Endocrinology of Pregnancy Flashcards
Which hormone is tested in a pregancy test?
Human chorionic hormone
After formation of the corpus luteum, which hormone increases?
Progesterone
An acute rise in LH causes what in females?
Ovulation
Which hormone does the ovum secrete?
Oestradiol (an oestrogen)
Which hormone does the pituitary secrete during pregancy?
Prolactin
Which hormones does the placenta secrete in pregnancy?
- Human placental lactogen (hPL)
- Placental progesterone
- Placental oestrogens
Which hormones contribute to increased insulin resistance in the mother during pregnancy?
- Human placental lactogen (hPL)
- Progesterones
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)?
May develop gestational diabetes
Why is preconception control of blood glucose essential for women with diabetes?
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)
Neural defects in the foeatus can be prevented by administering women with what before conception?
Folic acid (5mg)
Which complications may be experienced in pregnancy if blood sugars are uncontrolled?
- Congenital malformation (neural tube defects)
- Prematurity
- Intra-uterine growth retardation
- Macrosomia
- Polyhydramnios
- Intrauterine death
What is polyhydramnios?
A condition involving excess amniotic fluid
(can be diagnosed on USS)
What is the definition of macrosomia?
>90th percentile for size
Which complications may be experienced by the neonate after a pregnancy of poor glucose control?
- Respiratory distress (immature lungs)
- Hypoglycaemia (used to higher glucose levels)
- Hypocalcaemia
Which microvascular complication of diabetes can worsen in pregnancy?
Retinopathy
(check eyes every 3 months)
Which types of defects may impact a foetus if the mother has poorly controlled sugars?
- Anencephaly
- Spina bifida
- Caudal regression syndrome
Why does macrosomia occur in babies whose mothers have diabetes which is poorly controlled?
- Maternal hyperglycaemia causes foetal hyperglycaemia as glucose travels across the placenta
- This makes the foetus hyperinsulinaemic
- Insulin is a major growth factor causing excess growth
- Neonates will then develop hypoglycaemia
If women have diabetes and high blood pressure before conception, what medication changes may be required?
ACE inhibitors are teterogenic - change to labetalol, nifedipine or methyldopa
What is regarded as good blood sugar control during pregancy
a) pre-meal
b) 2hr post meal?
a) <4-5.5mmol/l
b) <7mmol/l
How is T1DM treated in pregnancy?
Insulin
How is T2DM treated in pregnancy?
Metformin
Insulin usually required
How is MODY treated in pregnancy?
Glibenclamide
(a sulphonylurea)
How is gestational diabetes treated?
- Lifestyle
- Metformin
- Insulin may be required
How can it be determined after pregnancy if a woman has T2DM and not just gestational diabetes?
6 week post natal GTT
(normal result = no diabetes, abnormal = diabetes)
What is the risk to the mother that she will develop T2DM after gestational diabetes in the following 10-15 years?
up to 50%
How can mothers prevent the development of T2DM after having gestational diabetes?
- Keep weight as low as possible
- Healthy diet (low refined sugar, low sat fat, low energy foods, predominant starch)
- Aerobic exercise
- Annual fasting glucose (early warning)
- Metformin, acarbose etc
When does gestational diabetes present?
2nd or 3rd trimester
Why is it an issue is a woman has hypothyroidism and becomes pregnant?
Pregnancy puts extra strain on the thyroid meaning the woman will be even more deficient in thyroid hormones
Which two hormones can impact on the thyroid in pregnancy and how do they influence thyroxine levels?
TSH and hGC
Increase thyroxine
How much should thyroxine be increased in women who are pregnant or think they may be?
25-50 micrograms
What is the aim for TSH in pregnancy?
<3 mU/L
What are the main risks of untreated hypothyroidism in pregnancy?
Increased abortion, preeclampsia, abruption, postpartum haemorrhage, preterm labour
Foetal neuropsychological development
How is intelligence impacted in the foetus if the mother had untreated hypothyroidism in pregnancy?
Average of 7 IQ points less
Higher risk of being IQ < 85 (19% chance vs 5% chance normally)
What are the complications of hyperthyroidism in pregnancy?
- Infertility
- Spontaneous miscarriage
- Still birth
- Thyroid crisis in labour
- Transient neonatal thyrotoxicosis
What are the main causes of thyrotoxicosis in pregnancy?
- Grave’s disease
- Toxic multinodular goitre/toxic adenoma
- Thyroiditis
What is the term given to very severe morning sickness in pregnancy?
Hyperemesis gravidarum
Hyperthyroidism may be confused for what in pregnancy?
Hyperemesis gravidarum
What are the symptoms of hyperthyroid/hyperemesis in pregnancy?
- Nausea and vomiting
- Tachycardia
- Warm and sweaty
- Failure to gain weight
How can hyperthyroid be treated in pregnancy?
- Hyperemesis will settle so watchful waiting to being with
- Beta blockers can be used if required
- Low dose antithyroid drugs (propylthiouracil (1st trimester) and carbimazole (2nd trimester) if failure to settle)
Wait as late as possible to use antithyroid drugs
Why are neither carbimazole or propylthiouracil ideal in pregnancy?
Carbimalzole - teterogenic (1st trimester)
- Scalp abnormalities
- GI abnormalities
- etc
Propylthiouracil
- Liver toxicity risk
- Switch to carbimazole when possible
What is the danger of the presence of TRAb (thyroid autoantibodies) antibodies in pregnancy?
Can cause neonatal transient hyperthyroidism in the foetus
Post-partum thyroiditis is more common in women with which condition?
T1DM
Post-partum thyroiditis is _______-_________
Post-partum thyroiditis is self-limiting
After post-partum thyroititis resolves, what typically develops?
Hypothyroid phase
(thyroxine can be used to treat this)
Why should carbimazole not be used to treat post-partum thyroiditis?
Post-partum thyroiditis is followed by a period hypothyroidism
Carbimazole will worsen the hypothyroid phase if administered
After how long can thyroxine be withdrawn in women who experience hypothyroidism following post-partum thyroiditis?
After around 1 year
