ABSTRACT
Introduction 280 Normal lipid metabolism 280 Maternal lipid metabolism 281 Maternal carbohydrate and insulin metabolism 282 Maternal protein metabolism 282 Maternal B12, folate, and homocysteine levels 282
Normal hemostasis and fibrinolysis 282 Maternal antepartum hemostasis 283 Maternal postpartum hemostasis 286 Links between maternal hemostasis and metabolism 287 References 288
Pregnancy is associated with significant changes in hemostasis, which prepare the mother for the hemostatic challenge of delivery. It is also likely that placental and maternal thrombin generation and fibrin formation are important in the developing feto/placental unit.1 An excessive maternal coagulation response has been associated with pregnancy failure and thrombosis. Although the exact mechanism of the physiologic changes in hemostasis is unknown, as with maternal metabolism, it may relate to a number of factors, including alterations in: hormone-influenced factor synthesis; changes in the volume of distribution; coagulation-lipid interaction; and alterations in the catabolism of coagulation proteins. In particular, pregnancy is characterized by a progressive increase in maternal estrogen, which is capable of altering the uptake of coagulation proteins into the uterus,2 and could increase uterine generation of tissue factor (TF).3
