Endocrine problems in pregnancy

Question 1

What is the hormone measured in pregnancy tests?

Answer 1

HCG

Question 2

Why is HCG released?

Answer 2

in response to implantation

Question 3

What days of the ovarian cycle represent menstruation?

Answer 3

1-4

Question 4

What days of the ovarian cycle represent follicular growth?

Answer 4

4-12

Question 5

What days of the ovarian cycle represent ovulation?

Answer 5

13-15

Question 6

What days of the ovarian cycle represent luteal function?

Answer 6

16-28

Question 7

What hormones lead to insulin resistance in the mother?

Answer 7

human placental lactose

progesterone

Question 8

In which trimester does gestational diabetes occur?

Answer 8

3rd

Question 9

What problems can pre existing diabetes have on the unborn baby?

Answer 9

congenital malformations
prematurity
intrauterine growth retardation

Question 10

What problems can pre existing and gestational diabetes have on the unborn baby?

Answer 10

macrosomnia - >90th centile for size
intrauterine death
polyhydramiros - increased fluid around the baby

Question 11

What problems can pre existing and gestational diabetes have on the newborn baby?

Answer 11

respiratory distress
hypoglycaemia - fits
hypocalceamia - fits
caudal regression syndrome
spina bifida
CNS defects

Question 12

When does the foetus start to produce its own insulin?

Answer 12

3rd trimester

Question 13

What happens in pregnancy in regard to the mothers glucose?

Answer 13

not taken up it is passed onto the baby

Question 14

Does insulin cross the placenta?

Answer 14

NO

Question 15

What is the managment of pre pregnancy diabetes?

Answer 15

Take folic acid 5mg
change from tablets to insulin
avoid ACEI and statins
good BG 3 months before conception

Question 16

What are the BG targets for pre pregnancy diabetes?

Answer 16

pre prandial - <4-5.5

post prandial - <6.5-7

Question 17

What is the managment of gestational diabetes?

Answer 17

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

Question 18

What is the role of HCG?

Answer 18

increased thyroxine

suppresses TSH

Question 19

What can HCG mimic?

Answer 19

hyperthyroidism (biochemically)

Question 20

What do thyroid hormones do naturally in pregnancy?

Answer 20

increase

and increase binding to plasma proteins

Question 21

Why are sufficient thyroid hormones needed in pregnancy?

Answer 21

maternal thyroxine is important for CNS development

therefore, if on thyroid medications

Question 22

What are the complications of untreated hypothyroidism?

Answer 22

abortion
preeclampsia
post partum haemorrhage
preterm labour
IQ 7 points lower on avg

Question 23

What does hyperthyroidism cause in pregnancy?

Answer 23

infertility
spontaneous miscarriage
still birth
increased risk of thyroid crisis
transient neonatal thyrotoxicosis

Question 24

What is the management of hyperthyroidism in prengnacy?

Answer 24

low dose anti thyroid drugs - PTU 1st trimester, carbimazole 2/3rd
B blockers

Question 25

Can TRAb antibodies cross the placenta and cause neonatal transient hyperthyroidism?

Answer 25

YES

Question 26

What is post partum thyroiditis?

Answer 26

small diffuse non tender goitre
hypothyroid phase that is associated with post natal depression
can get an exacerbation of all autoimmune conditions after pregnancy