Pregnancy diseases

Question 1

Diabetes

Answer 1

• associated with a number of neonatal complications, including transient hypoglycemia.
• fetus is subjected to high blood glucose levels since glucose freely crosses the placenta;
• maternal insulin is not able to cross the placenta
• . resulting fetal hyperglycemia leads to a compensatory rise in fetal insulin production and islet cell hyperplasia.
• Fetal hyperinsulinemia promotes abnormal fetal growth, resulting in macrosomia.
• After birth, the neonate is no longer exposed to the mother’s high blood glucose levels, but a hyperinsulinemic state persists for several days, predisposing the neonate to developing hypoglycemia.
• Diabetic ketoacidosis and hyperglycemia do not occur in the newborn of a diabetic mother even if diabetes is poorly controlled during pregnancy, as the fetus is able to synthesize appropriate amounts of insulin.
• Hypoglycemia in the neonate of a diabetic mother typically resolves within 3-7 days of birth as the hyperinsulinemia remits.
• Persistent hypoglycemia should prompt investigation for inborn metabolic abnormalities or genetic defects affecting insulin secretion (eg, persistent hyperinsulinemic hypoglycemia of infancy).

Question 2

venous thromboembolic disease (VTE)

Answer 2

Pregnancy increases the risk due to increased venous stasis, endothelial injury (eg, during delivery), and hypercoagulability.
- As the gravid uterus grows, it compresses the inferior vena cava and internal iliac veins, reducing flow from the lower extremities.
- as pregnancy advances there is a progressive shift toward hypercoagulability due to increases in factors I, II, VII, VIII, IX, and X, accompanied by a drop in protein S levels.
Tx:
Low-molecular-weight heparins (LMWHs) currently provide the best balance, especially during the early stages of pregnancy.
- Heparins do not cross the placenta (low risk of teratogenicity and fetal hemorrhage).
- LMWHs (eg, enoxaparin) have a fairly simple mode of administration and good bioavailability
- they also have short elimination times, meaning that they can be stopped shortly prior to delivery, thereby reducing the risk of intra- or postpartum hemorrhage.