Chronic conditions in pregnancy

Question 1

What are common chronic conditions in pregnancy that need additional management?

Answer 1

• hypothyroidsm
• hypertension
• epilepsy
• RA

Question 2

What can under-treated or untreated hypothyroidism in pregnancy lead to?

Answer 2

• miscarriage
• anaemia
• small for gestational age
• pre-eclampsia.

Question 3

What is hypothyroidism treated with in pregnancy?

Answer 3

• levothyroxine(T4)
• an cross the placenta and provide thyroid hormone to the developing fetus
• levothyroxine dose needs to be increased during pregnancy, usually by at least 25 – 50 mcg
• Treatment is titrated based on the TSH level, aiming for a low-normal TSH leve

Question 4

What changes to medication for women with hypertension during pregnancy need to be made?

Answer 4

Medications that should be stopped:

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

Question 5

What hypertensive medications are not known to be harmful during pregnancy?

Answer 5

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

Question 6

What affect might pregnancy have on pts with epilepsy?

Answer 6

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

Question 7

What epileptic medications are safe and which are harmful during pregnancy?

Answer 7

• Levetiracetam, lamotrigine and carbamazepine are the safer anti-epileptic medication in pregnancy
• Sodium valproate is avoided as it causes neural tube defects and developmental delay
• Phenytoin is avoided as it causes cleft lip and palate

Question 8

How does pregnancy affect pts with RA?

Answer 8

• Ideally, RA should be well controlled for at least three months before becoming pregnant
• Often the symptoms of RA will improve during pregnancy and may flare
• treatment may need to be altered before and during pregnancy

Question 9

What RA medications are safe and which are harmful during pregnancy?

Answer 9

• Methotrexate is contraindicated, and is teratogenic, causing miscarriage and congenital abnormalities
• Hydroxychloroquine is considered safe during pregnancy and is often the first-line choice
• Sulfasalazine is considered safe during pregnancy
• Corticosteroids may be used during flare-ups

Question 10

What are some general medications that are avoided during pregnancy?

Answer 10

• NSAIDs
• Beta-blockers except for labetalol
• ACEi and ARBs
• Opiates
• Warfarin
• Sodium valporate
• Lithium
• SSRIs
• Isotretinoin (Roaccutane) (vit A)