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Endocrine > Endocrinology in pregnancy > Flashcards

Endocrinology in pregnancy Flashcards

1
Q

What hormone do follicles release?

A

oestradiol

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2
Q

Why does the level of LH remain steady?

A

when oestrogen is at low levels, it inhibits the release of LH and gonadotropin-releasing hormone

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3
Q

Why is there a sudden spike in LH?

A

when oestrogen levels get higher, thye stimulate LH release and also stimulate release GnRH

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4
Q

What happens at the spike of LH?

A

the ovum is released

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5
Q

What hormone does the implanted egg release?

A

hCG

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6
Q

What hormones do the corpus luteum release?

A

progesterone and HCG

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7
Q

What is the purpose of progestrone?

A

to maintain the endometrium

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8
Q

What hormones does the placenta produce?

A

human placental lactogen; placental progesteron; placental oestrogens

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9
Q

What are the complications of gestational diabetes in pregnancy?

A

macrosomia; polyhydramnios; intrauterine death

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10
Q

What are the complications in pregnancy for type 1 and 2 diabetes?

A

congenital malformation; prematurity; intra-uterine growth retardation

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11
Q

What are the complcations of maternal diabetes in the neonate?

A

respiratory distress- immature lungs; hypoglycaemia and hypocalcaemia (fits)

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12
Q

Why is a hypoglycaemia a complication in neonates with diabetic mothers?

A

due to high levels of glucose, the fetus produces lots of insulin to counteract, then post-partum, there is not as much glucose but are still making that much insulin

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13
Q

What are the CNS defects associated with diabetes?

A

anencephaly; spina bifida

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14
Q

What are the skeletal abnormalities associated with diabetes?

A

caudal regression syndrome

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15
Q

Why does fetal hyperinsulinaemia result in macrosomia?

A

insulin is a major growth factor

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16
Q

What is important in the managent of T1 and T2 diabetics in pregnancy?

A

good sugar control pre-conception; folic acid 5mg; change to inulin; regular eye checks; avoid ACEI and statins

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17
Q

Why are diabetic mothers put on higher doses of folic acid?

A

to reduce CNS defects

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18
Q

Why do diabetic mothers need regular eye checks?

A

there is accelerated retinopathy

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19
Q

What drugs should be used to control BP during pregnany?

A

labetalol, nifedipine, methyldopa

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20
Q

What drug should patients with MODY be on during pregnancy?

A

glibenclamide

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21
Q

How is GDM managed?

A

lifestyle, metformin, may need insulin

22
Q

How is resolution of GDM ensured?

A

6 week post-natal GTT

23
Q

What is the 10-15 year risk of pts with GDM gettting T2DM?

A

50%

24
Q

What does the 10-15 year risk for pts with GDM getting T2DM increase to if obese?

A

80%

25
Q

How does incorrect thyroid function affect the menstrual cycle?

A

both hypo and hyper cause anovultory cycles

26
Q

why is there an increased deamn on thyroid during pregnancy?

A

plasma protein binding increases, which mops up the hormones, so have to make more to compensate

27
Q

What hormone in pregnancy causes insulin resistance?

A

placental lactogen

28
Q

What is the evolutionary reason for lactogen causing insulin resistancei n hte motehr?

A

if mother is malnourished, directs sugar away from mother to help protect fetus from malnutrition

29
Q

What are patients on thyroxine of during pregnancy?

A

relative thyroid deficiency iff their thyroxine dose is not increased

30
Q

What hormone has a TSH like effect?

A

hCG

31
Q

Why might you see low TSH in pregnancy?

A

hCG is causing higher T3/T4, which negatively feedback on the TSH

32
Q

What is seen in hormones in hyperemesis gravidarum?

A

high hCG (which causes the vomiting) with abnormal TSH/fT4

33
Q

How often should TFTs be checked in patients with hypothyroidism in pregnancy?

A

monthly for first 20 weeks then 2 monthly until term

34
Q

How much is the soe of thyroxine increased by 20 weeks on average?

A

50%

35
Q

How much should thyroxine dose be increased by as soon as pregnancy suspected?

A

25mcg

36
Q

What are the risks associated with untreated hypothyroidism in pregnancy?

A

increased abortion, preeclampsia. abruption, postpartum haemorrhage, preterm labour, diminished foetal neuropsychological development

37
Q

What can hyperthyroidism in pregnancy cause?

A

infertility; spontaneous miscarriage; stillbirth; thyroid crisis in labour; transient neonatal thyrotoxicosis

38
Q

How can you differentiate hyperemesis from hyperthyroidism?

A

hyperemesis- increased hCG and decreased TSH; not Ab +ve; resolves by 20 weeks

39
Q

When should you treat hCG-associated thyrotoxicosis?

A

if persists past 20 weeks

40
Q

What are the symptoms of hyperthyroidism in pregnancy?

A

N and V; tachy; warm and sweaty; lack of wt gain

41
Q

What is the management of hyperthryoidism in pregnancy?

A

wait and see- if hyperemesis, will settle. Grave’s may settle as pregnancy suppresses autoimmunity

42
Q

What drugs can be given for hyperthyroidism in pregnancy?

A

beta-blockers; low dose anti-thyroid drugs- propylthiouracil 1st trimester; carbimazole 2/3rd trimester

43
Q

Why is carbimazole not given in the 1st trimester?

A

can cause embryopathy

44
Q

Why is propylthiouracil not given for the whole gestation period?

A

risk of hepatotoxicity

45
Q

Why should thyroid autoantibodies be chekced during pregnnacy?

A

can cross the placenta and cause neonatal transient hyperthyroidism

46
Q

What is the pattern of free thyroxine post-partum?

A

at 6-8 weeks - transient hyperthyroidism; at 4-6 motnhs, transient hypothyroidism

47
Q

Why is the tranisent hyperthyroidism not treated?

A

may make the following hypothyroidism worse

48
Q

When will post-partum thyroiditis usually resolve?

A

a year

49
Q

What other condition is the hypothyroid phase associated with?

A

postnatal depression

50
Q

What happens to all autoimmune conditions postpartum?

A

exacerbated

51
Q

If a patient still neeed thyroxine one year after delivery is she likely to need it lifelong?

A

yes

Endocrine (27 decks)

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