Endocrine problems in pregnancy Flashcards
What is the hormone measured in pregnancy tests?
HCG
Why is HCG released?
in response to implantation
What days of the ovarian cycle represent menstruation?
1-4
What days of the ovarian cycle represent follicular growth?
4-12
What days of the ovarian cycle represent ovulation?
13-15
What days of the ovarian cycle represent luteal function?
16-28
What hormones lead to insulin resistance in the mother?
human placental lactose
progesterone
In which trimester does gestational diabetes occur?
3rd
What problems can pre existing diabetes have on the unborn baby?
congenital malformations
prematurity
intrauterine growth retardation
What problems can pre existing and gestational diabetes have on the unborn baby?
macrosomnia - >90th centile for size
intrauterine death
polyhydramiros - increased fluid around the baby
What problems can pre existing and gestational diabetes have on the newborn baby?
respiratory distress hypoglycaemia - fits hypocalceamia - fits caudal regression syndrome spina bifida CNS defects
When does the foetus start to produce its own insulin?
3rd trimester
What happens in pregnancy in regard to the mothers glucose?
not taken up it is passed onto the baby
Does insulin cross the placenta?
NO
What is the managment of pre pregnancy diabetes?
Take folic acid 5mg
change from tablets to insulin
avoid ACEI and statins
good BG 3 months before conception
What are the BG targets for pre pregnancy diabetes?
pre prandial - <4-5.5
post prandial - <6.5-7
What is the managment of gestational diabetes?
lifestyle changes
metformin
post natal: check fasting glucose or GTT - if not normal consider T2DM
if they are not obese and need insulin - consider T1DM
What is the role of HCG?
increased thyroxine
suppresses TSH
What can HCG mimic?
hyperthyroidism (biochemically)
What do thyroid hormones do naturally in pregnancy?
increase
and increase binding to plasma proteins
Why are sufficient thyroid hormones needed in pregnancy?
maternal thyroxine is important for CNS development
therefore, if on thyroid medications
What are the complications of untreated hypothyroidism?
abortion preeclampsia post partum haemorrhage preterm labour IQ 7 points lower on avg
What does hyperthyroidism cause in pregnancy?
infertility spontaneous miscarriage still birth increased risk of thyroid crisis transient neonatal thyrotoxicosis
What is the management of hyperthyroidism in prengnacy?
low dose anti thyroid drugs - PTU 1st trimester, carbimazole 2/3rd
B blockers
Can TRAb antibodies cross the placenta and cause neonatal transient hyperthyroidism?
YES
What is post partum thyroiditis?
small diffuse non tender goitre
hypothyroid phase that is associated with post natal depression
can get an exacerbation of all autoimmune conditions after pregnancy
