8: Diabetes and endocrinology in pregnancy

Question 1

The jist of diabetes

Pregnant women can get gestational diabetes, 3rd trimester - 50% chance of > T2 after birth, give drugs (metformin / insulin) only if poor glycaemic control

Untreated T1 diabetes in a prego mother is terrible for kiddo - birth defects, macrosomia

Pregnancy must be planned so glycaemic control is in place BEFORE conception

Intensely support mother after birth to reduce risk of progression to T2

Question 2

Jist of thyroid disease:

Hypothyroidism causes heavy periods, hyperthyroidism causes light periods

Thyroxine demand of mother increases during pregnancy > hypothyroidism > so increase their medication if they’re already on thyroxine

Untreated hypothyroidism and thyrotoxicosis will result in birth defects

Give anti-thyroid drugs as late and in as low a dose as possible

Question 3

Jist of thyroiditis:

Post-birth women may develop post-partum thyroiditis, producing hyperthyroid at 6 weeks, then hypothyroid (so make sure they’re off carbimazole at this point and get them on thyroxine if symptomatic, then slowly withdraw)

Small goitre

Question 4

hPL and progesterone produce insulin resistance in pregnant mothers - physiological because glucose isn’t stored and instead goes to baby

but if you’re already insulin resistant you’ll get gestational diabetes

Question 5

folic acid in all pregnant mothers!!!

Question 6

hyperglycaemia in mother during pregancy means baby is producing loads of insulin

upon birth they still will be –> hypoglycaemia, fitting