Pregnancy Flashcards
What is the sequence of events in the menstrual cycle?
Hypothalamus releases GnRH which stimulates the pituitary to secrete LH and FSH
FSH stimulates growth of follicles in the ovary
The growing follicle secretes oestrogen
LH levels rise sharply, stimulating ovulation
The remnant of the follicle becomes the corpus luteum, which secretes progesterone
If fertilisation does not occur the ovum is expelled with uterine lining in menstruation
How does blood glucose and insulin resistance change in pregnancy?
Placental progesterones cause increase in insulin resistance in the mother so that blood sugar increases and can be transferred to the foetus instead of the mother
What causes gestational diabetes?
If the mother is predisposed to diabetes, the increased blood glucose levels that physiologically occurs can result in gestational diabetes
When does foetal organogenesis start?
5 weeks - possibly earlier
What are the complications associated with T1 and T2 diabetes in pregnancy?
Congenital malformation
Prematurity
Intra-uterine growth retardation
What are the complications associated with GDM?
Macrosomia (baby in 90th percentile for size)
Polyhydraminos (increased fluid around the baby)
Intrauterine death
What complications associated with diabetes in pregnancy can occur in the neonate?
Respiratory distress due to immature lungs Hypoglycdaemia Hypocalcaemia CNS defects (anencephaly, spina bifida) Skeletal abnormalities Genital and GI abnormalities
How can maternal hyperglycaemia lead to neonatal hypoglycaemia?
Maternal hyperglycaemia lead to foetal hyperglycaemia and hyperinsulinaemia, which puts the baby at risk of hypoglycaemia when it is cut off from the mother’s glucose supply
How can maternal hyperglycaemia lead to macrosomia?
Maternal hyperglycaemia lead to foetal hyperglycaemia and hyperinsulinaemia. The foetus produces its own insulin in the 3rd trimester,, which is a major growth factor so hyperinsulinaemia leads to increased growth
What is the pre-pregnancy management for diabetic women wanting to conceive?
Good sugar control pre-conception Folic acid 5mg (much higher dose than normal) Consider change form tablets to insulin Regular eye checks Avoid ACEI Start aspirin
What is the management during pregnancy for diabetic women?
Diabetic diet
Aim for good blood sugar control
Use continuous blood glucose monitoring
Monitor HbA1c
Monitor BP
maintain good blood glucose during labour with IV insulin and dextrose
Insulin in T1, metformin/insulin in T2, lifestyle and metformin/insulin in GDM
What is the management post-pregnancy for GDM?
6 week postnatal fasting glucose or GTT to ensure resolution of DM - if still showing raised glucose they have T2DM
What proportion of women that have GDM go on to develop T2DM after 10-15 years?
50%
Nearer 80% for those obese
What advise is given to try and prevent diabetes after GDM?
Keep weight as low as possible
Healthy diet
Aerobic exercise
Annual fasting glucose
How does thyroid disease affect pregnancy?
Hypo and hyperthyroidism cause anovulatory cycles - reducing fertility
Maternal thyroxine is important for neonatal development so demand on thyroid increases during pregnancy - problem in thyroid disease
