Ch. 29 Endocrine and Metabolic Disorders Flashcards
What is it called when someone has any degree of glucose intolerance with onset or recognition during pregnancy?
Gestational Diabetes
What label is given to type 1 or type 2 diabetes that existed prior to pregnancy?
Pregestational Diabetes Mellitus
Which is the most common endocrine disorder associated with pregnancy?
DM
Is pregnancy complicated with DM considered high risk?
Yes
Can diabetes during pregnancy be successfully managed with a multidisciplinary approach?
Yes
What is the primary fuel for the fetus?
Glucose
Is glucose carried across the placenta?
Yes
Does insulin cross the placenta?
No
When does the fetus start producing insulin?
10th week of gestation
Do insulin needs change throughout pregnancy?
YES
In the 1st trimester what are insulin needs?
They are often reduced
Why are insulin needs often reduced in the 1st trimester?
- Body adapting to pregnancy so increased production of insulin
- N/V may affect dietary intake
What happens to insulin needs in the 2nd and 3rd trimester?
Insulin needs increase
Why do insulin needs increase in 2nd and 3rd trimester?
Some placental hormones act as antagonist to insulin which decreases its effectiveness
At birth maternal insulin levels return to what state?
pre-pregnant
Are babies from diabetic moms bigger in size?
Yes
May babies from diabetic mom have fat pads on their shoulders?
Yes
What is the amniotic fluid filled with?
Fetal urine
What are the pregestational diabetes maternal risks and complications?
- Macrosomia (large baby, >8lb 13 oz)
- Dystocia (difficult birth)
- Polyhrydramnios (excessive amniotic fluid)
- PIH, preeclampsia-eclampsi (HTN)
- Ketoacidosis
- Infections
Hyperglycemia, ketoacidosis, congenital abnormalities, and infection are thought to be some reasons for what?
Interuterine fetal death
Hyperglycemia during the first trimester when organs and systems are forming in a main concern for what?
Birth defects
Does blood sugar need to be controlled right away in pregnancy?
Yes
What does macrosomia mean?
Large on inside and outside
Insulin acts as a growth hormone for fetus causing a fetus to produce excess what?
Fat stores
Are large babies prone to birth injuries?
Yes
Why is there a fetal risk of hypoglycemia?
Fetal supply of glucose is cut off at birth
Do we potentially see slowed fetal lung development in a baby from a mom with DM?
Yes
What is the fetal risk associated with DM polycythemia?
An increase in RBCs
Polycythemia can lead to hyperbilirubinemia as a result of what?
Immature infant liver
What are forms of treatment to maintain an equal amount of insulin availability and glucose utilization in mom with DM?
- Diet therapy
- Exercise
- Glucose monitoring
- Insulin therapy
What does antepartum mean?
occurring not long before child birth
Due to DM what may need to occur during intrapartum ?
Hourly blood sugar checks and an insulin drip
Does GDM return to normal postpartum?
Yes
Do people with GDM have a greater risk of developing T2DM later in life?
Yes
What does monitoring maternal a-fetalprotein (AFP) tell us?
If there is a neural tube defect
When monitoring fetal activity, third trimester fetal movement counts for the prevention of what?
IUFD (Interuterine fetal death)
When is non stress testing (NST) started?
28 weeks
How often are ultrasounds done to monitor the baby?
every 4-6 weeks?
What must the L/S (lethicin/sphingomyelin) ratio be?
2:1
Do yo usually need a higher L/S ratio if the mom has diabetes?
Yes
Women who are obese prior to conception and develop GDM are at an increased risk to give birth to infants with what?
CNS defects
When does assessing for GD first occur?
At first pregnancy visit
For low risk of GD when are women screened?
24-28 weeks
For high risk of GD when are women screened?
as early as feasable
Is age over 35 a risk factor for GD?
Yes
Is family history of DM in a first-degree relative a risk factor for GD?
Yes
Is prior macrosomic, malformed, or stillborn infant a risk factor for GD?
Yes
Is obesity a risk factor for GD?
Yes
Is glucosuria a risk factor for GD?
Yes
How is GDM cared for antepartum?
- Diet*
- Exercise*
- monitoring glucose levels
- medications for controlling blood sugar levels
- fetal surveillance
Can women have a good experience with GD without the need for insulin use?
Yes
What is hyperemesis gravid arum?
Excessive vommiting
What is the theory of the cause of hyperemesis gravidarum?
High levels of estrogen or HCG
What is hyperemesis gravid arum accompanied by?
- Dehydration
- Weight loss
- Electrolyte imbalance
- ketosis
What is clinically associated with hyperemesis gravidarum?
- other medical conditions
- 1st baby
- high BMI or very low BMI
- Family Hx
- Multiple gestation
- Younger mom
What can interventions can help hyperemesis gravid arum?
- Start IV fluids for electrolytes
- N/V meds
- Vit B, B-6 and thiamine
- Ginger
The toxic accumulation of phenylalanine in blood which interferes with brain development is called what?
Maternal phenylketonuria
What is they key to preventing maternal phenylketonuria?
Identification in women reproductive years
Are all newborns screened for PKU at birth?
Yes
Poor maternal glycemic control before conception and in the first trimester may be responsible for what?
fetal congenital malformations
Maternal insulin requirements increase as pregnancy progresses and may quadruple by term as a result of insulin resistance created by what?
placental hormones, insulinase, and cortisol
Poor glycemic control during pregnancy can lead to maternal complications such as what?
Miscarriage, infection, and dystocia
Close glucose monitoring, insulin administration, and dietary counseling are used to create a normal what?
Intrauterine environment for fetal growth
Because GDM is asymptomatic in most cases, all women should undergo what?
Routine screening
Thyroid dysfunction during pregnancy requires close monitoring of thyroid hormone levels to regulate what?
Therapy and prevent fetal insult
The stress of the normal maternal adaptations to pregnancy on a heart whose functions are already taxed may cause what?
Cardiac decompensation
Maternal morbidity and mortality is a significant risk in pregnancy complicated by what?
Mitral valve stenosis
Anemia affects at least what percent of pregnant women?
20%
Asthma is the most common medical condition to what?
Complicate pregnancy
Pruritis is a common symptom in pregnancy-specific what?
Inflammatory diseases
A pregnant women with epilepsy should only take one anticonvulsant medication and at the lowest what?
Dose level
Lupus is the most common autoimmune disease affecting what women?
Of childbearing age
Type 2 more prevalent diabetes, may go unnoticed for years-risk factors include ?
- age
- sedentary lifestyle
- family hx
- genetics
Gestational diabetes may be diet controlled or may involve what for treatment?
insulin
When are women with gestational diabetes reclassified?
6 weeks post party
Macrosomia fetus =?
> 4000 gms (8lb 13 oz)
Babies of moms with GD are at risk for what things?
- Failure to descend
- Shoulder dystocia
- extensive episiotomies
- forceps
- vacuum deliveries
- likelihood of c-section
Polyhydramnios = amniotic fluid in access of ?
2000cc
Are hypertensive disorders increased with diabetes?
Yes
What is the accumulation of ketones in blood resulting from hyperglycemia?
Ketoacidosis
Infections are more common in women with diabetes as disorders of carbohydrate metabolism alter the body’s normal resistance to what?
infections (vaginal infections and UTIs)
Infant morbidity and mortality may be significantly reduced with what in mom’s with diabetes?
strict control of maternal blood glucose
-hyperglycemia
-ketoacidosis
-congenital anomalies
-infections
-maternal obesity
…are all reasons for what to happen?
IUFD
During Intrapartum mom’s with diabetes may require bs and insulin maintain glucose levels in what range?
80-120mg.dl
Women who are overweight may be encouraged to do what?
to decrease wt and exercise
Children of women with GDM are at risk for what?
childhood obesity and increased wt gain in adolescense.
Pregnancies associated with diabetes have increased risk for neural tube defects due to what? test 16 weeks and f/u with US
increase in anomalies first trimester (test 16 weeks and f/u with US)
US-seen every 4-6 weeks may include what? (with diabetes or everyone?)
BPP (breathing, fetal activty, AFI, tone, reactivity)
High levels of glucose affect LS ratio-so LS ration may not be what? in mom’s with diabetes
mature at 35 weeks 2:1 like it should normally be
When is GD usually diagnosed?
Second half of pregnancy
Diet therapy is instrumental in the therapy of what during pregnancy?
GD
Does exercise have the ability to reduce the need for insulin during pregnancy?
Yes
-nulliparious
-increased body wt
-multiple gestations
-carrying a fetus with an anomoly
-carrying a female fetus
-family hx as well
-some cases there is interrelated psycological issue as well
… are all clinical association with what during pregnancy?
Hyperemesis Gravidarum
Encouraging small frequent meals, dry crackers before rising, and non greasy foods is suggested for mom’s with what?
Hyperemesis Gravidarum
Graves disease is caused by what?
Hyperthyroidism
S/S of hyperthyroidism that may be seen as normal in pregnancy are what?
- fatigue
- anxiety
- heat intolerance
- tachycardia
S/S of hyperthyroidism that may be seen as not normal in pregnancy are what?
- weight loss
- goiter
- pulse >100bpm
- Elevated T3 and T4
- decreased TSH
Medication for Rx hyperthyroidism r= ?
PTU (propylthiouracil) 100-150 mg q 8 hours
S/S of hypothyroidism include what?
- wt gain
- lethargy
- cold intolerance
- decrease in exercise capacity
- hair loss
- brittle nails
- dry skin
What would labs for hypothyroidism look like?
- elevated TSH
- may have decreased T4 levels
What medication is used to treat hypothyroidism?
synthroid 0.1-0.15mg/day
**Research studies have shown that mild hypothyroidism during the first trimester may be associated with what?
long-term neuropsychological damage in children
TORCH is a group of organisms that can do what?
cross the placenta and adversely affect growing fetus
Toxoplasmosis Other infections Hepatitis A Hepatitis B Rubella Cytomegalovirus Herpes simplex ... these organisms represent what?
TORCH
Asymptomatic UTI’S = Standard that all women are screened for asymptomatic UTI at first visit, if UTI present what happens?
treated and repeat UA in 1-2 weeks
What antibiotics are commonly used to treat UTI’s?
- ampicillin
- amoxicillin
- kefles
- macrobid
- bacrtrim
A bladder infection where white blood cells and bacteria are present is called what?
Cystitis
pyelonephritis = renal infection, most common serious infection of pregnancy often develops when?
Second trimester (more times in R kidney)
-e coli organism
-chills
-fever
-shaking
-back pain
..all indicate what?
pyelonephritis
When is the safest time to do surgery when pregnant?
2nd trimester
Does pregnancy make it harder to diagnose other medical conditions?
Yes
