endocrinology in pregnancy Flashcards
where does HCG come from?
the fertilised implanted egg
what can human placental lactogen (HPL) cause apart from breast development?
insulin resistance
what are the diabetes complications in pregnancy?
Congenital Malformation
Prematurity
Intra-uterine growth retardation (IUGR)
macrosomia (big baby)
Polyhydramnios (too much amniotic fluid)
Intrauterine Death
what are diabetes complications in neonates?
Respiratory Distress - immature lungs
Hypoglycaemia & Hypocalcaemia causing fits
how do you manage type 1 and 2 diabetes in pregnancy?
good bg control pre conception
folic acid 5mg
regular eye checks
avoid aceis and statins
consider changing tablets to insulin in t2dm
start aspirin 150mg at 12 weeks as its is a high risk pregnancy
what do you do after pregnancy in gestational diabetes?
6 week post natal fasting glucose, HbA1c or GTT
- to ensure resolution of DM
- If not they have T2DM
how do you try and prevent diabetes after GDM?
Keep weight as low as possible
Healthy Diet
- low refined sugar
- predominant starch
- low saturated fat
- low energy foods
Aerobic exercise
?? Metformin, Acarbose, Pioglitazone
Annual fasting glucose
what impact does thyroid disease have on fertility?
hyper & hypothyroidism causes anovulatory cycles- causing reduced fertility
what is the treatment for hypothyroidism in pregnancy?
increase thyroxine dose by 25mg as soon as pregnancy suspected
check TFTs monthly for first 20 weeks then 2 monthly until term
aim for TSH of 3-4mU/l
what are the risks of untreated hypothyroidism in pregnancy?
Increased abortion, preeclampsia, abruption, postpartum haemorrhage, preterm labour,
effect on foetal neuropsychological development
how does hCG effect TSH levels?
hCG increases thyroxine which suppresses TSH
high hCG mimics hyperthyroidism
what are the risks associated with hyperthyroidism in pregnancy?
Infertility/Ammenorhoea
Spontaneous miscarriage
Stillbirth
Thyroid crisis in labour
Transient Neonatal thyrotoxicosis
what is the management of hyperthyroidism in pregnancy?
wait and see
check TRAB antibodies
b-blockers if needed short term
can use low dose anti-thyroid drugs if needed (propylthiouracil 1st trimester, carbimazole 2nd/3rd trimester) as a last resort
describe postpartum thyroiditis
hypothyroidism at 2 months and hyperthyroidism at 3 months, should resolve in a year
small, diffuse nontender goitre
don’t give drugs if can help it
can give thyroxine if hypothyroidism causes severe depression
