Endocrinology in pregnancy Flashcards
How does gestational diabetes develop and what time does it occur?
Occurs during third trimester of pregnancy and disappear after giving birth
What does ovum, corpus luteum and placenta secrete?
What are diabetes complications in pregnancy?
Congenital malformation (Spina bifida, caudal regression syndrome, etc)
Prematurity
Intra-uterine growth retardation (IUGR)
Macrosomia - big baby (can cause delivery problems)
Polyhydramnios
Intrauterine death
If a mother has diabetes, what complications might the neonate have?
Respiratory distress due to immature lungs
Fits of hypoglycaemia
Fits of hypocalcaemia
How does macrosomia precipitate?
What are T1/T2DM patient managements related to pregnancy?
What are drug treatments needed during pregnancy?
What are the two most important things to do for antenatal care in people with T1/T2 diabetes ?
Antenatal counselling and start on folic acid at 5mg dose for diabetic patients
What to do about diagnosed gestational diabetes after delivery?
6 week post natal fasting glucose, HbA1c or GTT
- to ensure resolution of DM
- If not they have T2DM
What is best method of prevention of diabetes after GDM?
Lifestyle maintenance
What is the relationship of pregnancy and thyroid?
Hypo- and hyperthyroidism causes anovulatory cycles – reduced fertility
Maternal thyroxine important for neonatal development (especially CNS)
Increased demand on thyroid during pregnancy
Plasma protein binding increases
What do you do for hypothyroidism patients if they get pregnant?
Unable to compensate for increase demand
Increase thyroxine dose by 25mcg AS SOON AS pregnancy suspected
Check TFTs monthly for first 20 weeks then 2 monthly until term
The average dose increase is by 50% (e.g. from 100mcg to 150mcg) by 20 weeks.
Aim for TSH <3-4 mU/l
What are the risks of pregnancy in untreated hypothyroidism (although very unlikely as they have aovulatory cycles)?
Increased abortion, preeclampsia, abruption, postpartum haemorrhage, preterm labour
Foetal neuropsychological development
Both TSH and hCG stimulate thyroid?
yes
and at early stages of gestation high hCG leads to high free T4, hence low TSH (this is same effect of overactive thyroid disease, so take care to differentiate)
High hCG also lead to hyperemesis
How to distinguish hyperemesis from hyperthyroidism?
In hyperemesis, TSH would be low but still detectable (so not completely suppressed)
What is postpartum thyroiditis?
