Preconception Care/ Pregnancy Care Flashcards
When is the best time to engage in preventive health discussions for pregnancy?
A. During the first trimester
B. During the “fourth trimester”
C. Before pregnancy is planned
D. After a missed period
C. Before pregnancy is planned
Correct: Preventive discussions before conception allow time for interventions like folic acid supplementation.
Incorrect Options:
A: Preventive discussions are most effective before pregnancy.
B: The “fourth trimester” is for postnatal care, not initial prevention.
D: After a missed period may be too late for critical interventions.
What is pica, and why is it a concern during pregnancy?
A. Craving for high-sugar foods; it increases gestational diabetes risk
B. Consumption of nutritionally void substances; it may replace healthful foods
C. Preference for bland diets; it can lead to iron deficiency
D. A rare genetic condition; it poses no significant risks
B. Consumption of nutritionally void substances; it may replace healthful foods
Correct Answer Explanation:
Pica is the craving and consumption of non-nutritive substances such as dirt, clay, chalk, ice, or even paint chips. These behaviors can lead to nutritional deficiencies, such as iron or zinc deficiency, because the substances consumed may replace healthy foods in the diet. Pica during pregnancy often signals an underlying nutritional imbalance, particularly iron deficiency anemia, which needs to be addressed with appropriate supplementation and dietary adjustments.
Incorrect Options Clarified:
A: Sugar cravings, while common in pregnancy, do not fall under the definition of pica. They are typically related to hormonal changes and energy demands.
C: Pica does not refer to eating bland foods. It involves non-food items with no nutritional value.
D: Pica does pose risks, such as toxic exposure (e.g., lead in paint chips) or digestive blockages, making it a significant health concern during pregnancy.
Which of the following statements is correct regarding exercise during pregnancy?
A. Pregnant women should avoid all forms of exercise.
B. Balance issues and joint relaxation may increase the risk of orthopedic injury.
C. Exercise during pregnancy has been shown to harm fetal development.
D. Exhaustion and overheating during exercise are not concerns for pregnant women.
B. Balance issues and joint relaxation may increase the risk of orthopedic injury.
Correct Answer Explanation:
These issues arise as pregnancy progresses, increasing injury risk. Pregnancy introduces balance issues due to a shifting center of gravity and joint relaxation caused by increased levels of the hormone relaxin. These factors can heighten the risk of falls and orthopedic injuries, especially during high-impact or unstructured exercise. Safe exercises during pregnancy are those that promote strength, flexibility, and endurance without overexertion or excessive joint stress. Examples include:
Low-impact aerobic exercises: Walking, swimming, and stationary cycling.
Prenatal yoga or pilates: Focuses on flexibility and strength while improving balance and reducing stress.
Strength training: Using light weights or resistance bands with controlled movements to avoid strain.
Kegel exercises: Strengthen pelvic floor muscles to support pregnancy and aid postpartum recovery.
Incorrect Options Clarified:
A: Exercise is not inherently dangerous during pregnancy. In fact, it provides numerous benefits, such as improved circulation, reduced back pain, and better mental health. However, activities involving high impact, heavy lifting, or the risk of falls (e.g., skiing, horseback riding) should be avoided.
C: Exercise does not harm fetal development when done safely and with guidance. It improves overall pregnancy outcomes, including reduced risk of gestational diabetes and preeclampsia.
D: Exhaustion and overheating are concerns, but they can be mitigated by avoiding strenuous activities, staying hydrated, and exercising in a cool environment.
What are the risks associated with tobacco and nicotine use during pregnancy?
A. High birth weight and delayed labor
B. Placental abruption, low birth weight, and orofacial clefts
C. Reduced susceptibility to respiratory infections
D. Faster postnatal growth in newborns
B. Placental abruption, low birth weight, and orofacial clefts
Correct: Tobacco and nicotine use increase these risks.
Incorrect Options:
A, C, D: These do not accurately reflect tobacco risks.
Effects of Nicotine Use in Pregnancy
Correct Answer Explanation:
Tobacco and nicotine exposure during pregnancy significantly increase the risks of placental abruption, low birth weight, and orofacial clefts:
Placental abruption: Smoking reduces blood flow to the placenta due to nicotine-induced vasoconstriction, which can result in the placenta detaching prematurely from the uterine wall. This is a life-threatening condition for both the mother and fetus.
Low birth weight: Nicotine and carbon monoxide from cigarettes .
Orofacial clefts (e.g., cleft lip and palate): Smoking during pregnancy interferes with embryonic development by exposing the fetus to teratogens, increasing the likelihood of these birth defects.
- Hypoxia (Reduced Oxygen Supply)
Tobacco smoke contains carbon monoxide (CO) and nicotine, which interfere with oxygen delivery: - Carbon monoxide binds to hemoglobin binding sites with a much higher affinity than oxygen, reducing the amount of oxygen transported in the blood. The reduce oxygen availability to the fetus restricts fetal growth.
- Nicotine causes vasoconstriction (narrowing of blood vessels), further restricting oxygen and nutrient flow to the placenta and fetus.
- Effects:
Low birth weight: Reduced oxygen leads to poor fetal growth and development.
Placental complications: Hypoxia increases the risk of placental abruption and prelabor rupture of membranes. - Fetotoxic and Teratogenic Chemicals
Tobacco smoke contains over 7,000 chemicals, including nicotine, cyanide, carbon monoxide, cadmium, lead, and hydrocarbons. These substances:
Directly damage fetal DNA, leading to developmental defects.
Disrupt normal cellular signaling and development in fetal tissues.
Effects:
Congenital defects: Orofacial clefts, limb reduction defects, and Poland sequence result from disrupted vascular or cellular development.
Sudden Infant Death Syndrome (SIDS): Nicotine exposure impairs brainstem development, affecting breathing and arousal responses.
3. Vascular Effects
Nicotine and other chemicals in cigarettes cause generalized vasoconstriction, including in the uteroplacental circulation.
Placental blood flow decreases, impairing nutrient and oxygen delivery to the fetus.
Effects:
Intrauterine growth restriction (IUGR): Fetal growth slows due to insufficient nutrients and oxygen.
Preterm birth: Smoking can trigger preterm labor through placental dysfunction or inflammation.
4. Inflammatory and Oxidative Stress
Smoking induces systemic inflammation and oxidative stress in the mother, which can cross the placenta and affect fetal tissues.
Inflammatory cytokines and oxidative damage disrupt normal development.
Effects:
Preterm labor: Inflammation can weaken fetal membranes, causing early rupture.
Low birth weight: Oxidative stress hinders proper cellular development.
5. Hormonal Disruption
Smoking alters maternal hormonal levels, including reducing estrogen and progesterone production, which are essential for maintaining pregnancy.
Effects:
Ectopic pregnancy: Smoking slows down and even paralyzes the cilia in the fallopian tubes, increasing the likelihood of implantation outside the uterus. It also does this in the lungs leading to increase mucus production and infections.
Miscarriage: Hormonal imbalances can lead to pregnancy loss.
6. Direct Impact on Male and Female Gametes
In women, smoking damages oocyte DNA and accelerates follicular depletion, reducing fertility.
In men, smoking impairs sperm quality, including motility and DNA integrity, which can affect embryo development and increase miscarriage risk.
Why These Effects Are Particularly Harmful During Pregnancy
The fetus relies entirely on the mother for oxygen, nutrients, and a healthy environment to grow. Smoking disrupts this environment by:
How does smoking affect the oocyte and sperm?
Effects on the oocyte:
Smoking generates reactive oxygen species (ROS), which can damage DNA in the oocyte.
It reduces the ovarian reserve by accelerating the loss of follicles, potentially leading to earlier ovarian aging or infertility.
Smoking can also impair oocyte quality, affecting fertilization and embryo development.
Effects on sperm:
Smoking reduces sperm motility (the ability to swim efficiently toward the egg).
It increases DNA fragmentation in sperm, leading to reduced fertility and potential risks for the offspring.
Smoking decreases sperm count and alters the morphology (shape) of sperm.
Limiting the oxygen and nutrient supply.
Exposing the fetus to toxic substances.
Increasing the risk of complications like placental abruption, preterm labor, and fetal growth restriction.
Incorrect Options Clarified:
A, C, D: Tobacco use during pregnancy is not primarily associated with neural tube defects, congenital heart defects, or gastrointestinal abnormalities. While smoking impacts overall fetal health, these risks are not directly tied to nicotine use.
Why is cannabis use during pregnancy discouraged?
A. It may increase protein levels in the fetus.
B. It has been proven to enhance neurodevelopment.
C. It is associated with low birth weight and impaired fetal neurodevelopment.
D. It has no significant risks if used medicinally for nausea.
C. It is associated with low birth weight and impaired fetal neurodevelopment
Correct: Cannabis poses risks to fetal growth and development.
Effects of Marijuana Use in Pregnancy
Correct Answer Explanation:
Cannabis use during pregnancy is associated with low birth weight and impaired fetal neurodevelopment:
Low birth weight: THC, the active psychoactive compound in cannabis, crosses the placenta, reducing oxygen and nutrient supply to the fetus. This can inhibit normal fetal growth.
Impaired fetal neurodevelopment: THC interacts with the endocannabinoid system, which plays a critical role in brain development. Prenatal exposure to cannabis is linked to cognitive delays, attention deficits, and behavioral problems in childhood.
Additional risks include preterm labor and stillbirth, particularly when cannabis is used in conjunction with tobacco or other substances.
Incorrect Options Clarified:
A, B, D: These do not reflect cannabis-specific risks. For example, cannabis is not strongly linked to structural anomalies or placental issues like abruption but instead affects fetal growth and neurodevelopment.
What is the primary management goal for asthma during pregnancy?
A. Minimizing the use of medications to avoid teratogenic effects
B. Preventing maternal hypoxia to ensure adequate fetal oxygenation
C. Avoiding all asthma triggers without lifestyle modifications
D. Reducing the frequency of prenatal monitoring visits
B. Preventing maternal hypoxia to ensure adequate fetal oxygenation
Correct: This is the primary goal of asthma management in pregnancy.
Asthma Management in Pregnancy
Correct Answer Explanation:
The primary goal of asthma management during pregnancy is preventing maternal hypoxia to ensure adequate fetal oxygenation:
During pregnancy, the fetus is entirely dependent on the mother’s oxygen supply. Poorly managed asthma increases the risk of hypoxia, which can lead to intrauterine growth restriction (IUGR), preterm delivery, and even fetal demise.
Exacerbations of asthma during pregnancy can also increase maternal morbidity, including preeclampsia and the need for emergency care. Proper use of inhalers, medications like bronchodilators, and corticosteroids is critical.
Asthma’s Unique Challenges During Pregnancy:
Physiological changes: Pregnancy causes diaphragmatic elevation, increased oxygen demand, and nasal congestion, which can exacerbate asthma symptoms.
Medication considerations: While some patients may hesitate to use asthma medications during pregnancy, uncontrolled asthma poses far greater risks to both the mother and fetus than the use of appropriately managed inhaled or systemic therapies.
Incorrect Options Clarified:
A: Asthma management does not focus on preventing premature rupture of membranes.
C: Controlling allergic rhinitis is secondary to managing maternal oxygenation.
D: Maternal corticosteroid use is not the primary focus but rather a treatment tool when indicated.
What condition is indicated by an increased craving for and consumption of non-food items like clay or dirt during pregnancy?
A. Protein deficiency
B. Pica
C. Gastrointestinal pathology
D. Acid reflux
B. Pica
Correct: Pica involves cravings for non-food substances.
Incorrect Options:
A, C, D: These are unrelated to the symptoms of pica.
Which of the following strategies is recommended for smoking cessation during pregnancy?
A. Behavioral counseling using the five As framework
B. Using unregulated nicotine replacement products
C. Waiting until after pregnancy to quit
D. Limiting cigarette use to one per day
A. Behavioral counseling using The Five As Framework for Smoking Cessation
The Five As framework is a structured approach recommended for smoking cessation in healthcare settings:
Ask: Identify tobacco use by directly inquiring about smoking habits at every visit.
Example: “Do you currently smoke or use any form of tobacco?”
Advise: Provide clear, personalized advice to quit, emphasizing the benefits of cessation for both mother and fetus.
Example: “Quitting smoking now will improve your baby’s growth and development.”
Assess: Determine the patient’s willingness to quit.
Example: “On a scale from 1 to 10, how ready do you feel to quit smoking?”
Assist: Help the patient develop a quit plan, offer resources (e.g., counseling, nicotine replacement therapy when appropriate), and address barriers.
Example: Offer referral to a smoking cessation program or suggest coping strategies for cravings.
Arrange: Schedule follow-ups to provide ongoing support and monitor progress.
Example: “Let’s check in at your next visit to see how things are going.”
Incorrect Options Clarified:
B, C, D: Strategies like punitive measures, non-personalized advice, or generic educational materials are not as effective as the personalized, evidence-based Five As approach.
What are the potential effects of alcohol use during pregnancy?
A. Fetal growth acceleration and fewer birth complications
B. Reduced risk of neurodevelopmental disorders
C. Increased risk of Fetal Alcohol Spectrum Disorders and miscarriage
D. Improved maternal mental health and pregnancy outcomes
C. Increased risk of Fetal Alcohol Spectrum Disorders and miscarriage
Correct Answer Explanation:
Alcohol consumption during pregnancy is associated with the following major risks:
Fetal Alcohol Spectrum Disorders (FASDs):
FASDs include a range of physical, behavioral, and neurodevelopmental impairments caused by prenatal alcohol exposure.
Characteristic features: growth restriction, facial anomalies (e.g., smooth philtrum, thin upper lip), and cognitive or behavioral deficits (e.g., ADHD, learning disabilities).
Alcohol disrupts fetal brain development, particularly during the first trimester when critical structures form.
Miscarriage and stillbirth:
Alcohol increases the risk of miscarriage, particularly with heavy or binge drinking.
It disrupts placental function and may cause fetal hypoxia or abnormal cellular development, leading to pregnancy loss.
Preterm birth and low birth weight: Alcohol can impair placental function, leading to restricted fetal growth.
Incorrect Options Clarified:
A, B, D: While alcohol use can affect overall fetal health, these options do not specifically address the risks of FASDs, miscarriage, or stillbirth.
What is the role of preconception counseling for women with diabetes?
A. To delay conception until after the age of 35
B. To reduce maternal and fetal risks by maintaining preconceptional hemoglobin A1c levels below 7%
C. To encourage the use of angiotensin-converting enzyme inhibitors during pregnancy
D. To avoid addressing end-organ damage during pregnancy
To reduce maternal and fetal risks by maintaining preconceptional hemoglobin A1c levels below 7%
Correct Answer Explanation:
Maintaining preconceptional hemoglobin A1c levels below 7% is critical for reducing maternal and fetal risks associated with diabetes:
Congenital anomalies: Elevated HbA1c (>7%) during the first trimester increases the risk of neural tube defects, congenital heart defects, and other malformations. These risks are directly related to poor glycemic control in early pregnancy.
Preterm birth and macrosomia: High HbA1c levels increase the likelihood of fetal overgrowth (macrosomia), which complicates delivery and may lead to birth injuries or necessitate a cesarean section.
Preeclampsia: Poor glycemic control contributes to hypertension and increases the risk of preeclampsia.
Stillbirth: Persistent hyperglycemia can impair placental function, leading to fetal hypoxia and stillbirth.
Additional Goals of Preconception Counseling in Diabetes:
Optimize blood glucose control with lifestyle interventions and medications.
Identify and address complications like retinopathy, nephropathy, and cardiovascular issues that may worsen during pregnancy.
Incorrect Options Clarified:
A, C, D: The primary focus of preconception counseling is glycemic control to minimize maternal and fetal complications. These options do not adequately reflect this goal.
Which of the following infections is an asthmatic pregnant individual at higher risk for, requiring preventive measures during pregnancy?
a) Influenza
b) Respiratory syncytial virus (RSV)
c) COVID-19
d) All of the above
D) All of the above
1. Influenza
Increased Risk:
Pregnancy and asthma both independently increase the likelihood of complications from the flu, including pneumonia, bronchitis, and exacerbations of asthma symptoms.
Influenza can lead to hospitalization, preterm labor, and fetal complications such as restricted growth or stillbirth if untreated.
Preventive Measures:
Annual influenza vaccination (inactivated form) is strongly recommended for all pregnant individuals, especially those with asthma.
Hand hygiene, avoiding sick contacts, and prompt treatment with antivirals if infected (e.g., oseltamivir) are essential.
2. Respiratory Syncytial Virus (RSV)
Increased Risk:
RSV, a common cause of respiratory illness, can result in bronchiolitis and pneumonia in high-risk populations, including asthmatic pregnant individuals.
Asthma exacerbations triggered by RSV can cause decreased oxygen delivery to both the mother and fetus, increasing the risk of hypoxia and fetal distress.
Preventive Measures:
In 2023, the FDA approved an RSV vaccine for use in late pregnancy to protect both the mother and newborn during the vulnerable postpartum period.
General precautions include avoiding exposure to crowded or high-risk areas during RSV season.
3. COVID-19
Increased Risk:
Asthma increases susceptibility to severe respiratory complications from COVID-19, such as pneumonia and acute respiratory distress syndrome (ARDS).
Pregnancy further amplifies risks, including preterm delivery, severe illness, and potential effects on fetal growth and neurodevelopment.
Preventive Measures:
The COVID-19 vaccine and boosters are recommended for pregnant individuals to reduce the risk of severe illness.
Wearing masks in crowded places, practicing hand hygiene, and ensuring good asthma control minimize infection risk.
Why Preventive Care is Vital
Respiratory infections worsen asthma by increasing airway inflammation, bronchospasm, and mucus production, leading to acute exacerbations.
Poorly controlled asthma increases the risk of maternal hypoxia, which can result in fetal hypoxia, growth restriction, and preterm birth.
Conclusion
Correct Answer: d) All of the above
Pregnant individuals with asthma should be vaccinated against influenza and COVID-19 and may benefit from the new RSV vaccine. In addition to vaccination, good asthma management, infection prevention, and early treatment of symptoms are essential to mitigate risks.
More info on why:
- Changes in the Immune System
Shift to a T-helper 2 (Th2)-dominant immune response:
During pregnancy, the immune system adjusts to protect the fetus, which is considered semi-allogenic (partially foreign). This results in a reduced Th1-cell-mediated immune response, which is essential for fighting off viruses like influenza.
Weakened antiviral response: Pregnant individuals may have a less robust ability to clear viral infections, making them more susceptible to complications.
Increased susceptibility to secondary infections: A weakened immune response can lead to bacterial superinfections, such as pneumonia. - Cardiopulmonary Changes
Increased oxygen demand:
The growing fetus requires more oxygen, leading to elevated maternal respiratory rates and changes in lung mechanics. This increased demand makes the respiratory system more vulnerable to stress caused by influenza.
Reduced lung capacity:
As the uterus enlarges, it compresses the diaphragm, reducing lung expansion. This can exacerbate respiratory symptoms and make conditions like pneumonia more dangerous. - Increased Inflammatory Response
Heightened inflammatory state:
While the immune system shifts to protect the fetus, there is an increase in systemic inflammation during pregnancy. When infected with the flu, this exaggerated inflammatory response can lead to more severe symptoms and complications like acute respiratory distress syndrome (ARDS). - Risk of Complications
Severe respiratory symptoms:
Influenza can lead to worsening of asthma or other underlying respiratory conditions, causing severe breathing difficulties.
Maternal hypoxia:
Reduced oxygen levels in the mother can compromise oxygen delivery to the fetus, increasing the risk of fetal hypoxia, growth restriction, and preterm labor.
Increased hospitalizations:
Pregnant individuals with the flu are more likely to require hospitalization and intensive care than non-pregnant individuals of the same age. - Impact on the Fetus
Influenza infection in pregnancy has been associated with:
Fetal growth restriction
Preterm birth
Stillbirth
Neurodevelopmental issues later in childhood, potentially linked to maternal fever during critical periods of development.
Preventive Measures
Annual Influenza Vaccination:
Safe and recommended during any trimester of pregnancy, it protects both the mother and baby (by passive antibody transfer).
Early Antiviral Treatment:
Medications like oseltamivir (Tamiflu) can reduce the severity and duration of illness if started promptly.
Acid Reflux:
* Prevalence: Up to 72% in the third trimester due to compression of the upper gastrointestinal tract.
* Effective management of reflux is essential to minimize asthma exacerbations.Which of the following medications is recommended for managing gastroesophageal reflux (GERD), a common asthma trigger during pregnancy due to *
a) Proton pump inhibitors (PPIs)
b) Beta-blockers
c) Opioids
d) Nonsteroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: a) Proton pump inhibitors (PPIs)
Explanation: GERD is a common issue in pregnancy and
PPIs are a class of medications commonly used to manage GERD. They work by reducing stomach acid production, alleviating reflux symptoms, and minimizing complications such as asthma exacerbations triggered by GERD. PPIs are considered safe and effective during pregnancy when clinically indicated.
Rationale for incorrect:
b) Beta-blockers - are used to manage cardiovascular conditions such as hypertension or arrhythmias. They do not address GERD symptoms or reduce acid production in the stomach.
c) Opioids - are pain-relief medications and do not have any role in managing GERD. In fact, opioids can worsen GERD symptoms by reducing gastrointestinal motility, which may exacerbate reflux.
d) Nonsteroidal anti-inflammatory drugs (NSAIDs) -NSAIDs, such as ibuprofen, can irritate the stomach lining and increase the risk of gastric ulcers. They are contraindicated for managing GERD and may worsen symptoms.
What is the primary goal of stepwise asthma treatment during pregnancy?
a) Minimizing medication use
b) Maximizing fetal exposure to oxygen
c) Reducing maternal weight gain
d) Avoiding all inhaled corticosteroids
Correct Answer: b) Maximizing fetal exposure to oxygen
Explanation: Asthma management during pregnancy prioritizes optimal oxygenation for both the mother and fetus. Inhaled corticosteroids are commonly used when needed to achieve this.
What is the diagnostic criterion for chronic hypertension in pregnancy?
A. Blood pressure ≥ 130/80 mmHg before 30 weeks of gestation
B. Blood pressure ≥ 140/90 mmHg before 20 weeks of gestation or persisting postpartum
C. Blood pressure ≥ 160/110 mmHg at any point during pregnancy
D. Blood pressure ≥ 140/90 mmHg detected after 28 weeks of gestation
B. Blood pressure ≥ 140/90 mmHg before 20 weeks of gestation or persisting postpartum
Correct. Chronic hypertension is defined by blood pressure readings of ≥140/90 mmHg on two occasions at least 4 hours apart prior to 20 weeks of gestation or Hypertension that starts during pregnancy continuing beyond the postpartum period.
A. Blood pressure ≥ 130/80 mmHg before 30 weeks of gestation
Incorrect. While 130/80 mmHg is the threshold for hypertension in the general population, chronic hypertension in pregnancy is diagnosed earlier than 20 weeks of gestation.
C. Blood pressure ≥ 160/110 mmHg at any point during pregnancy
Incorrect. This threshold indicates severe hypertension but does not define chronic hypertension.
D. Blood pressure ≥ 140/90 mmHg detected after 28 weeks of gestation
Incorrect. Hypertension after 28 weeks is typically gestational hypertension unless it persists postpartum.
Diagnosis Criteria:
* Blood pressure ≥ 140/90 mmHg on at least two separate
occasions 4 hours apart.
* Chronic hypertension affects 1% to 2% of pregnancies in the United States, with rising prevalence due to population aging and increasing comorbidities.
Preeclampsia Postpartum Monitoring:
* Monitor blood pressure closely for at least 72 hours postpartum and again 7 to 10 days after delivery.
* Educate patients about the signs and symptoms of preeclampsia, which can develop up to six weeks postpartum.
Which of the following is the primary cause of chronic hypertension in pregnancy?
A. Diabetes mellitus
B. Renal disease
C. Primary hypertension
D. Collagen vascular disease
C. Primary hypertension
Correct. The most frequent cause of chronic hypertension in pregnancy is primary (essential) hypertension, with no identifiable secondary cause.
A. Diabetes mellitus
Incorrect. Diabetes may contribute to hypertension but is not the primary cause.
B. Renal disease
Incorrect. Renal conditions can cause secondary hypertension, but primary hypertension is more common.
D. Collagen vascular disease
Incorrect. While collagen vascular diseases (e.g., lupus) can lead to secondary hypertension, they are not the primary cause.
Which demographic group is at highest risk for chronic hypertension during pregnancy?
A. Hispanic women under 30 years old
B. White women over 40 years old
C. Black women over 35 years old
D. Asian women of all ages
C. Black women over 35 years old
Correct. Black women have a significantly higher prevalence of chronic hypertension, and age further increases risk.
A. Hispanic women under 30 years old
Incorrect. Hispanic women generally have a lower risk of chronic hypertension compared to Black women.
B. White women over 40 years old
Incorrect. Age is a risk factor, but Black women have the highest overall prevalence of chronic hypertension.
D. Asian women of all ages
Incorrect. Asian women have a lower prevalence of chronic hypertension compared to Black or White women.
Demographics:
* Race: Black women are twice as likely to experience chronic hypertension
compared to white women.
1. Age: Higher prevalence in women aged 35 years or older.
Primary Causes:
* 90% due to primary hypertension.
* Remaining 10% linked to conditions like renal disease, thyroid disease, diabetes
mellitus, and collagen vascular disease.
Q4. How does pregnancy physiologically influence blood pressure in the first half of pregnancy?
A. Blood pressure rises above baseline due to increased vascular resistance
B. Blood pressure decreases due to reduced systemic vascular resistance
C. Blood pressure remains stable due to hormonal balance
D. Blood pressure spikes unpredictably due to comorbidities
B. Blood pressure decreases due to reduced systemic vascular resistance
Correct. In early pregnancy, systemic vascular resistance decreases due to hormonal changes, leading to a decline in blood pressure.
A. Blood pressure rises above baseline due to increased vascular resistance
Incorrect. Vascular resistance decreases in early pregnancy, reducing blood pressure.
C. Blood pressure remains stable due to hormonal balance
Incorrect. Blood pressure typically decreases during the first half of pregnancy.
D. Blood pressure spikes unpredictably due to comorbidities
Incorrect. Pregnancy-related blood pressure changes are usually predictable, with a decrease in early pregnancy.
Key Physiological Changes of Cardiovascular System during pregnancy
Decreased systemic vascular resistance (SVR): Progesterone causes smooth muscle relaxation, which reduces SVR, leading to lower blood pressure during the first half of pregnancy (first 20 weeks of gestation).
Increased plasma volume and cardiac output: These adaptations ensure adequate blood supply to the placenta and fetus.
Effect on Blood Pressure:
First half of pregnancy: Blood pressure typically decreases due to reduced SVR.
Later pregnancy: Blood pressure rises back to baseline or slightly higher as SVR normalizes and the demands on the cardiovascular system increase.
These changes help optimize maternal-fetal circulation while accommodating the physiological stress of pregnancy.
- In the second half of pregnancy (after 20 weeks), blood pressure tends to return to baseline or slightly increase due to the growing demands on the cardiovascular system and increased plasma volume.
Which complication is most strongly associated with uncontrolled chronic hypertension during pregnancy?
A. Preterm labor
B. Preeclampsia
C. Gestational diabetes
D. Low birth weight
B. Preeclampsia
Correct. Chronic hypertension significantly increases the risk of preeclampsia, a severe and life-threatening complication.
A. Preterm labor
Incorrect. While possible, preterm labor is less directly linked to chronic hypertension than preeclampsia.
C. Gestational diabetes
Incorrect. Gestational diabetes is not directly associated with chronic hypertension.
D. Low birth weight
Incorrect. Low birth weight is a potential outcome but less directly linked than preeclampsia.
. What is the two- to four-fold increased fetal risk associated with maternal chronic hypertension?
A. Preterm delivery
B. Intrauterine growth restriction (IUGR)
C. Stillbirth or perinatal death
D. Neonatal congenital anomalies
C. Stillbirth or perinatal death
Correct. Chronic hypertension is associated with a two- to four-fold increase in stillbirth and perinatal death risk.
A. Preterm delivery
Incorrect. While possible, the increase in risk is more substantial for stillbirth.
B. Intrauterine growth restriction (IUGR)
Incorrect. IUGR is a known complication but does not account for the highest risk increase.
D. Neonatal congenital anomalies
Incorrect. Congenital anomalies are not directly linked to chronic hypertension.
What is the blood pressure goal during pregnancy to prevent severe complications?
A. < 120/80 mmHg
B. < 130/85 mmHg
C. < 140/90 mmHg
D. < 160/110 mmHg
C. < 140/90 mmHg
Correct. This is the recommended target to minimize maternal and fetal risks while maintaining adequate perfusion.
A. < 120/80 mmHg
Incorrect. Aggressive control to this level may compromise placental perfusion.
B. < 130/85 mmHg
Incorrect. This goal is lower than necessary for pregnancy-related hypertension management.
D. < 160/110 mmHg
Incorrect. This is the threshold for severe hypertension, not the target for control.
At what gestational age should low-dose aspirin ideally be initiated for high-risk preeclampsia prevention?
A. 4–8 weeks
B. 12–16 weeks
C. 20–24 weeks
D. 28–32 weeks
B. 12–16 weeks
Correct. Low-dose aspirin is most effective when started between 12–16 weeks of gestation.
A. 4–8 weeks
Incorrect. Initiating aspirin this early is unnecessary and not evidence-based.
C. 20–24 weeks
Incorrect. Starting aspirin after 20 weeks is less effective in preventing preeclampsia.
D. 28–32 weeks
Incorrect. Starting this late would not significantly prevent preeclampsia.
Preeclampsia prevention Strategies:
* Calcium Supplementation:
* May reduce the risk of preeclampsia in populations with low dietary calcium intake.
* Lifestyle Modifications:
* Encourage healthy diet, regular physical activity, and weight
management before and during pregnancy.
* Optimize chronic conditions before pregnancy
What lifestyle modification is contraindicated for managing chronic hypertension during pregnancy?
A. Sodium restriction
B. Weight loss
C. Moderate exercise
D. Smoking cessation
B. Weight loss
Correct. Weight loss during pregnancy is contraindicated as it can harm fetal growth.
A. Sodium restriction
Incorrect. Moderate sodium restriction is generally safe and can support blood pressure control.
C. Moderate exercise
Incorrect. Exercise is beneficial unless contraindicated for specific conditions.
D. Smoking cessation
Incorrect. Smoking cessation is always recommended for maternal and fetal health.
What is the approximate prevalence of prenatal depression in pregnant individuals?
A. 1% to 5%
B. 6.5% to 13%
C. 15% to 20%
D. 25% to 30%
B. 6.5% to 13%
Correct. This is the estimated prevalence of prenatal depression based on population studies.
A. 1% to 5%
Incorrect. This range significantly underestimates the prevalence.
C. 15% to 20%
Incorrect. This range is slightly higher than the typical prevalence.
D. 25% to 30%
Incorrect. This range is significantly higher than observed prevalence rates.
What additional feature is required to diagnose preeclampsia in a pregnant patient with blood pressure ≥140/90 mmHg?
A. Proteinuria ≥ 0.3 g in a 24-hour urine collection
B. Presence of fetal growth restriction
C. Severe headache unresponsive to medication
D. Any of the above
Answer: D Any of the above
Correct. Preeclampsia diagnosis requires hypertension and one of these features, making this the best choice
Explanations:
A. Proteinuria ≥ 0.3 g in a 24-hour urine collection
Correct. Proteinuria is one of the key diagnostic criteria for preeclampsia when hypertension is present.
B. Presence of fetal growth restriction
Correct. Fetal growth restriction is an associated complication that can confirm preeclampsia.
C. Severe headache unresponsive to medication
Correct. Severe headaches are a clinical feature of severe preeclampsia.
How long after delivery can chronic hypertension typically persist in women with preeclampsia?
A. 1 week postpartum
B. 6 weeks postpartum
C. 12 weeks postpartum
D. Indefinitely, if undiagnosed
Answer: D. Indefinitely, if undiagnosed
Correct. Chronic hypertension is a long-term condition that persists unless managed or treated.
Explanations:
A. 1 week postpartum
Incorrect. While blood pressure may start to stabilize postpartum, chronic hypertension can persist much longer.
B. 6 weeks postpartum
Incorrect. This is the resolution timeframe for gestational hypertension, not chronic hypertension.
C. 12 weeks postpartum
Incorrect. Chronic hypertension, by definition, persists beyond 12 weeks postpartum.
Risk Factors for Prenatal Depression
Q3. Which of the following is a major risk factor for prenatal depression?
A. Lack of prenatal vitamins
B. History of major depressive disorder (MDD)
C. Gestational diabetes mellitus
D. Age under 25 years
B. History of major depressive disorder (MDD)
Correct. A previous history of depression is the strongest predictor of prenatal depression.
Explanations:
A. Lack of prenatal vitamins
Incorrect. While nutritional deficiencies can affect overall health, they are not a major risk factor for prenatal depression.
C. Gestational diabetes mellitus
Incorrect. While gestational diabetes can increase stress, it is not a leading cause of prenatal depression.
D. Age under 25 years
Incorrect. Age alone is not a primary risk factor unless combined with other vulnerabilities like lack of social support.
When should routine screening for depression occur during pregnancy?
A. First trimester only
B. First and third trimesters
C. Every trimester and postpartum
D. Postpartum only
C. Every trimester and postpartum
Correct. Guidelines recommend frequent screening during pregnancy and postpartum for early detection and intervention.
Explanations:
A. First trimester only
Incorrect. Depression can emerge at any point during pregnancy, so one-time screening is insufficient.
B. First and third trimesters
Incorrect. Screening only during these trimesters may miss cases developing in the second trimester.
D. Postpartum only
Incorrect. While postpartum depression is a concern, antenatal depression should also be screened.
What fetal complication is most strongly associated with untreated maternal prenatal depression?
A. Macrosomia
B. Preterm birth
C. Neural tube defects
D. Fetal arrhythmias
B. Preterm birth
Correct. Untreated maternal depression increases stress levels, which are strongly linked to preterm labor and delivery.
Explanations:
A. Macrosomia
Incorrect. Macrosomia is more commonly linked to gestational diabetes than depression.
C. Neural tube defects
Incorrect. Neural tube defects are primarily linked to folic acid deficiency, not depression.
D. Fetal arrhythmias
Incorrect. Fetal arrhythmias are not associated with maternal depression.
Which antidepressant class is considered first-line for managing depression during pregnancy?
A. Tricyclic antidepressants (TCAs)
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Monoamine oxidase inhibitors (MAOIs)
D. Benzodiazepines
Examples: Fluoxetine, Sertraline, Citalopram
Why SSRIs Are Safer:
Mechanism of Action: SSRIs selectively inhibit serotonin reuptake in the brain, which increases serotonin levels. They are better tolerated and have fewer side effects compared to older antidepressants like TCAs or MAOIs.
Safety Profile in Pregnancy: SSRIs are extensively studied in pregnancy. The most commonly used SSRIs (e.g., fluoxetine, sertraline) are associated with minimal risk of major congenital malformations. They are considered first-line for treating depression in pregnant women because untreated depression poses a greater risk to both the mother and the fetus.
Potential Risks:
Poor Neonatal Adaptation Syndrome (PNAS): This transient condition can include symptoms like irritability, jitteriness, and feeding difficulties but usually resolves within a few days after birth.
Pulmonary Hypertension of the Newborn (PPHN): There is a slight increased risk, but the absolute risk is very low.
Benefit-Risk Balance: For moderate-to-severe depression, the benefits of using SSRIs far outweigh the minimal risks.
A. Tricyclic Antidepressants (TCAs)
Examples: Amitriptyline, Nortriptyline, Imipramine
Effects in Pregnancy:
Risks to the Fetus: TCAs cross the placenta and can lead to complications such as poor neonatal adaptation syndrome (e.g., jitteriness, irritability, respiratory distress). There may also be a small increased risk of congenital malformations, though this is not well-established.
Maternal Side Effects: TCAs have significant anticholinergic effects (e.g., dry mouth, constipation, sedation) and cardiovascular risks (e.g., arrhythmias), which can be particularly concerning in pregnancy due to altered maternal physiology.
C. Monoamine Oxidase Inhibitors (MAOIs)
Examples: Phenelzine, Tranylcypromine
Effects in Pregnancy:
Risks to the Fetus: MAOIs inhibit monoamine oxidase enzymes, leading to elevated levels of neurotransmitters like serotonin, norepinephrine, and dopamine. This can cause complications, including fetal growth restriction and congenital abnormalities.
Risks to the Mother: MAOIs interact with tyramine-containing foods (e.g., aged cheeses, cured meats) and other medications, potentially causing hypertensive crises (dangerous spikes in blood pressure).
Conclusion: MAOIs are generally avoided in pregnancy due to their unpredictable and severe risks.
D. Benzodiazepines
Examples: Diazepam, Lorazepam, Clonazepam
Effects in Pregnancy:
Risks to the Fetus: Benzodiazepines cross the placenta and are associated with:
Teratogenic Risks: Some studies suggest a slight increased risk of oral clefts, though data is inconclusive.
Neonatal Risks: “Floppy infant syndrome” (hypotonia, respiratory depression) and withdrawal symptoms (e.g., irritability, poor feeding) can occur if benzodiazepines are taken in the third trimester.
Risks to the Mother: Benzodiazepines can cause sedation, dependency, and withdrawal symptoms, which are not ideal in the context of pregnancy.
Conclusion: They are not used to treat depression and are typically reserved for short-term management of severe anxiety or insomnia when absolutely necessary.
Summary
SSRIs are first-line because they are effective, well-studied, and have minimal risks compared to other options.
TCAs and MAOIs are avoided due to side effects and fetal risks.
Benzodiazepines are not antidepressants and carry neonatal risks, limiting their use in pregnancy.
Which factor increases the risk of postpartum depression the most?
A. Short interval between pregnancies
B. Cesarean delivery
C. Antenatal depression
D. Advanced maternal age
C. Antenatal depression
Correct. A strong predictor of postpartum depression is untreated depression during pregnancy.
Explanations:
A. Short interval between pregnancies
Incorrect. While this may increase maternal stress, it is not the most significant risk factor.
B. Cesarean delivery
Incorrect. This may be associated with physical recovery stress but is not the primary risk factor.
D. Advanced maternal age
Incorrect. While advanced age may pose risks, it is not as significant as pre-existing depression.
What is the definition of infertility according to the general criteria?
A. The inability to achieve pregnancy over six months of unprotected intercourse.
B. The inability to achieve pregnancy over 12 months of unprotected intercourse.
C. A condition requiring medical intervention regardless of the duration of unprotected intercourse.
D. A condition primarily caused by male infertility factors.
Correct Answer: B
Explanation: Infertility is defined as the inability to achieve pregnancy over 12 months of unprotected intercourse.
Why Others Are Incorrect:
(A): Six months applies to females over 35, not the general definition.
(C): While medical intervention may be necessary in some cases, this is not part of the general definition.
(D): Infertility can result from male, female, or combined factors, so this statement is overly narrow.
Which type of infertility refers to couples who have never achieved a pregnancy?
A. Primary infertility
B. Secondary infertility
C. Recurrent pregnancy loss
D. Oligoasthenozoospermia
Correct Answer: A
Explanation: Primary infertility is defined as the inability to conceive despite having never achieved a pregnancy.
Why Others Are Incorrect:
(B): Secondary infertility applies to couples unable to conceive after having one or more previous pregnancies.
(C): Recurrent pregnancy loss refers to repeated miscarriages and is a subtype of primary or secondary infertility.
(D): Oligoasthenozoospermia is a condition involving reduced sperm count and motility, not a type of infertility.
When should infertility evaluation begin for a couple where the female partner is over 35 years old?
A. After 3 months of unprotected intercourse.
B. After 6 months of unprotected intercourse.
C. After 12 months of unprotected intercourse.
D. Immediately upon deciding to conceive.
Correct Answer: B
Explanation: For women over 35, infertility evaluation is recommended after 6 months of attempting pregnancy due to the age-related decline in fecundability.
Why Others Are Incorrect:
(A): Three months is not a standard guideline for evaluation.
(C): Twelve months applies to women under 35.
(D): Immediate evaluation is generally advised for women over 40, not those 35–39.