9- Medical problems in pregnancy (pre-existing conditions, safe prescribing for common conditions)

Question 1

what aspect of being pregnant can make asthma worse

Answer 1

acid reflux

Question 2

asthma treatments and pregnancy

Answer 2

Most asthma medicines are safe to use in pregnancy and, if your asthma is well controlled, there’s little to no risk for you or your baby. This includes reliever inhalers; preventer inhalers; long-acting and combined relievers; theophylline; and steroid (prednisolone) tablets.

• continue to take prescribed astham treatments during pregnancy

Question 3

asthma treatment and breastfeeding

Answer 3

It’s safe to continue any asthma treatment while you’re breastfeeding.

Question 4

managing asthma in pregnancy

Answer 4

using a preventer inhaler (steroids) when you get a cough or cold

• speak to a doctor about using preventer inhalers in pregnancy
• avoiding smoking
• get tips on stopping smoking in pregnancy
  avoiding things that trigger allergic reactions for you – for example, pet fur
• controlling hay fever with antihistamines
• talk to a doctor or pharmacist about which antihistamines are safe to take in pregnancy
• avoiding hay fever triggers, such as mowing the lawn
• continuing to exercise and eat a healthy diet
• have the flu jab in pregnancy

Question 5

Asthma and giving birth

Answer 5

It is very rare to have an asthma attack during labour. If you have asthma symptoms during labour it’s safe to use your reliever inhaler as normal.

Make sure you tell your midwife and the hospital staff about any allergies you have.

Question 6

what should pregnant women with epilepsy take during pregnancy

Answer 6

Women with epilepsy should take folic acid 5mg daily from before conception to reduce the risk of neural tube defects.

Question 7

how can pregnancy affect epilepsy

Answer 7

Pregnancy may worsen seizure control due to the additional stress, lack of sleep, hormonal changes and altered medication regimes. Seizures are not known to be harmful to the pregnancy, other than the risk of physical injury.

Question 8

if a women is trying to get pregnant how should epilepsy be treated

Answer 8

Ideally, epilepsy should be controlled with a single anti-epileptic drug before becoming pregnant.

Question 9

which anti-epileptic medications are safe in pregnancy

Answer 9

• Levetiracetam
• Lamotrigine
• Carbamazepine

are the safer anti-epileptic medication in pregnancy

Question 10

which two anti-epileptic drugs should be avoided

Answer 10

sodium valproate and phenytoin

Question 11

sodium valproate is avoided in pregnancy because

Answer 11

it causes neural tube defects and developmental delay

Question 12

sodium valproate is avoided in pregnancy because

Answer 12

it causes neural tube defects and developmental delay

Question 13

phenytoin is avoided in pregnancy because

Answer 13

it causes cleft lip and palate

Question 14

sodium valproate should not be given to

Answer 14

women of a childbearing age
- *unless there are no suitable alternatives
- if sodium valproate given - strict criteria must be met to ensure they do not get pregnancy “Prevent programme”

Question 15

why is opitmal management of hypothyroidism important in pregnancy

Answer 15

Untreated or under-treated hypothyroidism in pregnancy can lead to several adverse pregnancy outcomes, including miscarriage, anaemia, small for gestational age and pre-eclampsia.

Question 16

how is hypothyrodism treated

Answer 16

levothyroxine (T4)

Question 17

how does levothyroxine dose need changing during pregnancy

Answer 17

it needs to be increased by at least 25-50 mcg(30-50%). Levo can psss the placenta and provide thryoid hormones to developing baby
- treatment ios titrated based on TSH leevl aiming for a low-normal TSH level

Question 18

if a patient has pre-existing type 1 and type 2 diabetes and get pregnant there are increased risks of

Answer 18

• a large baby – which increases the risk of a difficult birth, having your labour induced or needing a caesarean section
• polyhydramnos
• a miscarriage
• baby devloping obesity or diabetes later in life

Question 19

complications of diabetes in pregnancy

Answer 19

• diabetic retinopathy
• diabetic nephropathy
• diabetic ketoacidosis (esp if T1DM)

Question 20

reducing risks to mothers with prexisting diabetes and their baby

Answer 20

• Ensure your diabetes is well controlled before you become pregnant -monthly HbA1c
• High dose folic acid 5mg before pregnant and until 12th week

Question 21

management of existing diabetes in pregnancy

Answer 21

• regular glucose monitoring
• T2DM –> switch to insulin

Question 22

hypertension and pregnancy

Answer 22

Women with existing hypertension may need changes to their medications.
- important kept under control

Question 23

hypertension drugs not safe in pregnancy

Answer 23

• ACE inhibitors (e.g. ramipril)
• Angiotensin receptor blockers (e.g. losartan)
• Thiazide and thiazide-like diuretics (e.g. indapamide)

Question 24

antihypertensive Medications that are not known to be harmful:

Answer 24

• Labetalol (a beta-blocker – although other beta-blockers may have adverse effects)
• Calcium channel blockers (e.g. nifedipine)
• Alpha-blockers (e.g. doxazosin)

Question 25

management of congenital heart problems in pregnany

Answer 25

team-based care: cardiologist, obstetrician and midwife

Question 26

risks to baby with a mother with congenital heart disease

Answer 26

• prematurity
• risks baby inherits disease e.g. Marfan syndrome

Question 27

management of pregnant mothers with congenital heart disease

Answer 27

may need to chance certain medications e.g. ACEi

Question 28

Risk of having coronary heart disease in pregnancy

Answer 28

• myocardial infarction
• harm to baby

Question 29

management of coronary heart disease in pregnancy

Answer 29

• Aspirin
• good diet
• control weight
• exercise
• stop smoking

Question 30

Changes to your heart and blood vessels during pregnancy

Answer 30

Your body experiences many changes during pregnancy. These changes put extra stress on your body and force your heart to work harder. The following changes are normal during pregnancy. They help your growing fetus receive enough oxygen and nutrients.

• Increase in blood volume: Your blood volume goes up during the first few weeks of pregnancy and continues rising from there. Most people experience a 40% to 45% total increase in blood volume during pregnancy.
• Increase in heart rate: It’s normal for your heart rate to increase by 10 to 20 beats per minute during pregnancy. It goes up gradually during your pregnancy and is the highest by your third trimester.
• Increase in cardiac output: Cardiac output is the amount of blood your heart pumps each minute. By 28 to 34 weeks, your cardiac output may increase by 30% to 50%. This is because of the higher blood volume and faster heart rate. If you’re pregnant with twins, your cardiac output may increase up to 60%.

Question 31

which diabetes drugs are safe in pregnancy

Answer 31

metformin and insulin

Question 32

which diabetes drugs are safe in pregnancy

Answer 32

metformin and insulin