chronic conditions in pregnancy- HTN, Thyroid, epilepsy, RA

Question 1

what can happen if hypothyroidism is untreated in pregnancy?

Answer 1

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

Question 2

which HTN medications need to be stopped in pregnancy?

Answer 2

• ACE inhibitors
• ARB
• Thiazide-like diuretics

Question 3

which HTN medications aren’t known to be harmful in pregnancy?

Answer 3

• labetelol
• CCB- nifedipine
• alpha- blockers- doxazosin

Question 4

what dose of folic acid should be given to pregnant epileptic women and why?

Answer 4

5mg to prevent neural tube defects

Question 5

which anti-epileptic medications are safer to take in pregnancy?

Answer 5

Levetiracetam
lamotrigine
carbamazepine

Question 6

which anti-epileptic medications should be avoided and why?

Answer 6

• Sodium valproate is avoided as it causes neural tube defects and developmental delay
• Phenytoin is avoided as it causes cleft lip and palate

Question 7

which RA drugs can be used in pregnancy?

Answer 7

• 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 8

which RA drugs cannot be used in pregnancy?

Answer 8

Methotrexate is contraindicated, and is teratogenic, causing miscarriage and congenital abnormalities

Question 9

why is it suggested to avoid NSAIDS in pregnancy?

Answer 9

• they block prostaglandins which are important in maintaining the ductus arteriousus in the foetus
• in the third trimester it can delay softening of the cervix and uterine contractions

Question 10

what are the risks of using ACE inhibitors in pregnancy?

Answer 10

• Oligohydramnios (reduced amniotic fluid)
• Miscarriage or fetal death
• Hypocalvaria (incomplete formation of the skull bones)
• Renal failure in the neonate
• Hypotension in the neonate

Question 11

explain neonatal abstinence syndrome

Answer 11

• withdrawal symptoms neonates gets if mother was taking opiates:
• 3-72 hrs after birth
• irritability
• tachypnoea
• high temp
• poor feeding

Question 12

what are the risks linked with lithium?

Answer 12

cardiac abnormalities - abstains abnormality, big right atrium and small right ventricle , especially in the first trimester

toxic in infant when breast feeding and should not be taken by breast feeding mothers

Question 13

what type of monitoring should people on lithium have?

Answer 13

monitored every 4 weeks and then weekly from 36 weeks

Question 14

what can SSRIs cause if taken in the first trimester?

Answer 14

• congenital abnormalities, especially paroxetine

Question 15

what can taking SSRIs cause in the third trimester?

Answer 15

third-trimester use has a link with persistent pulmonary hypertension in the neonate

Neonates can experience withdrawal symptoms, usually only mild and not requiring medical management