Endocrinology of Pregnancy Flashcards Preview

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Flashcards in Endocrinology of Pregnancy Deck (31)
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1

Fxn of placenta

1. maintain corpus luteum during first 7-10 weeks
2. Adjust maternal metabolism --> nutrients go to fetus
3. Stim maternal circulatory system to transport gases and nutrients to and from the growing fetus
4. Dampen uterine contractility
5. Prepare maternal tissues for childbirth
6. Prepare breasts for lactation
7. Make hormones that lead to parturition

2

Insulin sensitivity in preggos

Early on:
Insulin sensitivity

Later on:
Insulin resistance

3

Anemia of pregnancy

increase in bv (30-40%) more than RBCs

4

What resp. concerns do we have for preggos?

Resp alkalosis
(due to increase in TV)
-->
Compensated metabolic acidosis --> lower buffering capacity --> earlier DKA

5

Increase in GFR in pregnancy leads to what?

1. Decrease in BUN and Cr
2. Increased renal bf
3. Altered tubular fxn (glucosuria)
4. decreased ureteral peristalsis (pyelo)
5. Lowered osmostat for vasopressin release and thirst (hyponatremia)

6

GI changes in pregnancy

1. Decreased fxn in lower esophageal sphincter (LES)
- GERD
- Aspiration pneumo
2. Decreased stomach emptying, peristalsis
- gastroparesis
- delayed absoprtion
- constipation
3. Decreased GB emptying
- cholestasis

7

Relaxin

potent stimulus in rats to increase GFR and renal plasma flow and decrease SVR

Softens cervix, lengthens interpubic ligament

8

Syncytiotrophoblasts
- major site of what?

major site of protein and steroid production

Hemochorioendothelial placentation
- direclty bathed by maternal blood w/in intervillous space
- separated from fetal blood by several layers of tissue

9

What day does the placenta take over and make hormones?

8-9 weeks

10

What hormones are actively metabolized by placenta?

1. T4--> T3
by Type III Monodeiodinase

2. Cortisol --> cortisone
by 11-B hydroxysteroid dehydrogenase

11

When is hCG levels highest?

10-12 weeks

*also when women are the sickest

!!! hCG has TSH activity at high levels --> makes T3 and T4 --> downreg TSH
- dont give antithyroid thinking its graves

12

hPGH

Secreted by syncytiotrophoblast

Not regulated by GHRH

Secreted tonically, and replaces pit GH ~ 20 weeks

Does not cross placenta but regulates IGF-1

Major insulin resistance hormone of pregnancy

Potent somatogen
- lost during labor and 1 hr after placenta removal

13

hPL

1. Facilitates mobilization and utilization of FFAs for energy by increased lipolysis
2. Both insulin and anti-insulin fx
3. Stimulate insulin secretion
4. Weak GH activity and mainly a lactogen - promotes growth of mammary tissue and stim prolactin

14


Major insulin resistance hormone of pregnancy

hPGH
- decreased in growth restricted fetuses
- women with pre-existing insulin resistance --> GDM --> further insulin resistance form placental hormones and inadequate insulin secretion

15

What should we give women with luteal defect?

Give women progesterone prior to 8-11 weeks
- since corpus luteum cant make it

16

Progesterone synthesis requires LDL receptors on trophoblast plasma membranes. Progesterone is the substrate for synthesis of

cortisol and aldosterone

17

How can we prevent preterm labor?

give progesterone - inhibits uterine contraction
- smooth muscle relaxant (GI, uterus, GU)

18

Progesterone clinical correlates in preg

1. given for luteal phase defects
2. prevents preterm labor
3. misoprostone acts as abortifacent
4. autoimmune ds may improve

19

Estrogen fx on prl

Induces lactotrophs --> inhibits dopa --> increases PRL

But

Antagonizes PRL at level of breast

20

E FX on T3 and T4

E Increases them

Double trouble
*recall that hCG acts like TSH --> makes T3 and T4 --> neg feedback decreases TSH in early preg.
- dont give antithyroid thinking its graves

21

What hormones arrest the transit of the embryo in the reproductive tract?

Progesterone and hCG

22

What hormone creates a suitable environment to enable placental attachment

progesterone and hCG

23

Chorionic ACTH-CRH system

involved in parturition (giving birth)

24

Day 4: the embryo differentiates into

What happens on day 6-7?

inner cell mass (fetus)
and
Trophectoderm (placenta)

Endometrial attachment of trophoblast

25

What hormone induces apoptosis of endometrial T cells to promote immune survival of embryo?

hCG

26

What hormone regulates differentiation of cytotrophoblast --> syncytiotrophoblast?
- It also regulates trophoblastic invasion

hCG

27

What hormone can cause hyperemesis?

hCG

28

What hormone promotes retinopathy worsening?

Estrogen
(increase coag factors and anemia)
(really ischemia retina not getting enough O2)

29

Estrogen induced hypertriglyceridemia can cause _____

pancreatitis

30

How does maternal utilization of E change in first half and second half of pregnancy?

First half of pregnancy --> increasing maternal fat stores
Second half --> diversion of glucose to placenta and increase in maternal lypolysis instead
(due to fetal depletion of liver glycogen)

- puts mother at risk for accel starvation in pregnancy