2- endocrinology in pregnancy

Question 1

what hormones made in follicular phase of ovarian cycle?

Answer 1

• FSH stimulates follicle growth
• developing follicles secrete oestrogen (oestradiol)

Question 2

what hormones cause ovulation?

Answer 2

high oestrogen makes surge of luteinizing hormone which causes release off egg

Question 3

what hormones are made in luteal phase?

Answer 3

progesterone made by corpus luteum (also makes some oestrogen but main one progesterone)

Question 4

what hormone is made by fertilised egg when implanted?

Answer 4

hCG = what test for pregnancy

Question 5

what is hormones produced by placenta?

Answer 5

• human placental lactogen (hPL)
• placental progesterone
• placental oestrogens

Question 6

what is produced by pituitary in pregnancy?

Answer 6

prolactin (to produce lactogen)

Question 7

how does gestational diabetes occur?

Answer 7

placental progesterones & hPL →insulin resistance in mother (to increase blood glucose in body to feed the baby)

• if normal & healthy then this no problem
• if predisposed (high BMI etc)→raised blood glucose →gestational diabetes

Question 8

what are some diabetic complications in pregnancy?

Answer 8

• congenital malformation
• prematurity
• intrauterine growth retardation (baby grows slowly & is small)
• macrosomia (big newborn baby)
• polyhydramnios (too much amniotic fluid)
• intrauterine death

Question 9

what are complications in neonate with diabetes?

Answer 9

• resp distress = immature lungs
• hypoglycaemia or hypocalcaemia = fits

*also just CNS defects like spina bifida

Question 10

what trimester does foetus start producing own insulin?

Answer 10

3rd trimester

Question 11

what is management of diabetes in pregnancy?

Answer 11

1. good blood sugar control and good monitoring before & during pregnancy
2. need more folic acid = 5mg (usually just need 400 micrograms)
3. regular eye checks as accelerated retinopathy
4. consider med change like tablets to insulin and ACE inhibitor or statins
5. diabetic diet
6. aspirin 150mg at 12 weeks since high risk preeclampsia

Question 12

what drug treatment needed in pregnancy for type 1, type 2 and gestational?

Answer 12

• type 1 needs insulin
• type 2 needs metformin and maybe insulin later
• GDM needs lifestyle, metformin, maybe insulin

Question 13

what are the 2 most important things for antenatal care in type 1 and type 2 diabetes?

Answer 13

aspirin (150mg) and folic acid (5mg)

Question 14

what is chance of gestational diabetes progressing to type 2 after pregnancy? how would you prevent?

Answer 14

50% chance to type 2 within 10 years

• keep weight low, healthy diet, exercise, annual fasting glucose (to monitor)