Diabetes and Endocrine in Pregnancy Flashcards Preview

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Flashcards in Diabetes and Endocrine in Pregnancy Deck (33)
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1

Name the two phases of the menstrual cycle

Follicular
Luteal

2

What sex hormone does the growing follicle release during the menstrual cycle?

Oestrogen

3

A peak in what hormone causes ovulation, and when in a menstrual cycle does this usually occur?

LH peak
Day 14

4

What hormone is released by the corpus luteum which develops during the luteal phase?

Progesterone

5

What hormone is released by the placenta after egg implantation, and therefore what can it be used for?

Human Chorionic Gonadotropin (HCG)
Used in pregnancy tests

6

What other hormones are secreted by the placenta?

Human Placental Lactogen (hPL)
Placental Progesterone
Placental Oestrogens

7

What hormones are known to increase insulin resistance in mothers?

hPL
Progesterones

8

In what trimester is gestational diabetes most likely to present?

3rd trimester

9

When does foetal organogenesis usually begin?

5 weeks (sometimes slightly earlier)

10

What complications can arise during pregnancy if the mother is diabetic?

Congenital Malformation
Premature birth
Intra-uterine growth retardation (IUGR)
Macrosomia (large baby => potential delivery problems)
Polyhydramnios (excess amniotic fluid around baby)
Intra-uterine Death

11

What complications can arise in a neonate if the mother is diabetic?

Respiratory Distress (due to immature lungs)
Hypoglycaemia
Hypocalcaemia

12

What CNS defects are common in babies born from mothers with endocrine conditions?

Anencephaly
Spina Bifida

13

If the mother of a newborn is diabetic, how many times more likely is the child to have caudal regression syndrome?

200x more likely than a non-diabetic

14

What abnormality is often seen in the urinary tract in relation to diabetic pregnancy?

Ureteric Duplication

15

Over what birth weight counts as macrosomia?

Birth weight >4kg

16

How should pregnant mothers with Type 1 or 2 diabetes be managed before and during pregnancy?

Good sugar control
Folic Acid 5mg
Consider change from tablets to insulin
Regular eye checks
Avoid ACEI, Statin

17

What drugs can be used for blood pressure control instead in pregnancy?

Labetalol
Nifedipine
methyldopa

18

To ensure good sugar control, what are the normal targets for pre and post meal glucose levels?

pre-meal <4- 5.5 mmol/l
2h post meal <6.5-7 mmol/l

19

What test can be carried out 6 weeks post-natal to check for the regression of gestational diabetes?

Fasting glucose OR Glucose Tolerance Test (GTT)

20

How can diabetes be prevented after gestational diabetes?

Healthy Diet
Aerobic exercise
Medication - Metformin, Acarbose, Pioglitazone
Annual fasting glucose test

21

Both hypo- and hyperthyroidism can cause reduced fertility. TRUE/FALSE?

TRUE
due to anovulatory cycles and loss of ovulation and luteal phase

22

Why is the thyroid demand higher during pregnancy?

Maternal thyroxine is important for neonatal development
(especially CNS)

23

If a patient has pre-exisiting hypothyroidism, by how much should they increase their Levothyroxine dose if they suspect they are pregnant?

25mcg AS SOON AS pregnancy suspected

24

What is the average Levothyroxine dose increase by 20 weeks of pregnancy?

50%
i.e. 100mcg -> 150mcg

25

If hypothyroidism is untreated in pregnancy, what complications can occur in the child?

- Increased abortion
- preeclampsia
- abruption (placenta breaks away from wall)
- postpartum haemorrhage
- preterm labour
- Foetal neuropsychological development

26

Explain the effects of hCG on Thyroxine and TSH

Increase Thyroxine
Suppress TSH

27

How do you tell the difference between hyperthyroidism and hyperemesis gravidarum?

Hyperemesis Gravidarum (nausea and vomiting):
- Not TRab antibody positive
- Resolves by 20 wks gestation ie improves
- Only treat if persists > 20 wk

28

What complications can arise in a pregnancy where the mother has hyperthyroidism?

- Infertility
- Spontaneous miscarriage
- Stillbirth
- Thyroid crisis in labour
- Transient Neonatal thyrotoxicosis

29

What can cause thyrotoxicosis in pregnancy?

- Graves’ disease
- Toxic Multinodular Goitre/Toxic Adenoma
- Thyroiditis

30

How is hyperthyroid managed in pregnancy?

- B-blockers if needed
- LOW DOSE anti-thyroid drugs
=> Propylthiouracil 1st trimester
=> Carbimazole 2/3rd trimester
(wait as late as possible)