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Endocrine > Endocrinology in pregnancy > Flashcards

Endocrinology in pregnancy Flashcards

1
Q

What hormone will a follicle release?

A

Oestradiol

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2
Q

What will the corpus luteum release?

A

Progesterone

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3
Q

When is hCG reelased?

A

When the ferilised follice (corpus lutem) is implaned

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4
Q

What hormones does the placenta release?

A

Human placental lactogen (hPL)
Placental progesterone
Placental oestrogens

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5
Q

What will the pituitary release during pregnancy?

A

Prolactin

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6
Q

When is the peak of LH in the menstrual cycle?

A

During ovulation - commonly day 14

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7
Q

When is the peak of FHS in the menstrual cycle?

A

Ovulation - day 14

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8
Q

How long does the luteal phase last?

A

14 days

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9
Q

How long does the follicular phase last?

A

14 days but can be very variable

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10
Q

When is the peak of progesterone in the menstrual cycle?

A

In the luteal phase around day 21

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11
Q

What are the 3 phases of the menstrual cycle?

A

Menses
Proliferative phase
Secretory phase

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12
Q

What hormones lead to increased insulin resistance in a pregnant woman?

A

Progesteron

hPL

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13
Q

What can increased insulin resistance lead to?

A

If predisposed then can lead to gestational diabetes

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14
Q

When does gestational diabetes tend to start?

A

In the 3rd trimester as the placental hormones are at their highest level

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15
Q

When does foetal organogenesis start?

A

At 5 weeks

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16
Q

What complications in pregnancy can happen due to gestational diabetes?

A

Macrosomia - >90th centile, over 4kg
Polyhydraminos
Intrauterine death

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17
Q

What complications in pregnancy can happen due to pre-existing diabetes in pregnancy?

A 
Congenital malformation
Prematurity 
Intra-uterine growth retardation 
Macrosommia
Polyhydraminos
Intrauterine death
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18
Q

What complications can occur in the neonate from a diabetic pregnancy?

A

Respiratory distress - immature lungs
Hypoglycaemia - fits
Hypocalcaemia - fits

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19
Q

What CNS defects are more common in diabetic pregnancies?

A

Anencephaly

Spina bifida

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20
Q

What skeletal abnormalities are more common in diabetic pregnancies?

A

Caudal regression syndrome

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21
Q

What genital and GI abnormalities are more common in diabetic pregnancies?

A

Urteric duplication

UTI

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22
Q

Why does maternal diabetes lead to macrosomia?

A

Maternal hyperglycaemia
Foetal hyperglycaemia
Foetal hyperinsulinaemia
Results in macrosomia and neonatal hypoglycaemia

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23
Q

Why does foetal hyperinsulinaemia lead to increased growth?

A

In the 3rd trimester, the foetus produces its own insulin which is a major growth factor

24
Q

What pre-pregnancy advice would you give to diabetic mothers?

A

Good sugar control 3 months pre-conception

Limit risk of congenital malformation

25
Q

What is the advice surrounding folic acid in diabetic mothers?

A

Folic acid 5mg instead of the 400 micrograms for the geneal pop

26
Q

What is the advice around eye checks in diabetic mothers?

A

Regular eye checks (10/20/30 weeks gestation) as there is accelerated retinopathy

27
Q

What drugs should be stopped during pregnancy for diabetic mothers?

A

Avoid ACEI and statins
Change tablets to insulin if T2DM
If hypertensive - change to labetalol, nifedipine or methyldopa

28
Q

What are the aims for blood sugar control in pregnant diabetics?

A

Pre-meal <4-5.5 mmol/l

2h post meal <6.5-7 mmol/l

29
Q

What is the management for pregnant diabetics?

A 
Diabetic diet and lifestyle
Good blood sugar control
Monitor HbA1c
Monitor BP 
Maintain good glucose levels during labour - IV insulin and IV dextrose
30
Q

What drug treatments for diabetes are approved in pregnancy?

A

T1: insulin
T2: metformin and insulin
GDM: lifestyle, metformin, may need insulin

31
Q

When should the blood sugars be checked in a women with diabetes with GDM?

A

6 weeks post natal fasting glucose or GGT to ensure they have resolution of DM and to ensure they dont have T2DM

32
Q

What is the risk factor for developing T2DM ifi you have gestational diabetes?

A

50% after 10-15 years

80% for those who are obese

33
Q

How can diabetes be prevented after GDM?

A

Keep weight as low as poss
Healthy diet - low refined surgar, predominant starch, low saturated fat, low energy foods
Aerobic exercise
Annual fasting glucose

34
Q

What can hypo and hyperthyroidism do to the menstrual cycle?

A

Anvovulatory cyles - reduced fertility

35
Q

What happens to the demand for thyroxine during pregnancy?

A

Maternal thyroxine important for neonatal development (esp CNS)
Increased demand on the thyroid during pregnancy as the plasma protein binding increases

36
Q

What will happen to the size of the thyroid gland during pregnancy?

A

Increase in size

Increased T4 production to maintain normal conc

37
Q

What happens in pregnancy to a women with pre-existing hypothyrodism?

A

Unable to compensate for increased demand
Increase thyroxin dose by 25 micograms as soon as pregnancy is suspected
Check TFTs monthy for the first 20 weeks then 2 months until term
Average dose is increased by 50% by 20 weeks

38
Q

What is the target TSH in pregnancy?

A

<3 mU/I

39
Q

What are the risks of untreated hypothyrodism in pregnancy?

A 
Increased abortion 
Preeclamsia
Abruption
Postpartum haemorrhage
Preterm labour 
Foetal neuropsychological development
40
Q

What is the link between TSH and hCG?

A

hCG increases the need for thyroxine therefore supressing TSH

41
Q

What will the thyroid function tests be like in hyperemesis gravidarum?

A

hGC HIGH, 50% have a low TSH and a high fT4

42
Q

What is the hCG effect of thyroid tests in pregnancy?

A

fT4 increased in 14% of pregnancies
Low TSH (0.1-0.4) of pregnancies
Mimics hyperthyrodism biochemically

43
Q

What are the signs and symptoms of gestational hCG-associated thyrotoxicosis?

A

Hyperemesis gravidarum - increased hCG and decreased TSH
Not TRab antibody positive
Resolves by 20 weeks
Only treat if it persists beyond 20 weeks

44
Q

What effects does hypertyrodism have on conception, pregnancy and labour?

A

Infertility due to anovulatory cycle
Spontaneous miscarriage
Stillbirth
Thyroid crisis in labour

45
Q

What effect will maternal hyperthyrodism have on the neonate?

A

Transient neonatal htyrotoxicosis - thyroid receptor antibodies cross the placenta causing an overactive thyroid in the foetus

46
Q

What are the symptoms of hyperthyrodism in pregnancy?

A

N+V
Tachycardia
Warm and sweaty
Lack of wt gain

47
Q

How should hyperthyrodsim be managed in pregnancy?

A

Supportive - if hyperemesis it will settle. Graves may also settle during pregnancy
Beta blockers if needed

48
Q

What is the pharma management of hyperthyrodism in pregnancy?

A

Low soe anti-thyroid drugs
Propylthiouracil in 1st trimester
Carbimazole in 2/3rd trimester

49
Q

Why should you never use carbimazole in pregnancy?

A

Teratogenic - scalp abnormalities, GI abnormalities, chanal and oesophageal atresia

50
Q

What are the issues with propylthiouracil?

A

Risk of liver toxicity

51
Q

When should TRAb antibodies be checked in pregnancy?

A

3rd trimester

If present should alert neonatologist

52
Q

What is the treatment if the baby has hyperhyrosidm?

A

Low does carbimazole until settles - is transient

53
Q

What is post-partum thyroditis?

A

Normal thyroid level at delivery but development of thyroditis 6/8 weeks post partum and then 4/6 months of hypothyrodism until it settles at around a year

54
Q

Why shouldnt carbimazole be given in post-partum thyroditis?

A

Makes the hypo crash MUCH worse

55
Q

What blood test should you do in post-natal depression?

A

Thyroid levels - hypothyrodism can cause depression

56
Q

What will happen if the post partum mother still needs levothyroxine after 1 year post partum?

A

Persistent hypothyrodism - likley need levothyroxine lifelong

Endocrine (35 decks)

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