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ENDOCRINE > Diabetes and Endocrine in Pregnancy > Flashcards

Diabetes and Endocrine in Pregnancy Flashcards

1
Q

Name the two phases of the menstrual cycle

A

Follicular

Luteal

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2
Q

What sex hormone does the growing follicle release during the menstrual cycle?

A

Oestrogen

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3
Q

A peak in what hormone causes ovulation, and when in a menstrual cycle does this usually occur?

A

LH peak

Day 14

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4
Q

What hormone is released by the corpus luteum which develops during the luteal phase?

A

Progesterone

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5
Q

What hormone is released by the placenta after egg implantation, and therefore what can it be used for?

A

Human Chorionic Gonadotropin (HCG)

Used in pregnancy tests

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6
Q

What other hormones are secreted by the placenta?

A

Human Placental Lactogen (hPL)
Placental Progesterone
Placental Oestrogens

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7
Q

What hormones are known to increase insulin resistance in mothers?

A

hPL

Progesterones

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8
Q

In what trimester is gestational diabetes most likely to present?

A

3rd trimester

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9
Q

When does foetal organogenesis usually begin?

A

5 weeks (sometimes slightly earlier)

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10
Q

What complications can arise during pregnancy if the mother is diabetic?

A

Congenital Malformation
Premature birth
Intra-uterine growth retardation (IUGR)
Macrosomia (large baby => potential delivery problems)
Polyhydramnios (excess amniotic fluid around baby)
Intra-uterine Death

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11
Q

What complications can arise in a neonate if the mother is diabetic?

A

Respiratory Distress (due to immature lungs)
Hypoglycaemia
Hypocalcaemia

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12
Q

What CNS defects are common in babies born from mothers with endocrine conditions?

A

Anencephaly

Spina Bifida

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13
Q

If the mother of a newborn is diabetic, how many times more likely is the child to have caudal regression syndrome?

A

200x more likely than a non-diabetic

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14
Q

What abnormality is often seen in the urinary tract in relation to diabetic pregnancy?

A

Ureteric Duplication

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15
Q

Over what birth weight counts as macrosomia?

A

Birth weight >4kg

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16
Q

How should pregnant mothers with Type 1 or 2 diabetes be managed before and during pregnancy?

A 
Good sugar control
Folic Acid 5mg 
Consider change from tablets to insulin
Regular eye checks
Avoid ACEI, Statin
17
Q

What drugs can be used for blood pressure control instead in pregnancy?

A

Labetalol
Nifedipine
methyldopa

18
Q

To ensure good sugar control, what are the normal targets for pre and post meal glucose levels?

A

pre-meal <4- 5.5 mmol/l

2h post meal <6.5-7 mmol/l

19
Q

What test can be carried out 6 weeks post-natal to check for the regression of gestational diabetes?

A

Fasting glucose OR Glucose Tolerance Test (GTT)

20
Q

How can diabetes be prevented after gestational diabetes?

A

Healthy Diet
Aerobic exercise
Medication - Metformin, Acarbose, Pioglitazone
Annual fasting glucose test

21
Q

Both hypo- and hyperthyroidism can cause reduced fertility. TRUE/FALSE?

A

TRUE

due to anovulatory cycles and loss of ovulation and luteal phase

22
Q

Why is the thyroid demand higher during pregnancy?

A

Maternal thyroxine is important for neonatal development

especially CNS

23
Q

If a patient has pre-exisiting hypothyroidism, by how much should they increase their Levothyroxine dose if they suspect they are pregnant?

A

25mcg AS SOON AS pregnancy suspected

24
Q

What is the average Levothyroxine dose increase by 20 weeks of pregnancy?

A

50%

i.e. 100mcg -> 150mcg

25
Q

If hypothyroidism is untreated in pregnancy, what complications can occur in the child?

A
  • Increased abortion
  • preeclampsia
  • abruption (placenta breaks away from wall)
  • postpartum haemorrhage
  • preterm labour
  • Foetal neuropsychological development
26
Q

Explain the effects of hCG on Thyroxine and TSH

A

Increase Thyroxine

Suppress TSH

27
Q

How do you tell the difference between hyperthyroidism and hyperemesis gravidarum?

A

Hyperemesis Gravidarum (nausea and vomiting):

  • Not TRab antibody positive
  • Resolves by 20 wks gestation ie improves
  • Only treat if persists > 20 wk
28
Q

What complications can arise in a pregnancy where the mother has hyperthyroidism?

A
  • Infertility
  • Spontaneous miscarriage
  • Stillbirth
  • Thyroid crisis in labour
  • Transient Neonatal thyrotoxicosis
29
Q

What can cause thyrotoxicosis in pregnancy?

A
  • Graves’ disease
  • Toxic Multinodular Goitre/Toxic Adenoma
  • Thyroiditis
30
Q

How is hyperthyroid managed in pregnancy?

A
  • B-blockers if needed
  • LOW DOSE anti-thyroid drugs
    => Propylthiouracil 1st trimester
    => Carbimazole 2/3rd trimester
    (wait as late as possible)
31
Q

What congenital effects can occur if carbimazole is taken during pregnancy?

A

embryopathy (1st Trimester)
Scalp abnormalities
GI abnormalities
Choanal and Oesophageal atresia

32
Q

What are the adverse effects of propylthiouracil during pregnancy?

A
  • Risk of liver toxicity

- Best avoided except possibly in 1st trimester, but then switch to Carbimazole

33
Q

How does post partum thyroiditis usually present?

A
  • Small, diffuse, nontender goitre

- Transiently thyrotoxic then to Hypothyroid

ENDOCRINE (22 decks)

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