endocrine dis In Pregnancy Flashcards
One of Uncontrolled diabetes is Septal hypertrophy can be complicated by:
Aortic stenosis > still-born
By which percentage Increased risk for metabolic syndrome and type II diabetes later in life of GDM mothers
(>50% women with gestational diabetes develop type II DM)
diabetes can developed early In certain Genetic syndromes like
Down syndrome, klinefelter, Turner
Infectious etiologies of diabetes
CMV, coxsackievirus, congenital rubella
— to — % of women with GDM are found to have DM immediately after pregnancy
5-10 %
The incidence of macrosomia rises significantly when maternal blood glucose concentrations chronically exceed
130 mg/dL
The risk of fetal death in women with pregestational diabetes is …x higher
3-4 times higher in DM alone
While 7 fold in pregnant with HTN and DM
Complications of Diabetes in pregnancy:
Fetal and neonatal
- Fetal: spontaneous abortion- unexplained fetal demise- preterm delivery- malformations- altered fetal growth- hydramnios.
- neonatal: greater risk of NEC, late-onset sepsis, RDS, hypoglycaemia, hypocalcemia, hyperbillirubinemia, polycythemia, hypertrophic cardiomyopathy of intraventricular septum, long- term cognitive dysfunction, inheritance of diabetes,
The risk of developing type1 DM if either parent is affected is — to — %, while with Type2 DM, if both parent affected the risk of developing it approaches —%
The risk of developing type1 DM if either parent is affected is 3 to 5 %, while with Type2 DM, if both parent affected the risk of developing it approaches 40%
Maternal Complications of Diabetes in pregnancy:
- Maternal: PET(3-4X in overt DM), increase risk of HTN, cardiac and respiratory complications and retinopathy, infection, depression, DKA, hypoglycaemia
pregnant with DM and chronic HTN are — times more likely to develop Preeclampsia
pregnant with DM and chronic HTN are 12 times more likely to develop Preeclampsia
Perinatal mortality rates from single episode of DKA may reach —-%
Perinatal mortality rates from single episode of DKA may reach 35 %
The optimal glycemic control prior to conception
HbA1C <6.9 %
(Congenital malformation 4x greater risk in >10%)
Preprandial Glucose level 70-100
2 hrs postprandial 100-120
Reducing or withholding the dose of long-acting insulin before delivery is recommended and to continue on regular insulin
T
__fold greater risk for shoulder dystocia in newborns weighing >/= 4200 gm
76 fold greater risk for shoulder dystocia in newborns weighing >/= 4200 gm compared to those wt < 3500 g
In GDM management pharmacological are usually recommended if diet modification doesn’t consistently maintain the fasting Plasma Glucose < ? or 2hrs PP plasma Glu < ? (ACOG)
In GDM management pharmacological are usually recommended if diet modification doesn’t consistently maintain the fasting Plasma Glucose < 95 or 2hrs PP plasma Glu < 120 (ACOG)
ACOG recommends considering insulin in GDM women with 1 hr PP levels that exceeds —- or with 2 hrs levels > —-
ACOG recommends considering insulin in GDM women with 1 hr PP levels that exceeds 140 or with 2 hrs levels > 120
The starting dose of insulin is typically
0.7-1 units/ kg/ d, given in divided doses 2/3 in morning before breakfast and lunch
And 1/3 of in dinner
ACOG recommends that routine labor induction in GDM on diet women shouldn’t occur before ?wks
39 wks
ACOG recommends fasting glucose or 75 g 2hrs OGTT at 4-12 wks postpartum for dx of overt diabetes
ADA recommends testing every 3yrs in women with h/o GDM but normal postpartum glucose screening
In follow up of pregnant with hyperthyroidism serum free T4 concentration measured every
4-6 wks
The most common cause of hypothyroidism in pregnancy is
Hashimoto thyroiditis
Pregnant with positive Anti-TPO and thyroglobulin carry ??? fold increased risk of early pregnancy loss
Pregnant with positive Anti-TPO and thyroglobulin carry 2-5 fold increased risk of early pregnancy loss
Up to ? % of women who are thyroid-antibody positive in the first trimester will develop postpartum thyroiditis
Up to 50 % of women who are thyroid-antibody positive in the first trimester will develop postpartum thyroiditis
Hypercalcemic crisis manifests as
Stupor, Nausea, Vomiting, weakness, Fatigue and dehydration.
Parathyroidectomy indications in hyperparathyroidism:
1) symptomatic hyperparathyroidism
2) serum Ca 1 ml/dL above the upper normal range
3) calculated creatinine clearance < 60
4) reduced bone density assessment every 1 -2 yrs
Pheochromocytoma called
(10 precent tumor) because
10% are bilateral
10% are extraadrenal
10% are malignant
Arise from Adrenal medulla, can be associated with medullary thyroid Ca and hyperparathyroidism
Lymphocytic hypophysitis
Rare autoimmune pituitary disorder many are temporary due to pregnancy
Similar to signs of adenoma but with modestly elevated labs
What does NICE Guidelines advice pregnant diabetic women should keep their HBA1C below:
6.5% or 48 mmol/mol
Addison vs. Cushing vs. Conns disease
The American College of Obstetricians and Gynecologists (ACOG) recommends the following blood glucose targets in pregnancy:
fasting <90 mg/dL,
preprandial <105 mg/dL,
1-h postprandial <130–140 mg/dL, and 2-h postprandial <120 mg/dL.
Postpartum thyroiditis is most likely to recur in up to –% of subsequent pregnancies.
Postpartum thyroiditis is most likely to recur in up to 70% of subsequent pregnancies
The risk of congenital malformation rises to —% if mothers had HbA1c values of more than —%.
The risk of congenital malformation rises to 22% if mothers had HbA1c values of more than 10%.
The risk of congenital malformation rises to —% if mothers had HbA1c values of more than —%.
The risk of congenital malformation rises to 22% if mothers had HbA1c values of more than 10%.
