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Prenatal Environment Flashcards

1
Q

Most common endocrine disorder affecting pregnancy

A

Gestational diabetes mellitus (GDM)

4-10% of pregnant women; fueled by obesity epidemic

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2
Q

Effect of GDM in early pregnancy

A

Teratogenic effect

  • spontaneous abortions
  • congenital malformations
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3
Q

Effects of GDM in later pregnancy

A

Elevations in maternal glucose—> Fetal hyperglycemia & increased fetal insulin production

  • Fetal macrosomia
  • Alterations in use of glucose & other nutrients
  • Altered patterns of growth and development
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4
Q

Macrosomia

A

Greater than 90th percentile for weight

-occurs in 25% -42% of diabetic pregnancies d/t hyperinsulinemia

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5
Q

Effects of macrosomia on infants

A

Increased morbidity & mortality rates

  • unexplained intrauterine death
  • birth trauma
  • hypertrophic cardiomyopathy
  • vascular thrombosis
  • neonatal hypoglycemia
  • hyperbilirubinemia
  • erythrocytosis
  • respiratory distress
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6
Q

Macromnia predisposes infant to an increased risk of what injuries during birth?

A
  • shoulder dystocia
  • brachial plexus injury
  • facial nerve palsy
  • dysfunctional labor patterns
  • operative vaginal birth
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7
Q

Prognostically bad signs of GDM during pregnancy

A
  • diabetic ketoacidosis
  • hypertension
  • pyelonephritis
  • maternal noncompliance
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8
Q

In preparing for delivery of an IDM, the neonatal team should consider…

A
  • The classification of maternal diabetes ( 1 or 2, or gestational)
  • quality of metabolic control throughout pregnancy & labor
  • maternal complications
  • duration of pregnancy-indications of fetal growth & well being
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9
Q

Sulfonylurea (glyburide) May cause…

A

Neonatal jaundice

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10
Q

When does fetus begin to concentrate iodine and produce T4?

A

8-10 weeks

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11
Q

Thyroid first trimester

A

Fetus dependent on maternal hormones

  • important for fetal neurological development
  • untreated maternal hypothyroidism is associated with a decrease in IQ of offspring as well as pregnancy loss, prematurity, preeclampsia, low birth weight, & placental abruption.
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12
Q

Hormone treatment for hypothyroidism during pregnancy is…

A

Well tolerated by fetus and reduces risks

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13
Q

Maternal hyperthyroidism

A

Offspring of women with Graves’ disease may have condition

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14
Q

Graves’ disease in newborn S/S

A
  • increased HR
  • growth restriction
  • prematurity
  • goiter
  • CHF
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15
Q

Antithyroid meds

A

Can lower thyroid hormone production in mother but may result in fetal HYPOTHYROIDISM and goiter.

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16
Q

Iodine deficiency in mother

A

Cause of fetal & neonatal hypothyroidism

-severe form leads to cretinism

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17
Q

Cretinism

A

Congenital iodine deficiency syndrome

- severely stunted physical & mental growth

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18
Q

Phenylketonuria (PKU)

A
  • inherited disorder
  • enzymes defect that prevents an essential amino acid phenylalanine from converting to tyrosine.
  • Excess phenylalanine in blood toxic to CNS
19
Q

Effects of PKU disorder

A
  • certain mental retardation
  • Newborn screening began in 1960’s
  • treatment is special diet
  • pregnant women should remain on diet
  • **treatment ending too early can cause blindness, learning disabilities, behavioral issues, & decrease in IQ.
20
Q

Renal blood flow increases in 1st trimester by…

21
Q

Renal changes during pregnancy

A
  • increase in glomerular filtration rate (GFR)
  • increase in effective renal plasma flow
  • decrease in renal vascular resistance
  • activation of the renal-angiotensin-aldosterone system
  • increased retention of sodium and water
22
Q

Causes of renal disease during pregnancy

A
  • UTIs
  • glomerular disease
  • severe hypertension
  • complication of systemic diseases (ie diabetes, lupus)
23
Q

Pregnancies where mom was hypertensive before present a increased risk for

A
  • preeclampsia
  • IUGR
  • preterm delivery
  • perinatal loss
24
Q

Drug therapy to control chronic hypertension

A

Beneficial effect on fetal outcome

25
Mild to moderate renal insufficiency
Serum creatinine < 1.5 mg/dl ***favorable outcome
26
Sever renal insufficiency
Serum creatinine > 1.6 mg/dl ***Increased risk for perinatal death
27
Bacteriuria
- occurs in 2%-7% of pregnancies - untreated—>pyelonephritis or acute cystitis—>fetus at risk for preterm birth and IUGR - increased risk of death
28
Maternal seizure disorders
- 1 in every 4,000 pregnancies - treated with antiepileptic drugs (AEDs) * *increased risk for spontaneous abortion, prematurity, small for gest. age, congenital defects, demise, neonatal depression, & hemorrhage
29
Many woman find that seizure activity _______ during pregnancy
Increases
30
Causes of increased seizure activity during pregnancy
- decreased compliance with medical regimens - physiologic changes associated with pregnancy - gestational changes of plasma levels of anticonvulsant drugs
31
Maternal seizures may…
Compromise fetal oxygenation d/t diminished placental blood flow or maternal hypoxemia
32
Fetuses of epileptic women treated with anticonvulsants are at risk for…
- congenital malformations | - adverse cognitive outcomes
33
Valproate (anticonvulsant)
- consistently associated with the highest rates of congenital malformations - neural tube defects (spina bifida) - orofacial defects (cleft lip/palate) - heart malformations (VSD) - urogentital defects (hypospadias) - skeletal abnormalities (radial Ray defects, phalangial hypoplagias) ***treatment with maternal folic acid has been shown to help
34
Infants born to mothers treated with anticonvulsants (esp. barbiturates) S/S
- generalized depression - decreased respiratory effort - poor muscle tone - feeding difficulties * **may also exhibit signs of drug withdrawals - tremors - hypertonia - hyperventilation - restlessness
35
Women treated with phenytoin, phenobarbital, & primidone…
Abnormal clotting & hemorrhage reported in infants - decreased in vitamin k dependent clotting factors - usually sever hemorrhage in 1st 24 hours...may result in death * ** infants need cord blood clotting studies done, vitamin k prophylaxis soon after birth, and close observation
36
Multiple Sclerosis (MS)
- typically strikes women during reproductive years - pregnancy well tolerated and usually causes an improvement in symptoms - possible low birth weight infant - mixed responses on adverse reactions during pregnancy - during PP higher than expected relapse rate
37
Potential MS complications
- bladder dysfunction leading to bladder infections * **prophylactic antibiotics - immunosuppressant use
38
Myasthenia Gravis (MG)
- autoimmune disease causing neuromuscular dysfunction - effects 1 in 20,000 pregnancies - may experience respiratory compromise d/t increased pressure on diaphragm - corticosteroids used to treat exacerbation - PROM & Csection risk reported - infant may experience a transient self limited course of MG
39
MG-tranplacentally acquired anti-acetylcholine receptor antibodies
- 12% of infants born to MG mothers affected - generalized weakness - feeble cry - diminished suck and swallow - decreased respiratory effort - subsides within a few weeks after birth and dies not reoccur
40
Systemic Lupus Erythematous (SLE)
- autoimmune disease typically effecting women of child bearing age - leading causes of death is infections and renal failure
41
SLE & pregnancy
- increased risk of preeclampsia, thrombotic events, spontaneous abortion, preterm delivery, stillbirth, IUGR
42
Neonatal manifestations of SLE
- transfer of maternal antibodies - transient lupus like rash (face, scalp, thorax) - thrombocytopenia * **clear within a few months
43
Maternal antibodies to the anti-Ro/SS-A and anti-La/SS-B antigens
Strong association with congenital heart block - treated with cardiac pacemakers - 1/3 of affected infants die by within 3 years

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