Endocrinology in pregnancy

Question 1

What hormone do follicles release?

Answer 1

oestradiol

Question 2

Why does the level of LH remain steady?

Answer 2

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

Question 3

Why is there a sudden spike in LH?

Answer 3

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

Question 4

What happens at the spike of LH?

Answer 4

the ovum is released

Question 5

What hormone does the implanted egg release?

Answer 5

hCG

Question 6

What hormones do the corpus luteum release?

Answer 6

progesterone and HCG

Question 7

What is the purpose of progestrone?

Answer 7

to maintain the endometrium

Question 8

What hormones does the placenta produce?

Answer 8

human placental lactogen; placental progesteron; placental oestrogens

Question 9

What are the complications of gestational diabetes in pregnancy?

Answer 9

macrosomia; polyhydramnios; intrauterine death

Question 10

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

Answer 10

congenital malformation; prematurity; intra-uterine growth retardation

Question 11

What are the complcations of maternal diabetes in the neonate?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

What are the CNS defects associated with diabetes?

Answer 13

anencephaly; spina bifida

Question 14

What are the skeletal abnormalities associated with diabetes?

Answer 14

caudal regression syndrome

Question 15

Why does fetal hyperinsulinaemia result in macrosomia?

Answer 15

insulin is a major growth factor

Question 16

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

Answer 16

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

Question 17

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

Answer 17

to reduce CNS defects

Question 18

Why do diabetic mothers need regular eye checks?

Answer 18

there is accelerated retinopathy

Question 19

What drugs should be used to control BP during pregnany?

Answer 19

labetalol, nifedipine, methyldopa

Question 20

What drug should patients with MODY be on during pregnancy?

Answer 20

glibenclamide

Question 21

How is GDM managed?

Answer 21

lifestyle, metformin, may need insulin

Question 22

How is resolution of GDM ensured?

Answer 22

6 week post-natal GTT

Question 23

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

Answer 23

50%

Question 24

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

Answer 24

80%

Question 25

How does incorrect thyroid function affect the menstrual cycle?

Answer 25

both hypo and hyper cause anovultory cycles

Question 26

why is there an increased deamn on thyroid during pregnancy?

Answer 26

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

Question 27

What hormone in pregnancy causes insulin resistance?

Answer 27

placental lactogen

Question 28

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

Answer 28

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

Question 29

What are patients on thyroxine of during pregnancy?

Answer 29

relative thyroid deficiency iff their thyroxine dose is not increased

Question 30

What hormone has a TSH like effect?

Answer 30

hCG

Question 31

Why might you see low TSH in pregnancy?

Answer 31

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

Question 32

What is seen in hormones in hyperemesis gravidarum?

Answer 32

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

Question 33

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

Answer 33

monthly for first 20 weeks then 2 monthly until term

Question 34

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

Answer 34

50%

Question 35

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

Answer 35

25mcg

Question 36

What are the risks associated with untreated hypothyroidism in pregnancy?

Answer 36

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

Question 37

What can hyperthyroidism in pregnancy cause?

Answer 37

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

Question 38

How can you differentiate hyperemesis from hyperthyroidism?

Answer 38

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

Question 39

When should you treat hCG-associated thyrotoxicosis?

Answer 39

if persists past 20 weeks

Question 40

What are the symptoms of hyperthyroidism in pregnancy?

Answer 40

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

Question 41

What is the management of hyperthryoidism in pregnancy?

Answer 41

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

Question 42

What drugs can be given for hyperthyroidism in pregnancy?

Answer 42

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

Question 43

Why is carbimazole not given in the 1st trimester?

Answer 43

can cause embryopathy

Question 44

Why is propylthiouracil not given for the whole gestation period?

Answer 44

risk of hepatotoxicity

Question 45

Why should thyroid autoantibodies be chekced during pregnnacy?

Answer 45

can cross the placenta and cause neonatal transient hyperthyroidism

Question 46

What is the pattern of free thyroxine post-partum?

Answer 46

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

Question 47

Why is the tranisent hyperthyroidism not treated?

Answer 47

may make the following hypothyroidism worse

Question 48

When will post-partum thyroiditis usually resolve?

Answer 48

a year

Question 49

What other condition is the hypothyroid phase associated with?

Answer 49

postnatal depression

Question 50

What happens to all autoimmune conditions postpartum?

Answer 50

exacerbated

Question 51

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

Answer 51

yes