As a result of the changes in the cardiovascular system,
renal plasma flow and glomerular filtration rate increase
in pregnancy. This results in an increase in urea, creatinine
and urate clearance and excretion of bicarbonate causing
plasma concentrations to be less than in the non-pregnant
population. The activities of renin-angiotensin, aldosterone and progesterone are increased leading to increased water
retention and a decreased plasma osmolality. Glycosuria
can be observed in 40% of parturients secondary to
reduced reabsorption of glucose. Urinary tract infections
are more common in pregnant patients due to urinary
stasis from progesterone mediated ureteric smooth muscle
relaxation.
The changes in renal physiology increase the volume of
distribution for drugs and those that are renally excreted
may have to be given in higher than normal dosages and
may have prolonged action
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