8.5 Chronic Conditions in Pregnancy Flashcards
What happens to levothyroxine replacement in pregnancy?
Needs to be increased, usually by 25-50 micrograms (30-50%).
Aim for low-normal TSH level.
What does hypothyroidism in pregnancy lead to?
- miscarriage
- anaemia
- small for gestational age
- pre-eclampsia
What medications for hypertension are harmful in pregnancy?
- ACE inhibitors eg ramipril
- ARBs eg losartan
- thiazides/ thiazide-like eg indapamide
What hypertension meds are not harmful?
- labetalol (but other beta blocker may have effects)
- CCBs eg nifedipine
- alpha-blockers eg doxazosin
What should women with epilepsy take during pregnancy?
not a medicine
5mg folic acid
reduce NTD risk
Why might seizure control worsen during pregnancy?
Additional stress, lack of sleep, hormonal changes, altered medication regimes.
(Seizure are not harmful except for physical injury)
What epileptic drugs are safe in pregnancy?
- Lamotrigine
- Levetiracetam
- Carbamazepine
(try and get epilepsy controlled by one drug before pregnancy)
What epileptic drugs are avoided in pregnancy?
- Sodium valproate avoid (NTD, teratogenic, development delay)
- Phenytoin avoid (cleft lip and palate)
What is the Prevent Programme (in medicine) for?
Prevent (valproate pregnancy prevention programme) ensures child bearing women and girls do not get pregnant when on SODIUM VALPROATE.
(teratogenic)
What DMARDs for RA can be used in pregnancy?
Hydroxychloroquine - safe and first line
Sulfasalazine - safe
Corticosteroids - use in flareups
What RA DMARD is contraindicated in pregnancy?
Methotrexate - teratogenic, miscarriage, congenital abnormalities
