Which hormone is primarily responsible for mood swings in pregnancy?

Constipation in pregnancyis common due to hormonal and mechanical factors. Progesteronerelaxes smooth muscle, slowing colonic transit, while the enlarging uterus compresses the intestines. Normal bowel movement frequency ranges from 3 times/day to 3 times/week. Low fiberintake (<25 g/day), reduced activity, and inadequate hydrationworsen symptoms. Typical clinical features are infrequent stools, straining, and hard stool consistency. Preventive strategies include dietary fiber >25–30 g/day, fluid intake >2 L/day, regular exercise, and meal pattern adjustment.

Rationale for correct answers

1.Increased fiber intake enhances stool bulk and water retention, stimulating peristalsis. Daily intake of 25–30 g is recommended for pregnant women to prevent constipation.

3.Regular exercise improves bowel motility by stimulating colonic activity. Activities like walking 30 minutes daily are safe and effective in pregnancy.

5.Promoting small, frequent meals helps regulate digestion, prevents gastric overfilling, and maintains steady bowel function. This supports peristalsis and reduces bloating.

Rationale for incorrect answers

2.Reducing fluid intake worsens constipation. Adequate hydration (≥2 L/day) softens stools and supports normal bowel function. Low fluid intake results in harder stools and straining.

4.Avoiding stool softeners is incorrect. Stool softeners such as docusate sodium are considered safe in pregnancy and may be used when lifestyle measures are insufficient. They reduce straining without systemic absorption.

Take home points

• Progesterone-induced smooth muscle relaxation slows bowel transit in pregnancy.

• Adequate fiber, fluids, and exercise are first-line preventive strategies.

• Small frequent meals regulate digestion and reduce bloating.

• Stool softeners are safe in pregnancy if lifestyle changes are inadequate.

Hypercoagulability in pregnancydevelops as a protective adaptation to minimize hemorrhageat delivery, but it also increases the risk of thromboembolism. There is a marked rise in fibrinogenand several clotting factors(VII, VIII, IX, X, XII), while fibrinolytic activity decreases. Normal fibrinogen levels in nonpregnant women are 200–400 mg/dL, but in pregnancy, they rise to 400–650 mg/dL. This procoagulant state peaks in the third trimester and the puerperium.

Rationale for correct answer

2.Increased fibrinogen levels contribute to the hypercoagulable state of pregnancy. Elevated fibrinogen enhances clot formation and is a major factor in increasing the risk of venous thromboembolism, which is one of the leading causes of maternal morbidity and mortality.

Rationale for incorrect answers

1.Decreased clotting factors would reduce coagulation and increase the risk of bleeding, not thrombosis. Pregnancy is characterized by increased clotting factor activity, not reduction.

3.Reduced platelet count (gestational thrombocytopenia) can occur, but it is usually mild and not enough to outweigh the hypercoagulable changes. A lower platelet count actually tends toward bleeding risk, not thromboembolism.

4.Decreased white blood cell count is not typical in pregnancy. Instead, leukocytosis (WBC up to 12,000–15,000/µL, sometimes 25,000/µL in labor) is common. White blood cell levels are not directly related to thromboembolic risk in pregnancy.

Take home points

• Pregnancy is a hypercoagulable state due to increased fibrinogen and clotting factors.

• Elevated fibrinogen levels (400–650 mg/dL) significantly increase thromboembolism risk.

• Platelet count may slightly fall, but this does not negate the hypercoagulable effect.

• Thromboembolism is a major cause of maternal morbidity and mortality, especially postpartum.