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Endocrine > Endocrinology and Pregnancy > Flashcards

Endocrinology and Pregnancy Flashcards

1
Q

What are the key events of the ovarian cycle?

A

Follicular growth = days 1-12, oestradiol produced
Ovulation = day 14
Luteal function = days 16-20, progesterone produced

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2
Q

What produced prolactin (lactogen)?

A

The pituitary

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3
Q

When does LH levels peak?

A

During ovulation

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4
Q

What contributes to insulin resistance in a mother?

A

Progesterone and hPL = if mother predisposed then blood glucose rises causing gestational diabetes

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5
Q

When does foetal organogenesis begin?

A

At 5 weeks (possibly earlier)

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6
Q

What are some complications in pregnancy caused by diabetes?

A

Congenital malformations, prematurity, macrosomia (>90th centile for size), intra-uterine growth retardation (IUGR), polyhydramnios, intrauterine death

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7
Q

What are some congenital malformations linked to diabetes?

A

Spina bifida, anencephaly, caudal regression syndrome, uteric dysfunction

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8
Q

What are some complications in neonates linked to diabetes?

A

Respiratory distress (immature lungs), fits due to hypoglycaemia or hypocalcaemia

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9
Q

Does diabetes increase the risk of congenital malformations?

A

Yes = CNS defects by 5x, skeletal defects by 200x, GI/GU defects by 20x

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10
Q

What causes macrosomia (BW >4kg) and neonatal hypoglycaemia?

A

Foetal hyperglycaemia and hyperinsulinaemia = caused by maternal hyperglycaemia, in 3rd trimester foetus produces own insulin which is major growth factor

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11
Q

How is the risk of congenital malformations reduced in patients with type 1 and 2 diabetes?

A

Pre-pregnancy counselling and good sugar control pre-conception

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12
Q

Why do type 1 and 2 diabetics get regular eye checks during pregnancy?

A

Their risk of retinopathy is accelerated

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13
Q

What medications should be avoided in type 1 and 2 diabetics during pregnancy?

A

ACE inhibitors, statins, labetol, nifedipine, methyldopa

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14
Q

What should type 1 and 2 diabetics be prescribed during pregnancy?

A

Folic acid 5mg (not 400ug as in non-diabetic pregnancy)
Consider change from tablets to insulin
Start aspirin 150mg at 12 weeks (in high risk pregnancy)

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15
Q

What is the management for all types of diabetes during pregnancy?

A

Diabetic diet and monitor HbA1c and blood pressure

Maintain good blood glucose during labour = IV insulin and IV dextrose

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16
Q

What is the blood sugar target during pregnancy for all kinds of diabetics?

A

Pre-meal = <4-5.5mmol/L

2hr post meal = <6.5-7mmol/L

17
Q

What drugs are used during pregnancy to treat diabetes?

A

Type 1 = insulin
Type 2 = metformin, may need inulin later
Gestational = lifestyle, metformin, may need insulin

18
Q

How is gestational diabetes confirmed?

A

6 week post natal fasting glucose or OGTT measured to ensure resolution = if not resolved then patient has type 2 diabetes

19
Q

What is the risk of developing another form of diabetes 10-15 years following gestational diabetes?

A

<5% get type 1 diabetes

About 80% get type 2 diabetes

20
Q

How can diabetes be prevented in patients who have had gestational diabetes?

A

Keep weight low as possible and healthy diet
Aerobic diet
Pioglitazone, acarbose, metformin (all possibilities)
Annual fasting glucose

21
Q

How does thyroid disease reduce fertility?

A

Hypo/hyperthyroidism cause anovulatory cycles

22
Q

How does thyroid disease impact pregnancy?

A

Maternal thyroxine important for neonatal development (especially CNS)
Increased demand on thyroid during pregnancy = increased T4 production
Plasma protein binding increases

23
Q

What happens to patients already on thyroxine during pregnancy?

A

Develop relative thyroid deficiency = thyroid cant cope with increased demand

24
Q

How should pre-existing hypothyroidism be managed during pregnancy?

A

Increase thyroxine dose by 25mcg as soon as pregnancy suspected, check TFT monthly for first 20 weeks then 2 monthly until term, aim for TSH <3mU/l

25
Q

What are the risks of untreated hypothyroidism during pregnancy?

A

Increased abortion, pre-eclampsia, abruption, postpartum haemorrhage, pre-term labour, foetal neuropsychological development (increased risk of IQ <85)

26
Q

What is the hCG effect on TFTs?

A

fT4 increased, low TSH (0.1-0.4), hyperemesis gravidarum (hCG high, 50% have low TSH)

27
Q

How is hyperemesis different from hyperthyroidism?

A

Hyperemesis gravidarum = increased hCG, low TSH
Not TRab antibody positive
Resolves by 20 weeks gestation
only treat if persists 20 weeks

28
Q

What does hyperemesis mimic biochemically?

A

Hyperthyroidism

29
Q

What can hyperthyroidism during pregnancy cause?

A

Infertility/amenorrhoea (before conception), spontaneous miscarriage, stillbirth, thyroid crisis in labour, transient neonatal thyrotoxicosis

30
Q

What can cause hyperthyroidism?

A

Grave’s disease (may settle as pregnancy supresses autoimmunity), TMNG, toxic adenoma, thyroiditis

31
Q

What is the management of hyperthyroidism during pregnancy?

A

Beta blockers if needed, wait and see (will settle if hyperemesis), low dose antithyroid drugs (propylthiouracil in 2st trimester, carbimazole in 2nd/3rd trimester)

32
Q

What are some features of carbimazole?

A

May cause embryopathy in first trimester (scalp and GI abnormalities, choanal and oesophageal atresia)

33
Q

What are some features of propylthiouracil?

A

Risk of liver toxicity, best avoided except in first trimester (then switch)

34
Q

Why should TRab antibodies be checked for during pregnancy?

A

Ideally checked in 3rd trimester = can cross placenta and cause neonatal transient hyperthyroidism

35
Q

How common is postpartum thyroiditis?

A

5% of postpartum women, 25% of type 1 diabetics

36
Q

What are some features of postpartum thyroiditis?

A

Transiently thyrotoxic, can last for up to 1 year postpartum, small diffuse non-tender goitre, hypothyroid phase associated with postnatal depression

37
Q

How many patients develop persistent hypothyroidism following postpartum thyroiditis?

A

25-50%

Endocrine (42 decks)

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