Diabetes and Endocrine in Pregnancy Flashcards
Name the two phases of the menstrual cycle
Follicular
Luteal
What sex hormone does the growing follicle release during the menstrual cycle?
Oestrogen
A peak in what hormone causes ovulation, and when in a menstrual cycle does this usually occur?
LH peak
Day 14
What hormone is released by the corpus luteum which develops during the luteal phase?
Progesterone
What hormone is released by the placenta after egg implantation, and therefore what can it be used for?
Human Chorionic Gonadotropin (HCG)
Used in pregnancy tests
What other hormones are secreted by the placenta?
Human Placental Lactogen (hPL)
Placental Progesterone
Placental Oestrogens
What hormones are known to increase insulin resistance in mothers?
hPL
Progesterones
In what trimester is gestational diabetes most likely to present?
3rd trimester
When does foetal organogenesis usually begin?
5 weeks (sometimes slightly earlier)
What complications can arise during pregnancy if the mother is diabetic?
Congenital Malformation
Premature birth
Intra-uterine growth retardation (IUGR)
Macrosomia (large baby => potential delivery problems)
Polyhydramnios (excess amniotic fluid around baby)
Intra-uterine Death
What complications can arise in a neonate if the mother is diabetic?
Respiratory Distress (due to immature lungs)
Hypoglycaemia
Hypocalcaemia
What CNS defects are common in babies born from mothers with endocrine conditions?
Anencephaly
Spina Bifida
If the mother of a newborn is diabetic, how many times more likely is the child to have caudal regression syndrome?
200x more likely than a non-diabetic
What abnormality is often seen in the urinary tract in relation to diabetic pregnancy?
Ureteric Duplication
Over what birth weight counts as macrosomia?
Birth weight >4kg
How should pregnant mothers with Type 1 or 2 diabetes be managed before and during pregnancy?
Good sugar control Folic Acid 5mg Consider change from tablets to insulin Regular eye checks Avoid ACEI, Statin
What drugs can be used for blood pressure control instead in pregnancy?
Labetalol
Nifedipine
methyldopa
To ensure good sugar control, what are the normal targets for pre and post meal glucose levels?
pre-meal <4- 5.5 mmol/l
2h post meal <6.5-7 mmol/l
What test can be carried out 6 weeks post-natal to check for the regression of gestational diabetes?
Fasting glucose OR Glucose Tolerance Test (GTT)
How can diabetes be prevented after gestational diabetes?
Healthy Diet
Aerobic exercise
Medication - Metformin, Acarbose, Pioglitazone
Annual fasting glucose test
Both hypo- and hyperthyroidism can cause reduced fertility. TRUE/FALSE?
TRUE
due to anovulatory cycles and loss of ovulation and luteal phase
Why is the thyroid demand higher during pregnancy?
Maternal thyroxine is important for neonatal development
especially CNS
If a patient has pre-exisiting hypothyroidism, by how much should they increase their Levothyroxine dose if they suspect they are pregnant?
25mcg AS SOON AS pregnancy suspected
What is the average Levothyroxine dose increase by 20 weeks of pregnancy?
50%
i.e. 100mcg -> 150mcg
If hypothyroidism is untreated in pregnancy, what complications can occur in the child?
- Increased abortion
- preeclampsia
- abruption (placenta breaks away from wall)
- postpartum haemorrhage
- preterm labour
- Foetal neuropsychological development
Explain the effects of hCG on Thyroxine and TSH
Increase Thyroxine
Suppress TSH
How do you tell the difference between hyperthyroidism and hyperemesis gravidarum?
Hyperemesis Gravidarum (nausea and vomiting):
- Not TRab antibody positive
- Resolves by 20 wks gestation ie improves
- Only treat if persists > 20 wk
What complications can arise in a pregnancy where the mother has hyperthyroidism?
- Infertility
- Spontaneous miscarriage
- Stillbirth
- Thyroid crisis in labour
- Transient Neonatal thyrotoxicosis
What can cause thyrotoxicosis in pregnancy?
- Graves’ disease
- Toxic Multinodular Goitre/Toxic Adenoma
- Thyroiditis
How is hyperthyroid managed in pregnancy?
- B-blockers if needed
- LOW DOSE anti-thyroid drugs
=> Propylthiouracil 1st trimester
=> Carbimazole 2/3rd trimester
(wait as late as possible)
What congenital effects can occur if carbimazole is taken during pregnancy?
embryopathy (1st Trimester)
Scalp abnormalities
GI abnormalities
Choanal and Oesophageal atresia
What are the adverse effects of propylthiouracil during pregnancy?
- Risk of liver toxicity
- Best avoided except possibly in 1st trimester, but then switch to Carbimazole
How does post partum thyroiditis usually present?
- Small, diffuse, nontender goitre
- Transiently thyrotoxic then to Hypothyroid
