Chronic Conditions in Pregnancy

Question 1

Risks of hypothyroidism in pregnancy

Answer 1

Miscarriage
Anaemia
Small for gestational age
Pre - eclampsia

Question 2

How to treat hypothyroidism during pregnancy

Answer 2

Levothyroxine dose increased during pregnancy by at least 25 – 50 mcg (30 – 50%).

Treatment titrated based on the TSH level, aiming for a low-normal TSH level

Levothyroxine crosses the placenta

Question 3

Hypertension medication that can cause congenital abnormalities

Answer 3

ACE inhibitors (e.g. ramipril)

Angiotensin receptor blockers (e.g. losartan)

Thiazide and thiazide-like diuretics (e.g. indapamide)

Question 4

Hypertension medications that are not known to be harmful

Answer 4

Labetalol (beta-blocker – other beta-blockers may have adverse effects)

Calcium channel blockers (e.g. nifedipine)

Alpha-blockers (e.g. doxazosin)

Question 5

Epilepsy in Pregnancy

Answer 5

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 6

Epilepsy in pregnancy precautions

Answer 6

Should take folic acid 5mg daily from before conception to reduce the risk of neural tube defects

Ideally should be controlled with 1 anti epileptic drug before becoming pregnant

Question 7

Anti epileptic medication

Answer 7

Sodium valproate - causes neural tube defects and developmental delay

Phenytoin - causes cleft lip and palate

Question 8

Which anti - epileptic drugs are safe during pregnancy

Answer 8

Levetiracetam
Lamotrigine
Carbamazepine

Question 9

Rheumatoid arthritis in pregnancy precautions

Answer 9

Rheumatoid arthritis should be well controlled for at least three months before becoming pregnant

Question 10

Rheumatoid arthritis during pregnancy

Answer 10

Often the symptoms of rheumatoid arthritis will improve during pregnancy, and may flare up after delivery.

Question 11

Rheumatoid arthritis medication during pregnancy

Answer 11

Methotrexate is contraindicated - teratogenic, causing miscarriage and congenital abnormalities

Question 12

Which rheumatoid drugs are safe during pregnancy

Answer 12

Hydroxychloroquine often the first-line choice

Sulfasalazine

Corticosteroids may be used during flare-ups