Endocrine Disorders and Pregnancy

Question 1

___________ enlarges during pregnancy due to increases vascularity and blood flow

Answer 1

Thyroid gland

Question 2

Due to this disorder, congenital anomalies may be present at birth

Answer 2

Thyroid Disfunction

Question 3

Hypothyroidism is the underproduction of thyroid hormones.

Rare but can happen, women with this are often ________.

Answer 3

anovulatory

Question 4

Risk of Hypothyroidism

Answer 4

miscarriage

Question 5

Tx: Hypothyroidism

Answer 5

a. levothyroxine (supplement which is increased (dose)
during pregnancy

Question 6

Management of Hypothyroidism

Answer 6

a. don’t take drugs containing iron, calcium or any antacids
b. Take at least 4 hours apart from these drugs
c. drug to be tapered down after pregnancy to prevent hyperthyroidism

Question 7

S/S: Hypothyroidism

Answer 7

a. easily fatigued
b. tend to be obese
c. dry skin (myxedema)
d. cold intolerance
e. N & V

Question 8

Overproduction of thyroid hormone, Hyperthyroidism/___________

Answer 8

Graves disease

Question 9

S/S Graves Disease

Answer 9

a. rapid HR
b. exophthalmos
c. heat intolerance
d. heart palpitations
e. weight loss

Question 10

Risks of Hyperthyroidism

Answer 10

a. heart failure
b. gestational hypertension
c. fetal growth restriction
d. preterm labor

Question 11

Dx of Graves disease

Answer 11

– radioactive uptake of 131I subtype

may cause fetal thyroid destruction so it should not be done in pregnancy

Question 12

Tx: of Hyperthyroidism that may cross placenta and cause congenital hypothyroidism and enlarged thyroid (goiter) in fetus

Answer 12

thiomides (methimazole or PTU)

Question 13

Hyperthyroidism/Graves disease

Infant may be born with symptoms of the disease and
may appear _______ with ____________ and ____________.

Answer 13

jittery

tachypnea and tachycardia

Question 14

Women with high Tx dose should not BF

• Surgery to reduce maternal thyroid functioning can be
  done but not in pregnancy

Answer 14

Hyperthyroidism/Graves disease

Question 15

pancreas cannot produce adequate insulin to regulate blood glucose

Answer 15

Diabetes Mellitus

Question 16

Normal glucose level:

Answer 16

80 – 120 mg/d

Question 17

3 challenges for DM

Answer 17

1. How to manage both type 1 and type 2 diabetes during
   pregnancy to achieve a healthy glucose/insulin balance
   during pregnancy
2. How to protect infant in utero from the adverse effects of
   increased glucose levels
3. How to care for the infant in the first 24 hours after birth until
   the infant’s insulin-glucose mechanism stabilizes

Question 18

Pathophysiology of DM

Answer 18

1. No insulin – no glucose for cells
2. hyperglycemia
3. glycosuria
4. polyuria
5. Dehydration occurs
6. ↓ blood flow - ↓ oxygenation
7. Fat converted to glucose – ketones pour into bloodstream
8. Proteins converted into glucose
9. kidney, heart, and retinal
   dysfunction

Question 19

Liver converts glycogen to glucose

Answer 19

hyperglycemia

Question 20

Kidneys begin to excrete glucose in urine

Answer 20

glycosuria

Question 21

Large amount of fluid excreted (urine)

Answer 21

polyuria

Question 22

blood serum becomes concentrated, total blood
volume decreases

Answer 22

Dehydration occurs

Question 23

anerobic metabolic reactions – lactic acid pour into blood stream

Answer 23

↓ blood flow - ↓ oxygenation

Question 24

ketones pour into bloodstream

Answer 24

Fat converted to glucose

Question 25

Proteins converted into glucose (Glucogenesis)

Answer 25

a. cells die b. production of sodium and potassium c. severe metabolic acidosis d. kidney, heart, and retina

Question 26

inadequate insulin production

Answer 26

Type I DM

Question 27

gradual loss of insulin production

Answer 27

Type II DM

Question 28

A Woman with Diabetes Mellitus * in pregnancy, all women develop an ______________, probably caused by hPL and high levels of cortisol, estrogen, progesterone and _______________ – helpful in non DM as it ________________; difficult to DM pt. as she needs additional insulin dose to prevent ___________.

Answer 28

insulin resistance catecholamines - prevents blood glucose decrease hyperglycemia

Question 29

WOF _________ and ________ caused by constant use of glucose by the fetus

Answer 29

hypoglycemia and ketoacidosis

Question 30

large baby due to (increased) insulin (produced by fetus) which acts as growth stimulant

Answer 30

Macrosomia

Question 31

Normal level of amniotic fluid

Answer 31

500 - 1000 mL

Question 32

high glucose cause extra fluid shift and enlarge amount of AF

Answer 32

Hydramnios

Question 33

Risks of DM

Answer 33

a. Cephalopelvic disproportion b. Shoulder dystocia c. Congenital anomalies d. Miscarriage e. Stillbirth

Question 34

lower extremities fail to develop

Answer 34

Caudal regression

Question 35

A Woman with Diabetes Mellitus * Neonates are prone to

Answer 35

a. Hypoglycemia b. RDS c. hypocalcemia d. hyperbilirubinemia

Question 36

DM Controlled blood sugar level in the __________ will decrease the risk for congenital anomalies

Answer 36

first trimester