Pregnancy Endocrinology Flashcards Preview

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Flashcards in Pregnancy Endocrinology Deck (66):
1

What major polypeptide hormones are produced by the placenta?

hCG
hPL
hPGH

2

What steroid hormones are produced by the placenta?

Estrogen
Progesterone

3

Detail the changes in E2, P, and PRL over the course of pregnancy.

Increase over time

4

What cell in the placenta is predominately responsible for steroid and protein production?

Syncytiotrophoblast

5

What circulation are most placental hormones secreted into?

Maternal circulation

6

When is hCG produced, by what cells?

8 days post fertilization
Cytotrophoblasts
Synctiotrophoblasts

7

What effect does hCG have on the corpus luteum?

Maintains corpus luteum
Corpus luteum produces progesterone until week 11 when the placenta takes over

8

What effect can hCG have on TSH?

Suppresses TSH

9

What effect can hCG have on thyroid function?

hCG has TSH activity at high levels

10

What is the most abundent secretory product of the placenta?

hPL

11

What cells secrete hPL?

Syncytiotrophoblasts

12

Is hPGH regulated by GHRH or somatostatin?

No

13

What effect does hPGH have on the mother?

Promotes insulin resistance

14

Why are statins contraindicated in pregnancy?

Cholesterol precursors for steroid synthesis are required

15

What is the role of progesterone during pregnancy?

Maintains uterine lining
Promotes decidua formation
Maintains uterine quiescence

16

What is the substrate used by the placenta to make progesterone?

LDL, vLDL

17

How is the fetus protected from high progesterone levels?

Lacks enzyme needed to convert pregnenolone to progesterone

18

What effect does progesterone have on a mother regarding cellular immunity?

Decreased
Improvement of autoimmune processes
Increased susceptibility to intracellular pathogens

19

What is the precursor for estrogens?

60% fetal DHEAS
40% maternal DHEAS

20

What effect does estrogen have on coagulability during pregnancy?

Hypercoagulable state

21

What is the leading cause of maternal death?

PE

22

What happens to total cortisol and TT4 levels during prengnancy?

Increase- E2 increases binding protein synthesis at the liver

23

A woman develops pancreatitis during pregnancy. The physician believes it is likely hormonaly related. What hormone is responsible?

Estrogen- increased TG synthesis

24

Why does the pituitary increase in pregnancy?

Estrogen stimulates lactotrophs

25

An increased pituitary is at risk of what complication?

Sheehan syndrome/postpartum hypopituitarism- ischemic necrosis of pituitary gland due to blood loss and hypovolemic shock during/after birth

26

What must occur to maternal estrogen levels in order for successful lactation to occur?

Estrogen must fall- decreased competetion with prolactin for prolactin receptor

27

A woman with RA notices her condition has improved being pregnant. Explain why.

Progesterone- decreases cellular immunity

28

During pregnany women become resistant to aldosterone and AgII. Why?

Progesterone competes for aldosterone receptor

29

What medication is a progesterone antagonist that is an abortifacent when given early in gestation?

Misoprostol

30

Traditionally, what hormone has been identified as the placental hormone responsible for the development of maternal insulin resistance?

hPL

31

In the late second and third trimester women manifest a nearly 50% decrease in insulin mediated glucose disposal. What effect does this have on maternal insulin production?

Increased

32

Glucose transport to the fetus occurs via what placental glucose transporter?

GLUT-1

33

When is fetal insulin secreted?

11 weeks
Response to maternal glucose

34

How quickly does insulin sensitivity return post partum?

48 hours

35

Gestational diabetes is caused by abnormalities in at least 3 aspects of fuel metabolism what are these aspects?

Insulin resistance
Impaired insulin secretion
Increased hepatic glucose production
(most women overweight, think unmasking of DM2)

36

Detail the normal fasting plasma glucose in a normal pregnancy.

~10 mg/dl lower than non-pregnant individuals
Presumably due to increase in glucose uptake by fetoplacental unit

37

What effect does hyperglycemia have on fetal insulin production?

Increased- hyperinsulinemia
Beta cell hyperplasia

38

What effect does hyperglycemia/hyperinsulinemia have on fetal growth?

Increases

39

A 26-year-old G1P0 diabetic woman is delivering at 42 weeks' gestation has a complicated vaginal delivery in which the shoulders do not deliver with ease. The birth weight is 4300 grams. The baby is noted postpartum to have difficulty moving the left arm. What complication has likely occured?

Shoulder dystocia

40

What populations are at highest risk for GDM?

Hispanics
Native Americans
Pacific Islanders

41

Define macrosomia.

Fetal birth weight >4000 g

42

DM1 and DM2 can result in malformations of the heart or spine. Why are these complications not scene in women who develop GDM?

Glucose is teratogen in first trimester
Women with GDM should not have elevated glucose in first trimester

43

What are maternal complications that can arise from GDM?

Increased incidence of preeclampsia
Infection
Preterm labor due to polyhdramnios
Cesarean delivery
40-50% risk of developing DM2 in 10-20 years (most important complication)

44

What is standard practice for GDM screening?

50 g oral glucose test at 24-28 weeks
If abnormal (>130-140) give a diagnostic 3 hour 100 g OGTT
2 abnormal values on OGTT are diagnostic

45

What are risk factors for GDM?

BMI >30
DM in first degree relative
Hx of macrosomic infant
Hx of GDM
Hx of PCOS

46

When should women with risk factors for GDM be screened?

First prenatal visit

47

Detail the therapy for a woman diagnosed with GDM.

Carbohydrate, fat, calorie restricted diet
Check blood glucose throughout the day

48

If therapy or the fetus is showing abnormal growth in a woman with GDM what is the next course of action?

Insulin or glyburide

49

What hypoglycemic agent crosses the placenta least well?

Glyburide

50

How do maternal iodine requirements change during pregnancy?

Increase
Women who are unable to meet increased demand become increasingly hypothyroid and develop a goiter

51

What conditions lead to increased hCG and can result in gestational thyrotoxicosis.

Molar pregnancy
Hyperemesis gravidarum
Multiple pregnancy

52

What is the leading cause of hypothroidism globally and in the US?

Globally- iodine deficiency
US- hasimoto thyroiditis

53

Why should T3 not be used in pregnant women for replacement of thyroid hormone?

Fetal brain has mainly T4 receptors

54

What components of fetal brain development are dependent on T4?

Neurogenesis
Neuronal migration
Myelination

55

What women should be screened for thyroid disease? When?

Women with risk factors:
Hx of thyroid disease
Goiter
Hypothyroid symptoms
Anemia
Autoimmune disease
Family Hx
First prenatal visit

56

Does subclinical hyperthyroidism cause adverse pregnancy outcomes?

No

57

A pregnant woman has suppressed TSH, what test can not be done to differentiate the cause of thyrotoxicosis?

Radioactive iodine

58

Does gestational hyperthyroidism need to be treated with antithyroid medication?

No

59

Should TSH be used to titrate antithyroid therapy?

No- can remain suppressed and attempts to normalize it may render the fetus hypothryoid

60

Define post partum thyroiditis.

Hyperthyroidism, hypothyroidism, or both within the first year postpartum from autoimmune thyroid dysfunction not previously recognized

61

What types of valvular heart lesions improve with pregnancy, which do worse?

Mitral regurgitation improves
Aortic stenosis/pulmonary HTN do worse
(Increased CO)

62

When is TSH normally low?

1st trimester

63

What is the function of progesterone and pregnenolone in the fetus?

Substrate for fetal aldosterone and cortisol

64

A woman with DM becomes pregnant, why must her insulin dosing change?

Increased insulin sensitivity
Must decrease insulin
Risk for hypoglycemia

65

What hormone increases lipolysis and insulin secretion in pregnancy?

hPL

66

What hormone causes 50% of women with hyperemesis gravidarium to become hyperthyroid?

hCG