Endocrinology problems in pregnancy Flashcards
What hormones are secreted from:
- ovum
- fertilisation
- corpus luteum
- placenta
Ovum - estradiol
Fertilisation - HCG
Placenta - human placental lactogen, placental progesterone, placental estrogens
What is gestational diabetes?
insulin resistance in mother (Progesterones and hPL) and if predisposed this leads to increases blood glucose levels during pregnancy
=gestational diabetes
Does gestational diabetes resolve at delivery?
yes - to ensure this do a 6wk post-natal GCC
Does gestational diabetes predispose to diabetes in later life?
50% fine after
50% 10-12 years post disease get T2DM
<5% T1DM
How can T2DM be prevented/monitored after gestational diabetes?
- healthy BMI
- Diet
- Aerobic exercise
- Annual fasting glucose
What complications of pregnancy does gestational diabetes predispose to?
- congenital malformations
- prematurity
- intrauterine growth retardation
- macrosomia >90th centile for size
- polyhydramnios
- intrauterine death
What complications does gestational diabetes predispose to in the neonate?
- resp. distress
- hypogylcaemia can lead to fits (maternal hyperglycaemia leads to foetal hyperglycaemia and this causes foetal hyperinsulinaemia and then when baby is born = hypoglycaemia)
- hypocalcaemia (fits)
- CNS defects: anencephaly/spina bifida
- Skeletal abnormality: caudal regression syndrome
what is the diagnosis of gestational diabetes?
Diagnose gestational diabetes if the woman has either:
a fasting plasma glucose level of 5.6 mmol/litre or above or a 2-hour plasma glucose level of 7.8 mmol/litre or above.
How is gestational diabetes managed?
- Diet and exercise if fasting level <7mmol/L at diagnosis
- metformin if targets not met by lifestyle changes within 1-2wks, if targets still not met add insulin
- Insulin if metformin can’t be given
- Immediate insulin with or without metformin if fasting level >7mmol/L at diagnosis, or if levels are 6-6.9mmol/L and there are complications (macrosomia/polyhydramnios)
-if can’t tolerate metformin or who decline insulin therapy and metformin isn’t enough consider glibenclamide2
Describe the management of T1DM and T2DM in pregnancy
- Pre-pregnancy counselling
- folic acid 5mg
- consider change from tablets to insulin
- regular eye checks (accelerates diabetic retinopathy
- avoid ACEI and statins (for BP use labetalol, nifedipine, methyldopa)
What is the effect of hCG on thyroid hormones? How does the plasma protein binding of thyroid hormones change during pregnancy?
hCG: low TSH, fT4 increases, hyperemesis gravidarium
TBG: increases protein binding - usually fT4, so fT4 levels may fall if hypothyroid and pregnant
How is hypothyroidism managed during pregnancy?
- Unable to compensate for increase in TBG therefore thyroxine dose is increased as soon as pregnancy suspected
- TBG plataeus at 20wks, check TFTs for 1st 20 weeks then 2monthly until term - aim for TSH<3mU/L
what is the risk of untreated hypothyroidism in pregnancy?
- miscarriage
- preeclampsia
- abruption
- postpartum haemorrhage
- preterm labour
- foetal neuropsychological development
What are the causes of hyperthyroidism in pregnancy’?
- graves disease
- TMNG
- toxic adenoma
- thyroiditis
- gestational hCG thyrotoxicosis
What are the complications of thyrotoxicosis in pregnancy?
- infertility
- spontaneous miscarriage
- stillbirth
- thyroid crisis in labour
- transient neonatal thyrotoxicosis
