Endocrine disorders pregnancy Flashcards
Antibodies associated with T1DM?
anti-GAD or islet-cell antibodies
GDM BSL criteria AU + NZ
Au 5.1, 10, 8.5
NZ, 5.5, x, 9.0
Pregnancy hormones associated with GDM pathogenesis
human placental lactogen
glucagon
cortisol
Risk of congenital abnormality with periconceptual HbA1c of
a) >69mmol/L
b) < 69mmol/L
>69 = 22% <69 = 3-4%
Fetal cardiovascular effects of hyperglycaemia?
fetal catecholamine release (HR, BP)
cardiac remodelling
hypertension
Risk of T2DM after GDM on insulin?
90% in 10 years
Why is breastfeeding beneficial for women with diabetes in pregnancy?
lowers maternal BSL
best food for babies
length of breast feeding correlates to likelihood of developing diabetes later in life.
Most common antibody involved in hyperthyroidism in pregnancy?
TSH-receptor stimulating antibody
Grave’s Disease
PTU vs. carbimazole in pregnancy?
PTU preferred as less placental transfer, less breast milk excretion
If already stable on carbimazole however, do not change.
Can use propranolol for 3 weeks for tachycardia.
Signs of fetal hyperthyroidism on USS?
persistently extended fetal neck
fetal tachycardia
Investigations at delivery for fetal hyperthyroidism?
cord blood TFT and TSH receptor AB.
without treatment, mortality 15%
antibodies cleared within 4 months.
Fetal and neonatal implications of hypothyroidism in pregnancy due to autoimmune process?
TSH receptor AB = fetal goitre without tachycardia
TSH measured on Guthrie.
Most common time for exacerbation of hyperparathyroidism?
Neonatal effects?
postpartum period
calcium stops supplying fetus
sudden maternal hypercalcaemia—> acute pancreatitis
neonates have PTH suppression due to calcium
can have tetany, convulsions and hypocalcaemia 5-14 days PP
Treatment for hypoparathyroidism in pregnancy?
vitamin D dose - increase 200-300% in pregnancy
Calcium supplementation
Why is diagnosis of prolactinoma difficult in pregnancy?
PRL levels elevated due to pregnancy
Other tests: TFTs, visual field testing, MRI/CT brain
