ANS. B* In pregnancy: Add 350 kcal of energy and 23 g protein* For lactation: Add 600 kcal of energy (up to 6 months) and 520 kCal (after 6 months) and 19 g protein.Normal changes in pregnancyHematological changesCardiovascular changesPlasma volume increases by 40%Cardiac output increases by 40%Red cell volume increases by 20%Pulse rate increases by 10% or 15 bpmPhysiological dilution in pregnancyStroke volume increases by 10%Hemoglobin and hematocrit decreasePeripheral vascular resistance fallsWBC count increasesMean arterial pressure and DBP fallsPlatelets normal or slight decrease by 15%Colloid oncotic pressure fallsTotal proteins increase Plasma protein concentration decreases Albumin decreases Globulins increase slightly Albumin: globulin decrease 1:1 Fibrinogen increases by 50% Increase in factor VIII, IX and XRenal changesDecrease in anticoagulantsRenal blood flow increases by 80%Inhibition of fibrinolytic activityGFR increases by 50%ESR increases four timesCreatinine and other clearances increasedSerum iron decreasesSerum creatinine, urea and urate decreasedTotal iron binding capacity increasesGlycosuria may be normalAbbreviations: WBC, white blood cell; GFR, glomerular filtration rate; ESR, erythrocyte sedimentation rate; DBP, diastolic blood pressure# Parameters which does not change in pregnancy?1. pH2. Vital capacity3. FEV14. Inspiratory reserve volume5. Pulmonary capillary wedge pressure6. Respiratory rate.