Prenatal Environment Flashcards
Most common endocrine disorder affecting pregnancy
Gestational diabetes mellitus (GDM)
4-10% of pregnant women; fueled by obesity epidemic
Effect of GDM in early pregnancy
Teratogenic effect
- spontaneous abortions
- congenital malformations
Effects of GDM in later pregnancy
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
Macrosomia
Greater than 90th percentile for weight
-occurs in 25% -42% of diabetic pregnancies d/t hyperinsulinemia
Effects of macrosomia on infants
Increased morbidity & mortality rates
- unexplained intrauterine death
- birth trauma
- hypertrophic cardiomyopathy
- vascular thrombosis
- neonatal hypoglycemia
- hyperbilirubinemia
- erythrocytosis
- respiratory distress
Macromnia predisposes infant to an increased risk of what injuries during birth?
- shoulder dystocia
- brachial plexus injury
- facial nerve palsy
- dysfunctional labor patterns
- operative vaginal birth
Prognostically bad signs of GDM during pregnancy
- diabetic ketoacidosis
- hypertension
- pyelonephritis
- maternal noncompliance
In preparing for delivery of an IDM, the neonatal team should consider…
- 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
Sulfonylurea (glyburide) May cause…
Neonatal jaundice
When does fetus begin to concentrate iodine and produce T4?
8-10 weeks
Thyroid first trimester
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.
Hormone treatment for hypothyroidism during pregnancy is…
Well tolerated by fetus and reduces risks
Maternal hyperthyroidism
Offspring of women with Graves’ disease may have condition
Graves’ disease in newborn S/S
- increased HR
- growth restriction
- prematurity
- goiter
- CHF
Antithyroid meds
Can lower thyroid hormone production in mother but may result in fetal HYPOTHYROIDISM and goiter.
Iodine deficiency in mother
Cause of fetal & neonatal hypothyroidism
-severe form leads to cretinism
Cretinism
Congenital iodine deficiency syndrome
- severely stunted physical & mental growth