Disease states in pregancy and Lactation Flashcards
How is diabetes diagnosed in pregnant women, what are reasons the test would be given earlier
Oral Glucose Tolerance Test (OGTT) between 24-28 weeks gestation/
pregnant patient is overweight or obese and also
- physically inactive
- History or familial history of diabetes
- High risk race
- Previously gave birth to infant over 9 pounds
- Hypertension
- Polycystic overian syndrome
- Hisotry of cardiovascular disease
- A1c greater than or equal to 5.7%
How is the OGTT done, when is gestational diabetes diagnosed
Patient is given 50 grams of glucose, after one hour if blood sugar is greater than 140 mg/dl then a 3 hour 100 gram OGTT is done on a different day
- If the one hour glucose test is done and the blood sugar is greater than 200 they are automatically diagnosed as having GD
- If after the three hour glucose test is done and the patient has blood sugar greater than 140 mg/dl again the patient is diagnosed as having GD
- If the patient has an 8 hour fast that is greater than 95 mg/dl
How is GDM controlled
Weight management, dietary modifications, light or moderate exercise as tolerated
What is the pharmacological options for GDM
Insulin (doesn’t cross the placenta), Metformin
T/F: If a patient was already taking insulin before pregnancy they will not be switched off
True
What are the goals for GDM
Fasting 65-95 mg/dl
2 hour post-prandial: Less than 120
What is the most common complication in pregancy due to Hypertension
Pre-eclampsia
What is chronic hypertension, gestational hypertension
HTN diagnosis prior to pregnancy OR blood pressure greater than 140/90 mmHg on two seperate readings before 20 weeks of gestation
Blood pressure greater than 140/90 mmHg on two seperate readings after20 weeks of gestation
What are the pre-eclampsia risk factors
History of pre-eclampsia in previous pregnancies, family history, first pregnancy/twins ortriplets, age greater than 35, comorbidities including
- Diabetes
- Hypertension
- CKD
- Obesity
How is pre-eclampsia diagnosed
blood pressure greater than 140/90 on two different readings at least 20 mins apart PLUS
- Proteinuria
- Thrombocytopenia: less than 100,000
- SCr greater than 1.1 or doubling from baseline
- AST/ALT two times greater than ULN
- Pulmonary edmea
- Cerebral/Visual symptoms
OR
Blood pressure greater than 160/110 mmHg on two seperate readings at least 1-2 minutes apart
What are the non-pharmacological options for hypertension
Reduce stress, avoid smoking and alcohol
When and how is HTN handled in pregnant patients while using pharmacotherapy
Controlled hypertension: if medication controlled prior to pregnancy either continue medication or change to preferred agent
Gestational hypertension: Initiate therapy when blood pressure is over 150/100 OR when blood pressure is over 140/90 PLUS one other comorbid condition
What 1st line drugs are used to treat HTN in pregnant patients, 2nd line, avoid
- Labetalol, Nifedipine, Methyldopa (not as effective)
- Thiazide diuretics, Non-DHP CCBs
- Avoid: ACEs and ARBS, Atenolol
How is pre-eclampsia/eclampsia cured, other options
Delivery, betamethasone, labetalol or hydralazine for acute HTN, magnesium to prevent seizures
How is aspirin used in pre-eclampsia
T/F: Treating women with asthma is not worth the risk that is accompanied
False: It is safer for pregnant women with asthma to be treated with asthma medications than it is for them to have asthma symptoms and exacerbations
What medications would be used for rescue and other ashtma treatments
Resuce: Albuterol, budesonide, montelukast
What should be used for VTE in pregnant patients
LMWH (enoxaparin: 40 mg sc once daily or BID), heparin
When is warfarin ok to use in pregnant patients
2nd/3rd trimester for mechanical valves
What physiological changes effect the thyroid
Increased thyroid binding globulin (TBG), low iodide levels
What medications are used to hyperthyroidism, hypothyroidism
Propylthiouracil (1st trimester) and methimazole(2nd/3rd trimester)
Levothyroxine: 30% higher dose possbily requiring titration throughout pregnancy
What labs can be used for thyroid monitoring per trimester
TSH: First trimester- 0.1-2.5, 2nd/3rd trimester- 0.2/0.3-3.0
Free T4: First trimester- 0.8-1.2, 2nd/3rd trimester- 0.6-1 and 0.5-0.8
T/F: If someone has a moderate or high risk of pre-eclampsia they should be given aspirin started between 12-28 weeks, ideally prior to 16 weeks
True
What should be given for epilpsy management in pregnant patients
Folic acid, Vitamin K, ONE AED (except valproic acid)
T/F: A patient is on an AED before pregnancy they would stay on it throughout the pregnancy
True
What hormone controls lactation
Prolactin
T/F: If a drug is place in L5 it is the safest while L1 is dangerous
False: L1 is most safe while L5 is most dangerous
How much maternal dose goes to a baby while breast feeding
Less than one percent
When should a pregnant patient get Tdap shot
Between 27 and 36 weeks of gestation
Why should patients avoid estrogen while pregnant, how long till they can revieve it
VTE risk, 6 weeks after giving birth
If a patient is taking a nicotine lozenge while breastfeeding what should be done
Take a lozenge right before scheduled feedings
