LEC 5: Health Challenges in Pregnancy Flashcards

Question

Pregnancy, Insulin, and Glucose

Answer 1

* During early pregnancy, there is a decrease in maternal glucose levels because of the heavy fetal demand for glucose. The fruts is also drawing amino acids and lipids from the mother, decreasing the mother's ability to synthesize glucose. Maternal glucose is diverted across the placenta to assits the growing embryo/fetus during early pregnancy. As a result, maternal glucose concentrations decline to a level that would be considered "hypoglycemic" in anon-pregnant woman. During early pregnancy there is also a decrease in maternal insulin production and insulin levels. * The pancreas is responsible for the production of insulin, which facilitates entry of glucose into cells. Although glucose and other nutrients easliry cross the palcenta to the fetus, insulin does not. Therefore, the fetus must produce its own insulin to facilitate the entry of glucose into its own cells. * After the first trimester, hPL from the placenta and steroids (cortisol) from teh adrenal cortex act against insulin. hPL acts as an antagonist against maternal insulin, and thus more insulin must be secreted to counteract the increasing level of hPL and cortisol during the alst half of pregnancy. * Prolactin,e strogen, and progesterone are also thought o possie insuline. As a reuslt, glucose is less likely to enter the mother's cells and is more likely to corss over the placenta to the fetus.

Answer 2

* Incidence between 3 to 20% * Pre-existing diabetes * Developes after 20 weeks * Gestationla diabetes GDM * Glucose intolerance in pregnancy * 3.5% of non-Aboriginal women and up to 18% of Aboriginal women * Pre-existing not previously diagnosed * Increased risk of stillbirth, comorbid hypertension, injuries at delivery (larger baby), risk of developing type 2 diabetes

Answer 3

1. Fetus continually takes glucose from the mother 2. Placenta creates hromones, which alter effects of and resistance to insulin and glucose tolerance

Answer 4

* Is a diabetogenic effect of pregnancy * **First Trimester of Pregnancy** * ****Rise in hormones stimulate insulin production and increase tissue response to insulin * In the 1st trimester insulin needs frequently decrease * **Second and Third Trimester of Pregnancy** * ****Placental secretion of hPL begins * Increase resistance to insulin and decrease glucose tolerance * Insulin needs increase (may douple or triple by end of pregnacy) * Increase insluin required ot maintian normal concentration **RESULTS IN** * **Renal thershold for glucose decrease** * **Progress of vascualr disease may be accelerated**

Answer 5

* Preeclampsia/ exlampsia increase dt vascualr change * Polyhydramnios * PROM, premature rupture of membranes * Preterm labour * Worsening myopathies * Vascualr, renal, retinal * Pre-existing diabetes * Increase ketosis * Increase gestational hypertension * Increase type 2 diabetes later in life

Answer 6

* Macrosomia * Intrauterine growth restriction * Fetal demise * Congenital anomalies * Associated with pre-existing diabetes

Answer 7

* **Neonatal Effects** * Hypoglycemia * Hyperbilirubinemia * Immature respiratory develipment = RDS * **Child Effects** * ****Increased risk of developing diabetes and obesity

Answer 8

* Be sure to keep your apporintments for frquent prenatal visits and tests for fetal well-being * Perform blood glucose self-monitoring as directed, usually before each meal and at bedtime. Keep a record of your results and call your health care provider with any levels outside the established range. Bring your results to each prenatal visit. * Perform daily "fetal kick counts". Document them and reort any decrease in activity. * Drink 8 to 10 8-ounce glasses of water each day to prevent bladder indections and maintian hydration. * Wear proper, well-fitted footwear when walking to prevent injury. * Engage in a regular exercise program such as walking to aid in glucose control, but avoid exercising in temperature extremes. * Consider breastfeeding your ijnfant to lower your blood glucose levels. * If you are taking insulin: * Adminsiter the correct dose of insulin at the ocrrec time every day. * Eat breakfast within 30 minutes after injecting regular insulin to prevent a reaction. * Plan meals at a fixed time and snacks to prevent extremes in glucose levels. * Avoid simple sugars (cake, candy, cookies) , which rise blood glucose levels. * Know the signs and symptoms of hypoglycemia and trreatment needed: * Sweating; tremors; cold, clammy skin; headache * Feeling hungry, blurred vision, disorientation, irritability * Treatment: Drink 8 onces of milk and eat two crackers or glucose tablets * Carry glucose boosters to prevent hypoglycemia * Know the signs and symptoms of hypoglycemia and treatment needed: * Dry mouth, frequent urination, excessive thirst, rapid breathing * Feeling tired, flushed, hot skin, headache, drowsiness * Treatment: Notify healthcare provider, since hospitalization may be needed * Wear a diabetic identification bracelet at all times * Wash your hads frquently to prevent infections * Report any signs and symptoms of illness, infection, and dehydration to your health care provider, because these can affect blood glucose control.

Answer 9

* Being * 35 years of age or older * From a high-risk group * African, Arab, Asian, Hispanic, Indigenous, South Asian ethnicity * Using * Corticosteroid medication * Having * Obesity (BMI \>30) * Prediabetes * GDM in a previous pregnancy * Previous newborn \>4kg * A parent, brother or sister with type 2 diabetes * Polycystic ovary syndrome * **Recommended** * ****Breastfeed immediately after birth and for a minimum of 4 months in order to prevent hypoglycemia in your newborn, obesity in childhood, and diabetes for both you and your child

Answer 10

* CDA quidelines suggest routine screening of all women * At 24 to 28 weeks gestation with 50g glucose challenge test (GCT), using a threshold of 7.8 mmol/L (140 mg/dL) * 75g fasting glucose tolerance test (GTT) if \>7.8

Answer 11

* **Goal:** To attain and maintain a **euglycemic** state * Multidisciplinary team appraoch to controlling blood sugar * Aim for fasting of \<5.3 mmol/L, 1 hour pc \<7.8 mmol/L * Glucose monitoring * 4 to 7 times per day * Diet controled * Exercise * Daily * pc meals * Insulin as needed (still drug of choice) * Oral antiglycemics * Neeed for increase folic acid * Maternal risk for infections * Evaluate maternal/fetal conditon

Answer 12

* If euglycemic on diet, no special considerations in lanour * For IDDM: * Balance insulin with need for increase energy in labour * Monitor blood sugars q1-2h * Individualized IV glucose and IV insulin * Postmartum * Insulin requirements decrease significantly * Aprox. 20% will have IGT * 45% to 50% incidence of Type 2 diabetes within 5 years * Rarely diabetic immediately postpartum

Answer 13

* **May be increased risk for** * ****Preterm labour * Anemia and hypertension of pregnancy * Abnormal presentation * Twin-to-twin transfusion syndrome * Uterine dysfunction * Abription placenta/ placenta previa * Prolapsed cord * Postpartum hemmorhage

Answer 14

* Increased risk for motehr * C/S, GHTN, PPH * Increased intensity of compliants * Chorness of breath * Edema * Nausea, vomiting, heartburn * Insomnia, fatigue * Weight gain

Answer 15

* Excessive limitless weight gain in pregnancy is the most common cause of obesity in later life. * Women who gain \>25 kg in pregnancy have a very difficult time losing PP weight and often it remains a lifelong struggle * Possible link to hypertension, diabetes and obesity in later life for children borne of obese mother

Answer 16

* Spontaneous abortion/ stillbirth * Hypertension * Diabetes * Challenging to assess fetus during labour * Anesthetics can be challenging * Harder to insert epidural catheter

Answer 17

* Macrosomia/ Shoulder dystocia * Challenges in assessing fetus/ contractions * Increase cesarean * Anesthesia challenges * Increase thromboembolism

Answer 18

* Hypoglucemia * Breastfeeding issues * Birth defects

Answer 19

* Infection * Mobility * Thrombosis

Answer 20

* Begin pregnancy with BMI \< 30 * Pre‐conceptual assessment and counseling * Weight gain for BMI \> 30, total weight gain 7 kg (SOGC) * Nutrition ( increase folic acid preconception and first trimester) * Exercise * Risk of adverse outcomes for mom and baby * AP consultation with anesthesiologist * Assessment for risk of VTE

Answer 21

* Increased risk in physical and psycosocial * Physical * Preterm birth * Low birth weight infant * CPD * Anemia * GHTN * Psychosocial * Interruption of developmental tasks * Substance abuse * Poverty * Interruptiono r cessation of education * Less prenatal visits

Answer 22

* Promote physical health of adolescent with regular prenatal * Prenatal education * Support * Information about complications * Family adaptationvisits

Answer 23

* Support in school * INter-generationla households * Trusting relationship with healthcare providers * Promoting self-esteem and problem solving skills

Answer 24

* u35 * SK 2009 – 2010; 8.6% to mom’s \> 35; 1.6% to mom’s \> 40 * Decline in fertility * Increase in chronic diseases * Hypertension, cardiac, thyroid, cancers etc. * Increased difficulties in pregnancy * GDM, GHTN, PTL, Multiples, IUGR, Placenta previa, miscarriage, ectopic, stillbirth, neonatal death * Increased risk of c-section, induction * Increased genetic conditions, congenital anomalies

Answer 25

* 18.9% socially high-risk pregnant women use recreational drugs, 11% daily (Bowen, 2007) * 14% of Canadian women reported using alcohol during their last pregnancy, and 17% reported smoking during pregnancy. (SOGC, 2011) * In genreal, pregnant woman with substance use disorders are less likely to seek prenatal care, and they have higher rates of infectious disease such as HIV, hepatitis, and other sexually transmitted infections

Answer 26

* Spontaneous abortion * Inadequate weight gain * IUGR * Fetal alcohol psectrum disorer * The leading cause of metnal retardation

Answer 27

* Vasoconstriction and mild diuresis in mother * Fetal stimulation, but teratogenic effects not docu,entd via research

Answer 28

* Vasoconstriction * Reduced uteroplacental blood flow * Decreased birth weight * Abortion * Prematurity * Abruption of placenta * Fetal demise

Answer 29

* Vasoconstriction * Gestational hypertension * Abription placenta * Abortion * Snow baby syndrome * CNS defects * IUGR

Answer 30

* Anemia * Inadequare weight gain * Amotivational syndrome * Hyperactive startle reflex * Newborn tremors * Prematurity * IUGR

Answer 31

* Maternal and fetal withdrawal * Abruption placenta * Preterm labour * Premature rupture of membranes * Prenatal asphyxia * Newborn sepsis and death * Intelelctural impairment * Malnutrition

Answer 32

* CNS depression * Newborn withdrawal * Maternal seizures in labour * Newborn abstinence syndrome * Delayed lung maturity

Answer 33

* Most commonly used for women dependent on opioids- heroin * Blocks withdrawal symptoms * Reduces or eliminates the craving for narcotics * Corsses the placenta * Associated with pregnancy complications and abnormal fetal presentation * Prenatal exposure * Reduced head circumference and lwoer birth weight * Withdrawal symptoms

Answer 34

* Can negatively impact fertility * Crosses placenta * May harm a developing fetus * Associated with negative long-term effects in childhood and beyond * Passes into breastmilk * May cause negative developmental effects * Can negatively impact parenting

Answer 35

* Watch for signs of withdrawal * Watch for signs of drug use * Leave unit, leave baby unattened, high

Answer 36

* Watch for signs of withdrawal * Active use * NICU for observation and treatment * NAS scoring

Answer 37

* Pregnant women and breastfeeding mothers should have no more than **300 mg of caffeine per day** from all sources. This is approximately 2 (250 ml) cups of coffee * Large amounts of caffeine may increase the chances of: * Miscarriage * Premature delivery * Low birth weight * Withdrawal symptoms in newborn

Answer 38

* Alcohol * Drugs * Presccribed medications * Pathogens

Answer 39

* **CHEAP** * ******C**hickenpox and shingles * **H**epatitis B, C, D, E * **A**IDS * **P**arvovirus B19 * **TORCHES** * **T**oxoplasmosis * **O**ther (STI's, HIV, Hepatitis B, GBS) * **R**ubella * **C**ytomegalovirus * **H**erpes Simplx * **E**very STO * **S**yphilis

Answer 40

* Spontaneous abortions * Preterm delivery * Maternal and fetal morbidity and mortality

Answer 41

* GBS are common bacteria which are often fround in the vagina, rectum, or bladder of 15 to 40% of women * Screening by vaginal/ rectal culture 35 to 37 weeks * Treated with antibiotics in labor * Screen and treatl all women who are GBS+ * Treat based on risk factors

Answer 42

* Preterm labour before 37 weeks gestation * With or without ROM * Term rupture of membranes \>18 hours * Unexplained, mild fever during labour * Previous baby with a GBS infection * Previous or present GBS beacteruria caused by the GBS bacteria

Answer 43

* Modes of mother to child (vertical) transmission: * In utero (through the placenta) * During childbirth and delivery * Postpartum through breastfeeding * Without treatment: ≈ 25% chance of mother to child transmission * With proper treatment: less than 2% chance of mother to child transmission

Answer 44

* Behaviours that support a health immune system (proper sleep,and nutrition, regular contact with health professionals) * Use of delivery, dependent on maternal viral load and use of cART * Complimentary treatments (traditional Aboriginal healing practices, acupuncture)

Answer 45

* Three-part antiretroviral treatment (ART) prophylaxis regimen reduces risk of transmission to infant * Pregnancy/Antepartum - cART * Labor – Add Intravenous ZDV during labor until birth/3 hrs. prior to Cesarean birth * Infant – ZDV oral suspension * Given for 6 weeks * Testing at birth, 1 month, 3 months and 18 months * No Breastfeeding * Following Birth * Positive antibody titer * Refleccts the passive transfer of meternal antibodies rather than HIV infection * No breastfeeding (3rd world contries ok) * Seeing some reduction in transmission if loew viral load and breastfeeding exclusively