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Mom & Baby Exam 2 > Ch. 29 Endocrine and Metabolic Disorders > Flashcards

Ch. 29 Endocrine and Metabolic Disorders Flashcards

1
Q

What is it called when someone has any degree of glucose intolerance with onset or recognition during pregnancy?

A

Gestational Diabetes

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2
Q

What label is given to type 1 or type 2 diabetes that existed prior to pregnancy?

A

Pregestational Diabetes Mellitus

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3
Q

Which is the most common endocrine disorder associated with pregnancy?

A

DM

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4
Q

Is pregnancy complicated with DM considered high risk?

A

Yes

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5
Q

Can diabetes during pregnancy be successfully managed with a multidisciplinary approach?

A

Yes

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6
Q

What is the primary fuel for the fetus?

A

Glucose

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7
Q

Is glucose carried across the placenta?

A

Yes

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8
Q

Does insulin cross the placenta?

A

No

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9
Q

When does the fetus start producing insulin?

A

10th week of gestation

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10
Q

Do insulin needs change throughout pregnancy?

A

YES

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11
Q

In the 1st trimester what are insulin needs?

A

They are often reduced

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12
Q

Why are insulin needs often reduced in the 1st trimester?

A
  • Body adapting to pregnancy so increased production of insulin
  • N/V may affect dietary intake
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13
Q

What happens to insulin needs in the 2nd and 3rd trimester?

A

Insulin needs increase

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14
Q

Why do insulin needs increase in 2nd and 3rd trimester?

A

Some placental hormones act as antagonist to insulin which decreases its effectiveness

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15
Q

At birth maternal insulin levels return to what state?

A

pre-pregnant

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16
Q

Are babies from diabetic moms bigger in size?

A

Yes

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17
Q

May babies from diabetic mom have fat pads on their shoulders?

A

Yes

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18
Q

What is the amniotic fluid filled with?

A

Fetal urine

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19
Q

What are the pregestational diabetes maternal risks and complications?

A
  • Macrosomia (large baby, >8lb 13 oz)
  • Dystocia (difficult birth)
  • Polyhrydramnios (excessive amniotic fluid)
  • PIH, preeclampsia-eclampsi (HTN)
  • Ketoacidosis
  • Infections
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20
Q

Hyperglycemia, ketoacidosis, congenital abnormalities, and infection are thought to be some reasons for what?

A

Interuterine fetal death

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21
Q

Hyperglycemia during the first trimester when organs and systems are forming in a main concern for what?

A

Birth defects

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22
Q

Does blood sugar need to be controlled right away in pregnancy?

A

Yes

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23
Q

What does macrosomia mean?

A

Large on inside and outside

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24
Q

Insulin acts as a growth hormone for fetus causing a fetus to produce excess what?

A

Fat stores

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25
Q

Are large babies prone to birth injuries?

A

Yes

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26
Q

Why is there a fetal risk of hypoglycemia?

A

Fetal supply of glucose is cut off at birth

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27
Q

Do we potentially see slowed fetal lung development in a baby from a mom with DM?

A

Yes

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28
Q

What is the fetal risk associated with DM polycythemia?

A

An increase in RBCs

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29
Q

Polycythemia can lead to hyperbilirubinemia as a result of what?

A

Immature infant liver

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30
Q

What are forms of treatment to maintain an equal amount of insulin availability and glucose utilization in mom with DM?

A
  • Diet therapy
  • Exercise
  • Glucose monitoring
  • Insulin therapy
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31
Q

What does antepartum mean?

A

occurring not long before child birth

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32
Q

Due to DM what may need to occur during intrapartum ?

A

Hourly blood sugar checks and an insulin drip

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33
Q

Does GDM return to normal postpartum?

A

Yes

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34
Q

Do people with GDM have a greater risk of developing T2DM later in life?

A

Yes

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35
Q

What does monitoring maternal a-fetalprotein (AFP) tell us?

A

If there is a neural tube defect

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36
Q

When monitoring fetal activity, third trimester fetal movement counts for the prevention of what?

A

IUFD (Interuterine fetal death)

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37
Q

When is non stress testing (NST) started?

A

28 weeks

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38
Q

How often are ultrasounds done to monitor the baby?

A

every 4-6 weeks?

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39
Q

What must the L/S (lethicin/sphingomyelin) ratio be?

A

2:1

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40
Q

Do yo usually need a higher L/S ratio if the mom has diabetes?

A

Yes

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41
Q

Women who are obese prior to conception and develop GDM are at an increased risk to give birth to infants with what?

A

CNS defects

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42
Q

When does assessing for GD first occur?

A

At first pregnancy visit

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43
Q

For low risk of GD when are women screened?

A

24-28 weeks

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44
Q

For high risk of GD when are women screened?

A

as early as feasable

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45
Q

Is age over 35 a risk factor for GD?

A

Yes

46
Q

Is family history of DM in a first-degree relative a risk factor for GD?

A

Yes

47
Q

Is prior macrosomic, malformed, or stillborn infant a risk factor for GD?

A

Yes

48
Q

Is obesity a risk factor for GD?

A

Yes

49
Q

Is glucosuria a risk factor for GD?

A

Yes

50
Q

How is GDM cared for antepartum?

A
  • Diet*
  • Exercise*
  • monitoring glucose levels
  • medications for controlling blood sugar levels
  • fetal surveillance
51
Q

Can women have a good experience with GD without the need for insulin use?

A

Yes

52
Q

What is hyperemesis gravid arum?

A

Excessive vommiting

53
Q

What is the theory of the cause of hyperemesis gravidarum?

A

High levels of estrogen or HCG

54
Q

What is hyperemesis gravid arum accompanied by?

A
  • Dehydration
  • Weight loss
  • Electrolyte imbalance
  • ketosis
55
Q

What is clinically associated with hyperemesis gravidarum?

A
  • other medical conditions
  • 1st baby
  • high BMI or very low BMI
  • Family Hx
  • Multiple gestation
  • Younger mom
56
Q

What can interventions can help hyperemesis gravid arum?

A
  • Start IV fluids for electrolytes
  • N/V meds
  • Vit B, B-6 and thiamine
  • Ginger
57
Q

The toxic accumulation of phenylalanine in blood which interferes with brain development is called what?

A

Maternal phenylketonuria

58
Q

What is they key to preventing maternal phenylketonuria?

A

Identification in women reproductive years

59
Q

Are all newborns screened for PKU at birth?

A

Yes

60
Q

Poor maternal glycemic control before conception and in the first trimester may be responsible for what?

A

fetal congenital malformations

61
Q

Maternal insulin requirements increase as pregnancy progresses and may quadruple by term as a result of insulin resistance created by what?

A

placental hormones, insulinase, and cortisol

62
Q

Poor glycemic control during pregnancy can lead to maternal complications such as what?

A

Miscarriage, infection, and dystocia

63
Q

Close glucose monitoring, insulin administration, and dietary counseling are used to create a normal what?

A

Intrauterine environment for fetal growth

64
Q

Because GDM is asymptomatic in most cases, all women should undergo what?

A

Routine screening

65
Q

Thyroid dysfunction during pregnancy requires close monitoring of thyroid hormone levels to regulate what?

A

Therapy and prevent fetal insult

66
Q

The stress of the normal maternal adaptations to pregnancy on a heart whose functions are already taxed may cause what?

A

Cardiac decompensation

67
Q

Maternal morbidity and mortality is a significant risk in pregnancy complicated by what?

A

Mitral valve stenosis

68
Q

Anemia affects at least what percent of pregnant women?

A

20%

69
Q

Asthma is the most common medical condition to what?

A

Complicate pregnancy

70
Q

Pruritis is a common symptom in pregnancy-specific what?

A

Inflammatory diseases

71
Q

A pregnant women with epilepsy should only take one anticonvulsant medication and at the lowest what?

A

Dose level

72
Q

Lupus is the most common autoimmune disease affecting what women?

A

Of childbearing age

73
Q

Type 2 more prevalent diabetes, may go unnoticed for years-risk factors include ?

A
  • age
  • sedentary lifestyle
  • family hx
  • genetics
74
Q

Gestational diabetes may be diet controlled or may involve what for treatment?

A

insulin

75
Q

When are women with gestational diabetes reclassified?

A

6 weeks post party

76
Q

Macrosomia fetus =?

A

> 4000 gms (8lb 13 oz)

77
Q

Babies of moms with GD are at risk for what things?

A
  • Failure to descend
  • Shoulder dystocia
  • extensive episiotomies
  • forceps
  • vacuum deliveries
  • likelihood of c-section
78
Q

Polyhydramnios = amniotic fluid in access of ?

A

2000cc

79
Q

Are hypertensive disorders increased with diabetes?

A

Yes

80
Q

What is the accumulation of ketones in blood resulting from hyperglycemia?

A

Ketoacidosis

81
Q

Infections are more common in women with diabetes as disorders of carbohydrate metabolism alter the body’s normal resistance to what?

A

infections (vaginal infections and UTIs)

82
Q

Infant morbidity and mortality may be significantly reduced with what in mom’s with diabetes?

A

strict control of maternal blood glucose

83
Q

-hyperglycemia
-ketoacidosis
-congenital anomalies
-infections
-maternal obesity
…are all reasons for what to happen?

A

IUFD

84
Q

During Intrapartum mom’s with diabetes may require bs and insulin maintain glucose levels in what range?

A

80-120mg.dl

85
Q

Women who are overweight may be encouraged to do what?

A

to decrease wt and exercise

86
Q

Children of women with GDM are at risk for what?

A

childhood obesity and increased wt gain in adolescense.

87
Q

Pregnancies associated with diabetes have increased risk for neural tube defects due to what? test 16 weeks and f/u with US

A

increase in anomalies first trimester (test 16 weeks and f/u with US)

88
Q

US-seen every 4-6 weeks may include what? (with diabetes or everyone?)

A

BPP (breathing, fetal activty, AFI, tone, reactivity)

89
Q

High levels of glucose affect LS ratio-so LS ration may not be what? in mom’s with diabetes

A

mature at 35 weeks 2:1 like it should normally be

90
Q

When is GD usually diagnosed?

A

Second half of pregnancy

91
Q

Diet therapy is instrumental in the therapy of what during pregnancy?

A

GD

92
Q

Does exercise have the ability to reduce the need for insulin during pregnancy?

A

Yes

93
Q

-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?

A

Hyperemesis Gravidarum

94
Q

Encouraging small frequent meals, dry crackers before rising, and non greasy foods is suggested for mom’s with what?

A

Hyperemesis Gravidarum

95
Q

Graves disease is caused by what?

A

Hyperthyroidism

96
Q

S/S of hyperthyroidism that may be seen as normal in pregnancy are what?

A
  • fatigue
  • anxiety
  • heat intolerance
  • tachycardia
97
Q

S/S of hyperthyroidism that may be seen as not normal in pregnancy are what?

A
  • weight loss
  • goiter
  • pulse >100bpm
  • Elevated T3 and T4
  • decreased TSH
98
Q

Medication for Rx hyperthyroidism r= ?

A

PTU (propylthiouracil) 100-150 mg q 8 hours

99
Q

S/S of hypothyroidism include what?

A
  • wt gain
  • lethargy
  • cold intolerance
  • decrease in exercise capacity
  • hair loss
  • brittle nails
  • dry skin
100
Q

What would labs for hypothyroidism look like?

A
  • elevated TSH

- may have decreased T4 levels

101
Q

What medication is used to treat hypothyroidism?

A

synthroid 0.1-0.15mg/day

102
Q

**Research studies have shown that mild hypothyroidism during the first trimester may be associated with what?

A

long-term neuropsychological damage in children

103
Q

TORCH is a group of organisms that can do what?

A

cross the placenta and adversely affect growing fetus

104
Q 
Toxoplasmosis
Other infections
Hepatitis A
Hepatitis B
Rubella
Cytomegalovirus
Herpes simplex
... these organisms represent what?
A

TORCH

105
Q

Asymptomatic UTI’S = Standard that all women are screened for asymptomatic UTI at first visit, if UTI present what happens?

A

treated and repeat UA in 1-2 weeks

106
Q

What antibiotics are commonly used to treat UTI’s?

A
  • ampicillin
  • amoxicillin
  • kefles
  • macrobid
  • bacrtrim
107
Q

A bladder infection where white blood cells and bacteria are present is called what?

A

Cystitis

108
Q

pyelonephritis = renal infection, most common serious infection of pregnancy often develops when?

A

Second trimester (more times in R kidney)

109
Q

-e coli organism
-chills
-fever
-shaking
-back pain
..all indicate what?

A

pyelonephritis

110
Q

When is the safest time to do surgery when pregnant?

A

2nd trimester

111
Q

Does pregnancy make it harder to diagnose other medical conditions?

A

Yes

Mom & Baby Exam 2 (5 decks)

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