Endocrinology of Pregnancy Flashcards
What days does follicular growth occur
1 -9
At what day in the ovarian cycle does LH spike
13-15
What days does occupation occur
usually 15
What is the fate of the ovum
Ovum to corpus luteum to placenta
What hormones does the placenta produce
Human placental lactogen
placental progesterone
palcental oestrogens
What does the corpus luteum produce
Progesterone
What does the ovium produce
Oestradiol
What hormone does the pituitary gland produce that is particularly important to pregnancy
Prolactin (lactogen)
Why does gestational diabetes occur
Hormones cause an increase in insulin resistance
What 2 hormones can cause an increase in insulin resistance in the mother
Progesterones and hPL
When does gestational diabetes occur in pregnancy
The 3rd trimester (28 weeks)
When does foetal organogenesis occur
5 weeks (around the time the mother realises she has missed a period and notices she might be pregnant)
What are 6 complications in pregnancy for mothers with either type 1 or type 2 diabetes
congenital malformation prematurity intra-uterine growth retardation (IUGR) Macrosomia Polyhydramnios Intrauterine death
What complications can occur in gestational diabetes
Macrosomia
Polyhydramnios
Intrauterine death
What is polyhydramnios
fluid around the baby resulting in premature death and early delivery
what are some of the complications in a neonate of a mother with diabetes
Respiratory distress - immature lungs
Hypoglycaemia
Hypocalcaemia
Why would a neonate end up hypoglycaemic rather than hyperglycaemic
The pancreas has had to secrete more insulin during development due to the mothers increased glucose level. Now there is a normal glucose level but still too much insulin..
What part of the spine is affected by caudal regression syndrome
Lumbar spine
What patients are affected by caudal regression syndrome
Babies to mothers with diabetes. Unusual outside diabetes
What is a major growth factor for a foetus
When it produces its own insulin in the 3rd trimester
How can we manage patients with diabetes
Pre-pregnancy counselling and ensuring good glycemic control
Folic acid 5mg
Regular eye checks
Avoid ACEI an statins
What does folic acid do
Reduces the risk of CNS congenital malformations
What is the dose for a non-diabetic pregnant woman and a diabetic pregnant woman
400micrograms for non-diabetic
5milligrams for diabetic
What drugs can be used to control blood pressure in pregnancy
Labetalol
Nifedipine
Methyl dopa
How can we maintain good blood glucose during labour
IV insulin and IV dextrose
How often should blood sugars be monitored during pregnancy
pre-meal
post-meal and pre bed
some will do one during the night as well
What drugs can be used to control glucose levels during pregnancy
Insulin
Metformin
Glibenclamide
What type of diabetes is indicative of glibenclamide
MODY
When should a woman who has had gestational diabetes be tested again to ensure the blood glucose has returned to normal
6 weeks post natal
If the glucose levels have not returned to normal after 6 weeks, what does this indicate
Either type 1 or Type 2 diabetes
How can we prevent diabetes after gestational diabetes
Keep weight as low as possible
Healthy diet
Aerobic exercise
Annual fasting glucose
Foetal hyperinsulinaemia causes increased foetal growth
True
What is the risk of type 2 diabetes in a mother who developed gestational diabetes within 10 years after the baby has been born
50%
What is maternal thyroxine particularly important for
Neonatal development
What is the usual increase in the dose of thyroxine in a pregnant lady already on thyroxine
25mcg
What are some normal findings of thyroid tests during pregnancy
Low TSH
increased fT4
How often should TFTs be checked during pregnancy
Monthly for first 20 weeks then 2 monthly until term
What is the optimum level of TSH in the first trimester
What is the optimum level of TSH in the second or third trimester
What are some of the risks of untreated hypothyroidism
Increased abortion, preeclampsia, abruption, postpartum, haemorrhage,
preterm labour
Increased risk of foetal neuropsychological development
What are some causes of thyrtoxicosis and pregnancy
Grave’s disease
TMNG, toxic adenoma
Thyroiditis
Gestational hCG associated Thyrotoxicosis
What hormones can increase thyroxine
TSH and hCG
What happen if there is an increase in thyroxine
Suppression of TSH
What can hyperthyroidism cause in pregnancy
Infertility Spontaneous miscarriage stillbirth thyroid crisis in labour Grave's disease Transient neonatal thyrotoxicosis
What are some signs that a baby may hyperthyroid
Not good at feeding, failing to put on weight, fidgety
What is transient neonatal thyrotoxicosis
When auto-antibodies from the mum have passed to the baby through the placenta and remain in the baby for 4-6 weeks until they are excreted from the baby’s body
What is the main strategy applied for hyperthyroidism in pregnancy
conservative and supportive management
What can be used if hyperthyroidism is unmanageable
Beta blockers
Low dose anti-thyroid drugs
What antithyroid drug can be used in the 1st trimester
Propylthiouracil
What antithyroid drug can be used in the 2nd or 3rd trimester
Carbimazole
Why is carbimazole not used in the 1st trimester
Proven to cause foetal abnormalities
Why is propylthiouracil not used in the 2nd and 3rd trimester
Can cause liver damage
If TRAb antibodies cross the placenta, what can they cause
Neonatal transient hyperthyroidism
When should TRAb antibodies be tested
Ideally third trimester
What percentage of postpartum women have postpartum thyroiditis
5%
What do patients present with if they have postpartum thyroiditis
small diffuse, non-tender goitre
When is the classic time to develop hyperemesis
10th week of pregnancy
If a patient still needs thyroxine 1 year after delivery, how likely is it that she will require it life-long
Very likely
