Endocrine and Metabolic Disorders in Pregnancy Flashcards
How is obesity defined in pregnancy?
Obesity is defined as a body mass index (BMI) of 30 or higher at the first antenatal booking.
How is obesity classified based on BMI?
Class 1: BMI 30–34.9
Class 2: BMI 35–39.9
Class 3 (morbid obesity): BMI ≥ 40
Why is obesity in pregnancy significant?
It is increasingly common and is associated with increased maternal and fetal complications.
What are the maternal risks associated with obesity in pregnancy?
Gestational diabetes.
Hypertensive disorders (e.g., preeclampsia).
Miscarriage and stillbirth.
Difficulties in monitoring fetal growth and health.
Increased cesarean section rates and surgical complications.
Postpartum complications (e.g., infection, thrombosis).
What are the fetal risks associated with maternal obesity?
Macrosomia (large for gestational age).
Increased risk of birth injuries (e.g., shoulder dystocia).
Congenital anomalies (e.g., neural tube defects).
Prematurity.
Higher risk of obesity and metabolic syndrome later in life.
What advice should be given to women with obesity planning pregnancy?
Aim for weight loss before conception.
Encourage a balanced diet and regular exercise.
Consider folic acid supplementation: High-dose (5 mg/day).
Optimize management of comorbidities (e.g., diabetes, hypertension).
What are key aspects of antenatal care for women with obesity?
Early screening for gestational diabetes.
Regular ultrasound scans to monitor fetal growth.
Anesthetic review if BMI > 40.
Thromboprophylaxis with low molecular weight heparin (if indicated).
Monitor for hypertension and other complications.
Women with obesity in pregnancy should receive high-dose __________ supplementation to reduce the risk of neural tube defects.
Folic acid
What are the key considerations for intrapartum care in women with obesity?
Increased risk of cesarean section and prolonged labor.
Difficulty with epidural placement or general anesthesia.
Risk of postpartum hemorrhage (PPH).
Ensure availability of appropriate equipment (e.g., beds, operating tables).
What are the postpartum considerations for women with obesity?
Increased risk of thromboembolic events.
Higher risk of infection (e.g., wound infections).
Support with breastfeeding, as obesity may reduce milk production.
Encourage long-term weight loss and management of comorbidities.
True/False
Q: Obesity in pregnancy increases the risk of macrosomia and shoulder dystocia.
true.
A 32-year-old pregnant woman with a BMI of 35 attends her booking visit. What additional care should be provided?
Screen for gestational diabetes early (and repeat at 24–28 weeks if negative).
Recommend high-dose folic acid (5 mg/day).
Plan for regular growth scans in the third trimester.
Discuss risks of obesity and encourage healthy lifestyle changes.
Women with a BMI ≥ _________ should be referred for an anesthetic review during pregnancy.
40
What is Gestational Diabetes Mellitus (GDM)?
Chronic hyperglycemia and insulin resistance due to pregnancy.
What stimulates peripheral insulin resistance in normal pregnancy?
Local and placental hormones.
What is the purpose of peripheral insulin resistance?
- the purpose of this is to spare glucose for delivery to the developing foetus
What else increases free fatty acids and glucose levels?
lipolysis and gluconeogenesis
What happens to pancreatic beta-cells in GDM?
Hypertrophy and hyperplasia occur.
What is the purpose of hypertrophy and hyperplasia of pancreatic beta cells?
to protect maternal glucose homeostasis
What leads to Gestational Diabetes Mellitus (GDM)?
Beta-cell dysfunction + insulin resistance
What is a maternal complication of GDM?
Pre-eclampsia, T2DM, Increased risk of CVD
What is the increased risk of chronic type 2 diabetes after GDM?
0.6
Name some foetal complications of GDM?
Macrosomia, Neonatal hypoglycaemia, childhood obesity, increased risk of metabolic syndrome + associated complications in later life
What foetal complication is caused by macrosomia?
Shoulder dystocia
What condition causes neonatal hypoglycaemia in GDM?
Maternal hyperglycaemia raising endogenous foetal insulin
What is the risk of childhood obesity related to GDM?
2x background risk
Name some risk factors for GDM
BMI, previous macrosomia. previous GDM, FHx of DM, Ethnicity w/ high prevalence of diabetes
What is a risk factor for GDM related to weight?
BMI > 30
When should women with risk factors be screened for GDM?
24-28 weeks
When to screen women with glycosuria detected at a routine antenatal appointment?
Any time in pregnancy
First Line test for GDM?
Oral glucose tolerance test (OGTT) ; Fasting blood glucose, followed by 75g carbohydrate drink, with a second blood glucose test 2 hours later.
How do you rememeber diagnostic criteria for GDM?
5678
Fasting plasma glucose diagnostic criteria?
> 5.6mmol/L
2-hour glucose diagnostic criteria?
> 7.8mmol/L
First Line management after diagnosis for GDM?
2 week trial of diet, exercise and self-monitoring glucose levels
Second Line management for GDM if diet fails?
Metformin
What to do if FPG >7.0 in GDM?
Start insulin immediately
When should you do some extra growth scans if GDM?
Weeks 28, 32, 36
What is anaemia in pregnancy?
Anaemia in pregnancy is a condition characterized by a reduction in hemoglobin concentration below the normal threshold for gestation.
What are the WHO hemoglobin thresholds for diagnosing anaemia in pregnancy?
First trimester: <110 g/L
Second trimester: <105 g/L
Third trimester: <110 g/L
What are the common types of anaemia in pregnancy?
Iron-deficiency anaemia (most common).
Vitamin B12 deficiency.
Folate deficiency.
Thalassemia.
Anaemia of chronic disease.
Hemolytic anaemia (less common).
The most common cause of anaemia in pregnancy is ___________.
Iron-deficiency anaemia.
What are the causes of iron-deficiency anaemia in pregnancy?
Increased iron demand for fetal and placental development.
Blood volume expansion (physiological dilutional effect).
Poor dietary intake of iron.
Pre-existing low iron stores.
What are the symptoms of anaemia in pregnancy?
Fatigue.
Pallor.
Dyspnoea on exertion.
Dizziness.
Palpitations.
Symptoms may overlap with normal pregnancy changes.
What investigations are used to diagnose and evaluate anaemia in pregnancy?
Full blood count (FBC): Hb levels, mean corpuscular volume (MCV).
Ferritin: Assess iron stores.
Vitamin B12 and folate: Rule out other deficiencies.
Blood film: Assess for hemolytic or other causes.
Hemoglobin electrophoresis: If thalassemia or sickle cell disease is suspected.
In iron-deficiency anaemia, ferritin levels are typically __________
low
How is iron-deficiency anaemia managed in pregnancy?
Oral iron supplementation: Ferrous sulfate 200 mg once or twice daily.
Intravenous (IV) iron: If oral iron is not tolerated or if severe anaemia.
Dietary advice: Increase intake of iron-rich foods (e.g., red meat, green leafy vegetables).
Treat underlying causes (e.g., bleeding).
What are the causes and management of folate deficiency in pregnancy?
Causes:
Inadequate dietary intake.
Increased demand in pregnancy.
Medications (e.g., anticonvulsants).
Management:
Folic acid supplementation: 400 mcg/day (low risk) or 5 mg/day (high risk).
Why is vitamin B12 deficiency less common in pregnancy?
Because vitamin B12 stores are generally sufficient to meet increased pregnancy demands, but deficiency may occur in vegans or those with malabsorption disorders.
A 32-year-old woman at 28 weeks presents with fatigue and pallor. Blood tests show Hb 95 g/L, low ferritin, and normal B12 and folate levels. What is the most likely diagnosis and management?
Diagnosis: Iron-deficiency anaemia.
Management: Start oral iron supplementation and provide dietary advice.
What are the complications of anaemia in pregnancy?
Maternal:
Increased risk of infections.
Preterm labor.
Postpartum hemorrhage.
Fatigue and reduced quality of life.
Fetal:
Low birth weight.
Preterm delivery.
Fetal growth restriction.
Stillbirth.
How can anaemia be prevented in pregnancy?
Routine screening at booking and at 28 weeks.
Dietary advice to consume iron-rich foods.
Prophylactic iron and folic acid supplementation in high-risk groups.
True/False
Q: Thalassemia screening is part of routine antenatal care in high-prevalence areas.
true.
What is the threshold for severe anaemia in pregnancy, and how is it managed?
Threshold: Hb <70 g/L.
Management:
Blood transfusion: If symptomatic or rapidly deteriorating.
IV iron if oral supplementation is insufficient.
What is physiological anaemia of pregnancy?
A normal dilutional decrease in Hb levels due to an increase in plasma volume relative to red cell mass.
