diabetes and endocrinology Flashcards
what chemical marker is picked up on pregnancy test?
HCG
what produces HCG?
-implanted fertilised ovum
what hormones does the corpus luteum produce?
progesterone
what hormone does the ovum produce?
-oestradiol
what hormones does the placenta produce?
- human placental lactose (hPL)
- placental progesterone
- placental oestrogen
during pregnancy what does the pituitary produce?
-prolactin
what affect does placental progesterone have on blood glucose?
-it causes insulin resistance in mother which raises blood glucose and causes gestational diabetes
what types of diabetes may occur in pregnancy?
- type 1
- type 2
- GDM (gestational diabetes mellitus)
how to tell the difference between gestational diabetes and type 2?
- gestational will start during pregnancy and end once delivery where as type 2 continues after delivery
- usually 6 week post natal fasting glucose or GTT is done
when does fetal organogenesis occur?
-at 5 weeks (sometimes earlier)
what are some complications associated with type 1 and type 2 diabetes in pregnancy?
- congenital malformation
- prematurity
- intra uterine growth retardation (IUGR)
what are some complications associated with gestational diabetes in pregnancy?
- macrosomia (>90 centile for size which can cause problems with delivery)
- polyhydramnios
- intrauterine death
what are some complications for the neonates if the mother had diabetes during pregnancy?
- respiratory distress (due to immature lungs)
- hypoglycaemia (Can cause fits)
- hypocalcaemia (can cause fits)
why can GDM cause macrosomia?
-maternal hyperglycaemia causes foetal hyperglycaemia which causes foetal hyperinsulinemia (insulin is a major growth factor causing macrosomia)
why can the mother have diabetes cause neonatal hypoglycaemia?
- the mother has always had high blood glucose and once that gets cut off it takes a while for the baby to adjust to regulating their own blood glucose levels
what is the managent of type 1 and type 2 diabetes in pregnancy?
- pre-pregnancy counselling (good sugar control preconception)
- folic acid 5mg (recommended 3 months prior to pregnancy)
- if T2DM consider changing tablets to insulin
- regular eye checks every 10 weeks (pregnancy accelerated retinopathy)
- avoid ACEI and statin (use Labetalol, Nifedipine and methyldopa for controlling BP)
- start aspiring 150mg at 12 weeks
what is the blood glucose goal for pre and 2h post meal aim in pregnant diabetics?
pre meal < 4- 5.5 mmol/l
2hr post meal <6-6.5 mmol/l
what drugs are given to T1DM during pregnancy?
-insulin
what drugs are given to T2DM during pregnancy?
- metformin
- usually require insulin later on
what drugs are given to GDM during pregnancy?
- lifestyle changes
- metformin but if not well controlled may need insulin later on
what affect does hypo and hyper thyroidism have on fertility?
-reduced fertility
what occurs to thyroid during pregnancy?
- increased demand on thyroid
- thyroid increases in size
- more T4 produced to maintain normal concentration
what should be done for patients on thyroxine once they know they’re pregnant?
-increase it
what is the management of hypothyroidism in pregnancy?
- increased thyroxine dose by 25mg as soon as pregnancy expected
- check TFTs monthly for first 20 weeks then 2 months until tern
- aim for TSH <3 mU/l
what are the risks of untreat hypothyroidism in pregnancy?
- increased abortion
- pre eclampsia
- abruption
- postpartum haemorrhage
- preterm labour
- foetal neuropsychological development
what is the IQ like for children whos mothers had hypothyroidism compared to those with normal mothers?
-children with mothers who have hypothyroidism on average have lower IQs
what occurs to TSH levels in pregnant women and why?
-hCG levels increase which increases thyroxine and causes TSH to be suppressed
what affect does Grave’s have on TSH levels?
Grave’s increases thyroxine levels which causes a decrease in TSH
what risks does hyperthyroidism have with pregnancy?
- infertility/ ammenorheoa
- spontaneous miscarriage
- stillbirth
- thyroid crisis in labour
- transient neonatal thyrotoxicosis
what causes thyrotoxicosis in pregnancy?
- Graves’ disease
- TMNG toxic adenoma
- thyroiditis
what is the management of hyperthyroidism in pregnancy?
Wait and see how it goes (Graves may improve during pregnancy)
- BB if needed
- low dose anti thyroid drugs
- propylthiouracil 1st trimester
- carbimazole 2/3rd trimester
what medication would be given to a pregnant women with hyperthyroidism in her first trimester?
propylthiouracil
what medication would be given to a pregnant women with hyperthyroidism in her 2nd/3rd trimester?
-carbimazole
what can carbimazole cause if given in 1st trimester of pregnancy?
-emryopathy
what risk does propylthiouracil have when given to a pregnant woman?
-risk of liver toxicity (best to avoid using this drug however must use in 1st trimester over carbimazole)
what are some side effects of carbimazole in pregnant women?
- can cause embryopathy in 1st trimester
- scalp abnormalities
- GI abnormalities
- Choanal & oesophageal atresia
what causes neonatal hyperthyroidism?
TRAb antibodies can cross the placenta and cause neonatal hyperthyroidism (so check TRAb antibodies ideally during third trimester)
