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LC 02 > Endocrinology of Pregnancy > Flashcards

Endocrinology of Pregnancy Flashcards

1
Q

Fxn of placenta

A
  1. maintain corpus luteum during first 7-10 weeks
  2. Adjust maternal metabolism –> nutrients go to fetus
  3. Stim maternal circulatory system to transport gases and nutrients to and from the growing fetus
  4. Dampen uterine contractility
  5. Prepare maternal tissues for childbirth
  6. Prepare breasts for lactation
  7. Make hormones that lead to parturition
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2
Q

Insulin sensitivity in preggos

A

Early on:
Insulin sensitivity

Later on:
Insulin resistance

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3
Q

Anemia of pregnancy

A

increase in bv (30-40%) more than RBCs

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4
Q

What resp. concerns do we have for preggos?

A

Resp alkalosis
(due to increase in TV)
–>
Compensated metabolic acidosis –> lower buffering capacity –> earlier DKA

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5
Q

Increase in GFR in pregnancy leads to what?

A
  1. Decrease in BUN and Cr
  2. Increased renal bf
  3. Altered tubular fxn (glucosuria)
  4. decreased ureteral peristalsis (pyelo)
  5. Lowered osmostat for vasopressin release and thirst (hyponatremia)
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6
Q

GI changes in pregnancy

A
  1. Decreased fxn in lower esophageal sphincter (LES)
    - GERD
    - Aspiration pneumo
  2. Decreased stomach emptying, peristalsis
    - gastroparesis
    - delayed absoprtion
    - constipation
  3. Decreased GB emptying
    - cholestasis
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7
Q

Relaxin

A

potent stimulus in rats to increase GFR and renal plasma flow and decrease SVR

Softens cervix, lengthens interpubic ligament

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8
Q

Syncytiotrophoblasts

- major site of what?

A

major site of protein and steroid production

Hemochorioendothelial placentation

  • direclty bathed by maternal blood w/in intervillous space
  • separated from fetal blood by several layers of tissue
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9
Q

What day does the placenta take over and make hormones?

A

8-9 weeks

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10
Q

What hormones are actively metabolized by placenta?

A
  1. T4–> T3
    by Type III Monodeiodinase
  2. Cortisol –> cortisone
    by 11-B hydroxysteroid dehydrogenase
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11
Q

When is hCG levels highest?

A

10-12 weeks

*also when women are the sickest

!!! hCG has TSH activity at high levels –> makes T3 and T4 –> downreg TSH
- dont give antithyroid thinking its graves

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12
Q

hPGH

A

Secreted by syncytiotrophoblast

Not regulated by GHRH

Secreted tonically, and replaces pit GH ~ 20 weeks

Does not cross placenta but regulates IGF-1

Major insulin resistance hormone of pregnancy

Potent somatogen
- lost during labor and 1 hr after placenta removal

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13
Q

hPL

A
  1. Facilitates mobilization and utilization of FFAs for energy by increased lipolysis
  2. Both insulin and anti-insulin fx
  3. Stimulate insulin secretion
  4. Weak GH activity and mainly a lactogen - promotes growth of mammary tissue and stim prolactin
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14
Q

Major insulin resistance hormone of pregnancy

A

hPGH

  • decreased in growth restricted fetuses
  • women with pre-existing insulin resistance –> GDM –> further insulin resistance form placental hormones and inadequate insulin secretion
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15
Q

What should we give women with luteal defect?

A

Give women progesterone prior to 8-11 weeks

- since corpus luteum cant make it

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16
Q

Progesterone synthesis requires LDL receptors on trophoblast plasma membranes. Progesterone is the substrate for synthesis of

A

cortisol and aldosterone

17
Q

How can we prevent preterm labor?

A

give progesterone - inhibits uterine contraction

- smooth muscle relaxant (GI, uterus, GU)

18
Q

Progesterone clinical correlates in preg

A
  1. given for luteal phase defects
  2. prevents preterm labor
  3. misoprostone acts as abortifacent
  4. autoimmune ds may improve
19
Q

Estrogen fx on prl

A

Induces lactotrophs –> inhibits dopa –> increases PRL

But

Antagonizes PRL at level of breast

20
Q

E FX on T3 and T4

A

E Increases them

Double trouble

  • recall that hCG acts like TSH –> makes T3 and T4 –> neg feedback decreases TSH in early preg.
  • dont give antithyroid thinking its graves
21
Q

What hormones arrest the transit of the embryo in the reproductive tract?

A

Progesterone and hCG

22
Q

What hormone creates a suitable environment to enable placental attachment

A

progesterone and hCG

23
Q

Chorionic ACTH-CRH system

A

involved in parturition (giving birth)

24
Q

Day 4: the embryo differentiates into

What happens on day 6-7?

A

inner cell mass (fetus)
and
Trophectoderm (placenta)

Endometrial attachment of trophoblast

25
Q

What hormone induces apoptosis of endometrial T cells to promote immune survival of embryo?

A

hCG

26
Q

What hormone regulates differentiation of cytotrophoblast –> syncytiotrophoblast?
- It also regulates trophoblastic invasion

A

hCG

27
Q

What hormone can cause hyperemesis?

A

hCG

28
Q

What hormone promotes retinopathy worsening?

A

Estrogen
(increase coag factors and anemia)
(really ischemia retina not getting enough O2)

29
Q

Estrogen induced hypertriglyceridemia can cause _____

A

pancreatitis

30
Q

How does maternal utilization of E change in first half and second half of pregnancy?

A

First half of pregnancy –> increasing maternal fat stores
Second half –> diversion of glucose to placenta and increase in maternal lypolysis instead
(due to fetal depletion of liver glycogen)

  • puts mother at risk for accel starvation in pregnancy
31
Q

Why is pregnancy assoc. with lower fasting plasma glucose (~10 mg/dl)

A

due to the increase in glucose uptake by the fetoplacental unit

LC 02 (15 decks)

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