Pregnancy Flashcards
What contributes to insulin resistance in mothers?
Progesterone
Human placental lactogen (HPL)
What is gestational diabetes?
Diabetes that develops during pregnancy and goes away afterwards.
Complications associated with gestational diabetes in pregnancy
Macrosomia (newborn who is significantly larger than normal)
Polyhydramnios (excess amniotic fluid)
Intrauterine death
Complications of pregnancy associated with type 1 and type 2 diabetes
All complications also associated with gestational diabetes. Also: Congenital malformation Prematurity Intra-uterine growth retardation
Complications associated with diabetes in a neonate
Respiratory distress syndrome due to immature lungs
Hypoglycaemia- feotus is used to receiving high levels of glucose from the mother, when this is taken away e.g. at birth there is a risk of hypo
Hypocalcaemia- which may cause fits.
Management of type 1 and 2 diabetes in pregnancy
Pre-pregnancy counselling Folic acid Consider change from tablets to insulin Regular eye checks BP control- taken off ACEI and statins.
What is monitored throughout pregnancy for all diabetes
Blood pressure
HBA1C
Blood glucose
Which type 2 diabetes medications are acceptable to be used during pregnancy?
Metformin
Glibenclamide (only sulphonylurea allowed)
Insulin
What treatment would you give someone suffering gestational diabetes?
Lifestyle changes
Metformin
Sometimes insulin
What is the significance of having gestational diabetes?
Likely to develop type 2 diabetes because it shows you are likely to have insulin resistance.
T or F. Gestational diabetes occurs in the first trimester?
F- develops in the 2nd.
T or F. Methyldopa in pregnancy is a good treatment for blood pressure
T
T or F. Maternal hyperinsulinaemia causes increased feotal growth.
F- Maternal hyperglycaemia not the maternal hyperinsulaemia
T or F. The corpus luteum secretes HCG
False
T or F. After a pregnancy with GDM, the risk of developing type 2 diabetes in the next 10 years is 10%.
False- 90%
You are unlikely to get pregnant if you have
Pre-existing thyroid disease
Why is thyroxine important in pregnancy
Maternal thyroxine helps with brain development.
Why is there increased demand for thyroxine in pregnancy?
Increased plasma binding proteins mop up the extra thyroxine.
If patients are have hypothyroidism, what should you do if they find out they are pregnant?
Increase the oral thyroxine by 25mg.
What effect does HCG have on the thyroid
Acts like TSH by stimulating the thyroid to produce more T3 and T4.
What is hypermesis gravadum
Vomiting in pregnancy.
Risks of untreated hypothyroidism in pregnancy
Increased abortion Preclampsia Postpartum haemorrhage Preterm labour Abruption
What can hyperthyroidism lead too in pregnancy?
Infertility Miscarraige Stillbirth Thyroid crisis/storm in labour. Transient neonatal thyrotoxicosis.
It can be difficult to distinguish between hyperthyroidism and
Hyperemesis gravidarum in pregnancy.
Management of hyperthyroidism in pregnancy
Wait and see- if hyperemesis it will settle down.
Beta blockers for symptom control
Low dose anti-thyroid drugs
Which anti-thyroid drugs should you give.
Propylthiouracil- 1st trimester
Carbimazole- 2nd/ 3rd trimester.
Side effects of carbimazole
Can cause embryopathy in 1st trimester
Scalp abnormalities
GI abnormalities
Choanal and oesophageal atresia
Side effects of propothiouracil
Risk of liver toxicity
