based pharmacokinetic modelling. Clin Pharmacolkinet 2012; 51: 365–396.
Lin KC . Increase of maternal plasma leptin concentrations during pregnancy: comparison with nonpregnant women. Kaohsiung J Med Sci 1999; 15: 640–645.
Matthews KA, Rodin JJ . Pregnancy alters blood pressure responses to psychological and physical challenge. Psychophysiology 1992; 29: 232–240.
Ciliberto CF, Marx GF . Physiological changes associated with pregnancy. Update in Anaesthesia 9 (Article 2). 1998 Accessed: 20 February 2013.
Blackburn SS . Maternal, Fetal and Neonatal Physiology: A Clinical Perspective Third Edn Elsevier Health Sciences: St Louis, Missouri. 2007 pp 169–171, 196–205; 267–275; 315–321; 375–385; 598–605.
Theunissen IM, Parer JT . Fluid and electrolytes in pregnancy. Clin Obstet Gynecol 1994; 37: 3–15.
Kolarzyk EE, Szot WM, Lyszczarz JJ . Lung function and breathing regulation parameters during pregnancy. Arch Gynecol Obstet 2005; 272: 53–58.
Harirah HM, Donia SE, Nasrallah FK, Saade GR, Belfort MA . Effect of gestational age and position on peak expiratory flow rate: a longitudinal study. Obstet Gynecol 2005; 105: 372–376.
Chhabra SS, Nangia VV, Ingley KN . Changes in respiratory function tests during pregnancy. Indian J Physiol Pharmacol 1988; 32: 56–60.
Alba AA, Carleton LL, Dinkel LL, Ruppe RR . Increased lead levels in pregnancy among immigrant women. J Midwifery Womens Health 2012; 57: 509–514.
Osterloh JD, Kelly TJ . Study of the effect of lactational bone loss on blood lead concentrations in humans. Environ Health Perspect 1999; 107: 187–194.
Moline JJ, Lopez Carrillo LL, Torres Sanchez LL, Godbold JJ, Todd AA . Lactation and lead body burden turnover: a pilot study in Mexico. J Occup Environ Med 2000; 42: 1070–1075.
Tellez-Rojo MM, Hernandez-Avila MM, Gonzalez-Cossio TT, Romieu I, Aro AA, Palazuelos EE et al. Impact of breastfeeding on the mobilization of lead from bone. Am J Epidemiol 2002; 155: 420–428.
Gulson BL, Mizon KJ, Korsch MJ, Palmer JM, Donnelly JB . Mobilization of lead from human bone tissue during pregnancy and lactation—a summary of long-term research. Sci Total Environ 2003; 303: 79–104.
Gulson BL, Mizon KJ, Palmer JM, Korsch MJ, Taylor AJ, Mahaffey KR . Blood lead changes during pregnancy and postpartum with calcium supplementation. Environ Health Perspect 2004; 112: 1499–1507.
Gulson BL, Pounds JG, Mushak P, Thomas BJ, Gray B, Korsch MJ . Estimation of cumulative lead releases (lead flux) from the maternal skeleton during pregnancy and lactation. J Lab Clin Med 1999; 134: 631–640.
Hernandez-Avila M, Gonzalez-Cossio T, Palazuelos E, Romieu I, Aro A, Fishbein E . Dietary and environmental determinants of blood and bone lead levels in lactating postpartum women living in Mexico City. Environ Health Perspect 1996; 104: 1076–1082.
Butte NF, King JC . Energy requirements during pregnancy and lactation. Public Health Nutr 2005; 8: 1010–1027.
Butte NF, Wong WW, Treuth MS, Ellis KJ, O’Brian Smith E . Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr 2004; 79: 1078–1087.
Butte NF, Hopkinson JM, Mehta N, Moon JK, Smith EO . Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation. Am J Clin Nutr 1999; 69: 299–307.
Blackburn MW, Calloway DH . Energy expenditure and consumption of mature, pregnant and lactating women. J Am Diet Assoc 1976; 69: 29–37.
Widjaja A, Hofmann R, Bruhn J, von zur Muhlen A, Brabant G . Free and bound leptin levels during human pregnancy. Gynecol Endocrinol 2000; 14: 264–269.
APA (American Psychiatric Association). American Psychiatric Association: Diagnostic and Statistical Manual for Psychiatric Disorders 4th Edn, American Psychiatric Association: Washington, DC. 2000.
Hickey CA . Sociocultural and behavioral influences on weight gain during pregnancy. Am J Clin Nutr 2000; 71 (Suppl): 1364S–1370S.
US EPA (Environmental Protection Agency). Exposure Factors Handbook 2011 edn. National Center for Environmental Assessment: Washington, DC. 2011 EPA/600/R-09/052 F. Available from the National Technical Information Service, Springfield, VA, and online at http://www.epa.gov/ncea/efh.
Burmaster DE . Lognormal distributions for total water intake and tap water intake by pregnant and lactating women in the United States. Risk Anal 1998; 18: 215–219.
Ershow AG, Brown LM, Cantor KP . Intake of tapwater and total water by pregnant and lactating women. Am J Public Health 1991; 81: 328–334.
Landau RL . The appetite of the pregnant woman. JAMA 1983; 250: 3323.
Fowles ER . What’s a pregnant woman to eat? A review of current USDA dietary guidelines and mypyramid. J Perinatal Education 2006; 15: 28–33.
USDA (Department of Agriculture) A look at the diet of pregnant women. Nutrition Insights 17. Center for Nutrition Policy and Promotion, an organization of the US Department of Agriculture: Washington, DC. 2000.
Dewey KG, Heinig MJ, Nommsen LA . Maternal weight loss patterns during prolonged lactation. J Clin Nutr 1993; 58: 162–166.
Buck GM, Sever LE, Mendola P, Zielezny M, Vena JE . Consumption of contaminated sport fish from Lake Ontario and time-to-pregnancy. Am J Epidemiol 1997; 146: 949–954.
Bloomingdale A, Guthrie LB, Price S, Wright RO, Platek D, Haines J . A qualitative study of fish consumption during pregnancy. Am J Clin Nutr 2010; 92: 1234–1240.
Mirel LB, Curtin LR, Gahche J, Burt V . Characteristics of pregnant women from the 2001–06 National Health and Nutrition Examination Survey. Joint Statistical Meeting, Section on Government Statistics, 2009 pp 2592–2602 . Accessed: 18 December 2012. Center for disease Control and Prevention: Hyattsville, MD. https://www.amstat.org/membersonly/proceedings/2009/papers/304082.pdf.
Xue F, Holzman C, Rahbar MH, Trosko K, Fischer L . Maternal fish consumption, mercury levels, and risk of preterm delivery. Environ Health Perspect 2007; 115: 42–47.
Crozier SR, Robinson SM, Godfrey KM, Cooper C, Inskip HM . Women’s dietary patterns change little from before to during pregnancy. J Nutr 2009; 139: 1956–1963.
Oken E, Kleinman KP, Berland WE, Simon SR, Rich-Edwards JW, Gillman MW . Decline in fish consumption among pregnant women after a National Mercury Advisory. Obstet Gynecol 2003; 102: 346–351.
Fitzgerald E, Hwang SA, Briz KA, Bush B, Cook K, Worswick P . Fish PCB concentrations and consumption patterns among Mohawk women at Akwesasne. J Exp Anal Environ Epidemiol 1995; 5: 1–19.
Bronstein ES, Dollar J . Pica in pregnancy. J Med Assoc Ga 1974; 63: 332–335.
Cooksey NR . Pica and olfactory craving of pregnancy: how deep are the secrets? Birth 1995; 22: 129–137.
ATSDR (Agency for Toxic Substances and Disease Registry). Summary report for the ATSDR soil-pica workshop. ATSDR, US Department of Health and Human Services: Atlanta, GA. 2001.
Mills ME . Craving more than food: the implications of pica in pregnancy. Nursing Women Health 2007; 11: 266–273.
Simpson E, Mull JD, Longley E, East J . Pica during pregnancy in low-income women born in Mexico. West J Med 2000; 173: 20–24.
Smulian JC, Motiwala S, Sigman RK . Pica in a rural obstetric population. South Med J 1995; 88: 1236–1240.
Young SL . Pica in pregnancy: new ideas about an old condition. Annu Rev Nutr 2010; 30: 403–422.
Young SL, Sherman PW, Lucks JB, Pelto G . Why on earth? Evaluating hypotheses about the physiological functions of human geophagy. Quart Rev Biol 2011; 86: 97–120.
Gavrelis N, Sertkaya A, Bertelsen L, Cuthbertson B, Phillips L, Moya J . An analysis of the proportion of the U.S. population that ingests soil or other non-food substances. Hum Ecol Risk Assess 2011; 17: 996–1012.
Vermeer DE, Frate DA . Geophagia in rural Mississippi: environmental and cultural contexts and nutritional implications. Am J Clin Nutr 1979; 32: 2129–2135.
Klitzman S, Sharma A, Nicaj L, Vitkevich R, Leighton J . Lead poisoning among pregnant women in New York City: risk factors and screening practices. J Urban Health 2002; 79: 225–237.
ATSDR (Agency for Toxic Substances and Disease Registry). Toxicological profile for lead. ATSDR, US Department of Health and Human Services: Atlanta, GA. 2007.
Brochu P, Ducré-Robitaille J, Brodeur J . Physiological daily inhalation rates for freeliving pregnant and lactating adolescents and women aged 11 to 55 years, using data from doubly labeled water measurements for use in health risk assessment. Human Ecol Risk Assess 2006; 12: 702–735.
Mottola MF, Campbell MK . Activity patterns during pregnancy. Can J Appl Physiol 2003; 28: 642–653.
Borodulin K, Evenson KR, Wen F, Herring AH, Benson A . Physical activity patterns during pregnancy. Med Sci Sports Exerc 2008; 40: 1901–1908.
Borodulin K, Evenson KR, Herring AH . Physical activity patterns during pregnancy through postpartum. BMC Women Health 2009; 9: 32.
Evenson KR, Wen F . Measuring physical activity among pregnant women using a structured one-week recall questionnaire: evidence for validity and reliability. Int J Behav Nutr Phys Activity 2010; 7: 21.
Nethery E, Brauer M, Janssen P . Time–activity patterns of pregnant women and changes during the course of pregnancy. J Expos Anal Environ Epidemiol 2009; 19: 317–324.
Zender R, Bachand A, Reif J . Exposure to tap water during pregnancy. J Expo Anal Environ Epidemiol 2001; 11: 224–230.
Bell ML, Belanger K . Review of research on residential mobility during pregnancy: consequences for assessment of prenatal environmental exposures. J Expo Sci Environ Epidemiol 2012; 22: 429–438.
Just AC, Adibi JJ, Rundle AG, Calafat AM, Camann DE, Hauser R . Urinary and air phthalate concentrations and self-reported use of personal care products among minority pregnant women in New York City. Expo Sci Environ Epidem 2010; 20: 625–633.
IOM and NRC. Weight Gain During Pregnancy: Reexamining the Guidelines. The National Academies Press: Washington, DC. 2009.
Cox S . Weight gain during pregnancy. J Midwifery Womens Health 2003; 48: 229–230.
Janney CA, Zhang D, Sowers M . Lactation and weight retention. Am J Clin Nutr 1997; 66: 1116–1124.
Carmichael S, Abrams B, Selvin S . The pattern of maternal weight gain in women with good pregnancy outcomes. Am J Public Health 1997; 87: 1984–1988.
Riordan J, Wambach K . Breastfeeding and human lactation 4th Edn. Jones and Barlett Publishers, LLC: Sudbury, MA. 2010 pp 499–502.
Brewer MM, Bates MR, Vannoy LP . Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women. Am J Clin Nutr 1989; 49: 259–265.
NCHS (National Center for Health Statistics). Joint Policy on Variance Estimation and Statistical Reporting Standards on NHANES III and CSFII Reports: HNIS/NCHS Analytic Working Group recommendations. Human Nutrition Information Service (HNIS)/Analytic Working Group. Agricultural Research Service, Survey Systems/Food Consumption Laboratory: Riverdale, MD. 1993.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Moya, J., Phillips, L., Sanford, J. et al. A review of physiological and behavioral changes during pregnancy and lactation: Potential exposure factors and data gaps. J Expo Sci Environ Epidemiol 24, 449–458 (2014). https://doi.org/10.1038/jes.2013.92
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jes.2013.92
Keywords
This article is cited by
-
Inadequate dietary diversity practices and associated factors among postpartum mothers in Gambella town, Southwest Ethiopia
Scientific Reports (2023)
-
Metabolic and feeding adjustments during pregnancy
Nature Reviews Endocrinology (2023)
-
Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania
BMC Pregnancy and Childbirth (2021)
-
Yawning Is More Contagious in Pregnant Than Nulliparous Women
Human Nature (2021)
-
Association between urinary paraben concentrations and gestational weight gain during pregnancy
Journal of Exposure Science & Environmental Epidemiology (2020)