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Physiology Midterm > Module 2: Pregnancy II > Flashcards

Module 2: Pregnancy II Flashcards

1
Q

ovulation

A

mature egg released from ovary
moves down fallopian tube

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2
Q

fertilization

A

Fimbriae: little fingers that draw egg into fallopian tube
Implants into endometrium
Implants on day 8-9 post-fertilization

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3
Q

what is gestational diabetes mellitus (GDM)?

A

GDM: hyperglycemia

Glucose intolerance of variable severity with onset or first recognized in pregnancy

Hormone levels of progesterone, cortisol, hPL, prolactin, and growth hormone are increased. This decreases insulin sensitivity and allows adequate glucose transmission to fetus. There will be no compensatory increase in insulin secretion which leads to hyperglycemia.

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4
Q

how common is GDM?

A

Affects 7% of all pregnancies
Depending on population, can be as high as 14%
New york state: 6.5%
NYC: 11.5%

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5
Q

hormones causing GDM

A

Human placental lactogen
- Sends more glucose to the baby
- Main culprit
Progesterone
Cortisol
Growth hormone
Prolactin

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6
Q

normal glucose metabolism during pregnancy

A

Mild fasting hypoglycemia
Postprandial hyperglycemia
Higher blood sugars after eating
Hyperinsulinemia

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7
Q

abnormal glucose metabolism in GDM

A

More insulin resistant
Impaired release of insulin

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8
Q

maternal complications of GDM

A

Pre-eclampsia
C-section
Postpartum hemorrhage
3rd and 4th degree laceration
Development of type 2 DM later in life

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9
Q

pre-eclampsia

A

10% of pregnancies
Blood pressure goes up
Protein in urine
Can cause stillbirth, seizures, kidney failure
Only cure is to deliver the baby → problem comes from placenta
Most typical during end of pregnancy, but can be premature and problematic
Can develop almost overnight

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10
Q

fetal short-term complications of GDM

A

Large baby/macrosomia (>9 pounds)
Shoulder dystocia/birth injury
Stillbirth
Respiratory distress syndrome
Cardiomyopathy
Hypoglycemia
Electrolyte abnormalities
Polycythemia/hyperbilirubinemia

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11
Q

shoulder dystocia

A

Head comes out, shoulders stuck in pelvis
Can get nerve injury
Broken clavicle
Lowered oxygen to brain

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12
Q

fetal long-term complications of GDM

A

Increased risk as child/adult of:
Diabetes
Obesity
Hypertension
Metabolic syndrome
Learning disabilities and autism

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13
Q

screening for GDM

A

Tested 24-28 weeks
1 hour glucose challenge test (50g glucose load)
If score >135, perform 3 hr glucose tolerance test (100g glucose load)
If score >200, no need for 3 hr test
2 out of 4 values need to be elevated for diagnosis of GDM
Carpenter/Coustan criteria

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14
Q

treatment for GDM (non-pharmacologic)

A

About 2000 kcal/day diet
Complex carbohydrates 40%
Protein 20%
Unsaturated fat 40%
Exercise 20-30 minutes per day
Once giving birth, you no longer have GDM (insulin treatment can be immediately stopped)

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15
Q

treatment for GDM (pharmalogic)

A

Metformin
- Crosses the placenta
- Side effects: nausea, vomiting, diarrhea, abdominal, cramping, bloating
- 10-46% need insulin
Insulin
- Doesn’t cross the placenta
- Gold standard

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16
Q

future risks of GDM

A

Recurrence risk if ~40% in future pregnancies
Increased risk for type 1 DM, type 2 DM, metabolic syndrome, and cardiovascular disease
30% will have impaired glucose tolerance in the early postpartum period
10x higher risk of developing type 2 DM in the future
2x higher risk for future cardiovascular disease

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17
Q

obesity increases risks for (fertility related)

A

Women with obesity have higher risk for infertility
- If they have polycystic ovarian syndrome, the loss of just 5-10% of body weight will restore ovulation in 55-100% within six months
Obesity increases risk for miscarriage
Obesity increases risk for birth defects (e.g. spina bifida)
Obesity increases risk for stillbirth
Underweight (BMI <18) also have higher risk of infertility and preterm labor
- Prevents ovulation

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18
Q

pre-conception weight loss counseling

A

Try to achieve normal BMI (<25) prior to pregnancy
Losing any weight can be helpful
Small nutritional changes
Increasing activity levels

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19
Q

weight gain in pregnancy

A

Necessary to provide nutrients to developing fetus
Nutrient stores for breastfeeding
Too little or too much weight gain can result in complications

20
Q

if obese pregnant women gain less than recommendation,

A

reduced risk of preeclampsia

21
Q

IOM weight guidelines, twins

A

Adequate weight gain is especially important in twins because growing small or premature birth is more common

22
Q

underweight pregnant women have higher risk of

A

preterm birth
ensure is recommended as a supplement

23
Q

Increased Gestational Weight Gain (even if starting pregnancy at a normal weight) leads to increased risk for

A

Increased risk for:
Pre-eclampsia
Gestational diabetes
Large baby (macrosomia)
C-section
Delayed lactation
Postpartum obesity

24
Q

major pregnancy hormones

A

human chorionic somatotropin
human placental lactogen
leptin

25
Q

human chorionic somatotropin

A

Increases insulin resistance
Promotes fat breakdown for energy

26
Q

human placental lactogen

A

Increases availability of glucose and amino acids
Implicated in gestational diabetes

27
Q

leptin

A

Regulates appetite and lipid metabolism
Regulates weight gain and utilization of fat stores

28
Q

undernutrition reduces

A

uterine blood flow

29
Q

placenta development

A

Develops from embryonic tissue (before fetus)
Larger than the fetus
Uses 30-40% of glucose delivered by maternal circulation

30
Q

placenta functions

A

Hormone and enzyme production
Nutrient and gas exchange
Removal of waste products
Barrier to some harmful compounds

31
Q

things passed mother to fetus

A

Water electrolytes, urea, FFAs, steroids, vitamins, glucose, amino acids, calcium, iron, iodine, globulins, phospholipids, lipoproteins

32
Q

things passed fetus to mother

A

Carbon dioxide, water, urea, hormones, cytokines

33
Q

the fetus is NOT a parasite

A

Nutrients are first used for maternal needs, then for placenta, and last for fetal needs
The fetus is harmed more than the mother by poor maternal nutrition

34
Q

What changes in kidney function occur during pregnancy and what are some consequences of these changes?

A

Increased glomerular filtration rate (50-60%)
If on medications processed by the kidneys, dosage must increase
Increased sodium conservation
Increased risk for urinary tract infections
Increased frequency of urination
Progesterone stimulates bladder to contract more often

35
Q

cardiovascular changes during pregnancy

A

Blood volume increases by 20%
Increase in heart rate by 16%
Increase stroke volume by increasing the cardiac output and heart rate
Decrease in blood pressure
Around 8 weeks is lowest blood pressure
Heart enlarges (cardiomegaly)
If you become pregnant and have history of heart problems, they will likely worsen (Pregnancy puts a lot of pressure on the heart)

36
Q

Why shouldn’t women lay on their backs after 20 weeks (like Beyoncé when performing last year)? What happens to blood volume during pregnancy and why?

A

Aortocaval compression syndrome

After 20 weeks, pregnant people must sleep on their side
Inferior vena cava is compressed by the uterus → decreased blood supply to the heart → low blood pressure

37
Q

Why are pregnant women often short of breath?

A

Increased amount of air inhaled and exhaled
Increased oxygen consumption
Increased respiratory rate
“Dyspnea of pregnancy”

38
Q

musculoskeletal changes are caused by which hormone

A

relaxin

39
Q

musculoskeletal changes during pregnancy

A

Exaggerated lordosis of the lower back, forward flexion of the neck, and downward movement of the shoulders compensate for the enlarged uterus and change in center of gravity
- This is why pregnant women are at high risk of injury or falling
Joint laxity in the ligaments of the lumbar spine
Widening and increased mobility of the sacroiliac joints and pubic symphysis

40
Q

What is the role of progesterone in the GI tract during pregnancy and what symptoms are associated with these effects?

A

Increased gastric and intestinal transit time
Heartburn
Constipation
Nausea and vomiting

41
Q

skin changes caused by estrogen

A

Estrogen → darkening of skin
Linea nigra → line from pubic symphysis to zyphoid process (middle of chest)
Darker axilla (armpits)/groin/areola
vascular spiders
All temporary!

42
Q

melasma

A

mask of pregnancy
Up to 75% of pregnant people
Darker cheeks/forehead/upper lip/noise
Often goes away, but sometimes lasts for years

43
Q

nevi enlarge

A

moles get bigger

44
Q

palmar erythema

A

red palms

45
Q

varicosities

A

veins are larger and filled with blood (legs and vulva)

46
Q

hair changes during pregnancy

A

Hirsutism: increased hair on face, trunk, extremities
Scalp hair: thicker/denser due to slowing of the normal progression of hairs from anagen (the “growing” stage) to telogen (the “resting” stage) so more hairs are in the anagen phase
Postpartum: 1-5 months postpartum hair loss (telogen effluvium) is common and scalp hair becomes thin

Physiology Midterm (7 decks)

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