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The Endocrine System > Endocrinology of Pregnancy > Flashcards

Endocrinology of Pregnancy Flashcards

1
Q

Which hormone is tested in a pregancy test?

A

Human chorionic hormone

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2
Q

After formation of the corpus luteum, which hormone increases?

A

Progesterone

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3
Q

An acute rise in LH causes what in females?

A

Ovulation

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4
Q

Which hormone does the ovum secrete?

A

Oestradiol (an oestrogen)

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5
Q

Which hormone does the pituitary secrete during pregancy?

A

Prolactin

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6
Q

Which hormones does the placenta secrete in pregnancy?

A
  1. Human placental lactogen (hPL)
  2. Placental progesterone
  3. Placental oestrogens
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7
Q

Which hormones contribute to increased insulin resistance in the mother during pregnancy?

A
  1. Human placental lactogen (hPL)
  2. Progesterones
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8
Q

What happens if a woman is predisposed genetically to insulin resistance and also experienced incfeased insulin resistance due to the effects of progesterones and human placental lactogen (hPL)?

A

May develop gestational diabetes

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9
Q

Why is preconception control of blood glucose essential for women with diabetes?

A

Deformities can occur before 5 weeks and many women do not know they are pregnant at this stage

Trying to alter blood glucose at this stage is too late

(this is when foetal organogenesis occurs)

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10
Q

Neural defects in the foeatus can be prevented by administering women with what before conception?

A

Folic acid (5mg)

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11
Q

Which complications may be experienced in pregnancy if blood sugars are uncontrolled?

A
  1. Congenital malformation (neural tube defects)
  2. Prematurity
  3. Intra-uterine growth retardation
  4. Macrosomia
  5. Polyhydramnios
  6. Intrauterine death
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12
Q

What is polyhydramnios?

A

A condition involving excess amniotic fluid

(can be diagnosed on USS)

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13
Q

What is the definition of macrosomia?

A

>90th percentile for size

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14
Q

Which complications may be experienced by the neonate after a pregnancy of poor glucose control?

A
  1. Respiratory distress (immature lungs)
  2. Hypoglycaemia (used to higher glucose levels)
  3. Hypocalcaemia
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15
Q

Which microvascular complication of diabetes can worsen in pregnancy?

A

Retinopathy

(check eyes every 3 months)

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16
Q

Which types of defects may impact a foetus if the mother has poorly controlled sugars?

A
  1. Anencephaly
  2. Spina bifida
  3. Caudal regression syndrome
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17
Q

Why does macrosomia occur in babies whose mothers have diabetes which is poorly controlled?

A
  1. Maternal hyperglycaemia causes foetal hyperglycaemia as glucose travels across the placenta
  2. This makes the foetus hyperinsulinaemic
  3. Insulin is a major growth factor causing excess growth
  4. Neonates will then develop hypoglycaemia
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18
Q

If women have diabetes and high blood pressure before conception, what medication changes may be required?

A

ACE inhibitors are teterogenic - change to labetalol, nifedipine or methyldopa

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19
Q

What is regarded as good blood sugar control during pregancy

a) pre-meal
b) 2hr post meal?

A

a) <4-5.5mmol/l
b) <7mmol/l

20
Q

How is T1DM treated in pregnancy?

A

Insulin

21
Q

How is T2DM treated in pregnancy?

A

Metformin

Insulin usually required

22
Q

How is MODY treated in pregnancy?

A

Glibenclamide

(a sulphonylurea)

23
Q

How is gestational diabetes treated?

A
  1. Lifestyle
  2. Metformin
  3. Insulin may be required
24
Q

How can it be determined after pregnancy if a woman has T2DM and not just gestational diabetes?

A

6 week post natal GTT

(normal result = no diabetes, abnormal = diabetes)

25
Q

What is the risk to the mother that she will develop T2DM after gestational diabetes in the following 10-15 years?

A

up to 50%

26
Q

How can mothers prevent the development of T2DM after having gestational diabetes?

A
  1. Keep weight as low as possible
  2. Healthy diet (low refined sugar, low sat fat, low energy foods, predominant starch)
  3. Aerobic exercise
  4. Annual fasting glucose (early warning)
  5. Metformin, acarbose etc
27
Q

When does gestational diabetes present?

A

2nd or 3rd trimester

28
Q

Why is it an issue is a woman has hypothyroidism and becomes pregnant?

A

Pregnancy puts extra strain on the thyroid meaning the woman will be even more deficient in thyroid hormones

29
Q

Which two hormones can impact on the thyroid in pregnancy and how do they influence thyroxine levels?

A

TSH and hGC

Increase thyroxine

30
Q

How much should thyroxine be increased in women who are pregnant or think they may be?

A

25-50 micrograms

31
Q

What is the aim for TSH in pregnancy?

A

<3 mU/L

32
Q

What are the main risks of untreated hypothyroidism in pregnancy?

A

Increased abortion, preeclampsia, abruption, postpartum haemorrhage, preterm labour

Foetal neuropsychological development

33
Q

How is intelligence impacted in the foetus if the mother had untreated hypothyroidism in pregnancy?

A

Average of 7 IQ points less

Higher risk of being IQ < 85 (19% chance vs 5% chance normally)

34
Q

What are the complications of hyperthyroidism in pregnancy?

A
  1. Infertility
  2. Spontaneous miscarriage
  3. Still birth
  4. Thyroid crisis in labour
  5. Transient neonatal thyrotoxicosis
35
Q

What are the main causes of thyrotoxicosis in pregnancy?

A
  1. Grave’s disease
  2. Toxic multinodular goitre/toxic adenoma
  3. Thyroiditis
36
Q

What is the term given to very severe morning sickness in pregnancy?

A

Hyperemesis gravidarum

37
Q

Hyperthyroidism may be confused for what in pregnancy?

A

Hyperemesis gravidarum

38
Q

What are the symptoms of hyperthyroid/hyperemesis in pregnancy?

A
  1. Nausea and vomiting
  2. Tachycardia
  3. Warm and sweaty
  4. Failure to gain weight
39
Q

How can hyperthyroid be treated in pregnancy?

A
  1. Hyperemesis will settle so watchful waiting to being with
  2. Beta blockers can be used if required
  3. Low dose antithyroid drugs (propylthiouracil (1st trimester) and carbimazole (2nd trimester) if failure to settle)

Wait as late as possible to use antithyroid drugs

40
Q

Why are neither carbimazole or propylthiouracil ideal in pregnancy?

A

Carbimalzole - teterogenic (1st trimester)

  • Scalp abnormalities
  • GI abnormalities
  • etc

Propylthiouracil

  • Liver toxicity risk
  • Switch to carbimazole when possible
41
Q

What is the danger of the presence of TRAb (thyroid autoantibodies) antibodies in pregnancy?

A

Can cause neonatal transient hyperthyroidism in the foetus

42
Q

Post-partum thyroiditis is more common in women with which condition?

A

T1DM

43
Q

Post-partum thyroiditis is _______-_________

A

Post-partum thyroiditis is self-limiting

44
Q

After post-partum thyroititis resolves, what typically develops?

A

Hypothyroid phase

(thyroxine can be used to treat this)

45
Q

Why should carbimazole not be used to treat post-partum thyroiditis?

A

Post-partum thyroiditis is followed by a period hypothyroidism

Carbimazole will worsen the hypothyroid phase if administered

46
Q

After how long can thyroxine be withdrawn in women who experience hypothyroidism following post-partum thyroiditis?

A

After around 1 year

The Endocrine System (35 decks)

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