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Medical Complications of Pregnancy15
th
Jan 2009Rob Bradley1
 
Medical complications inPregnancy
 
 
Medical complications inPregnancy
•
Pregnancy effect on disease
•
Disease effect on pregnancy
 
 
Medical complications inPregnancy
•
Diabetes
•
Thyroid
•
 Asthma
•
Epilepsy
•
Renal
•
Cardiac
•
Obstetric cholestasis
 
 
Medical complications inPregnancy
•
Diagnosis
•
Pregnancy specific issues
 – 
Effect of pregnancy on disease
 – 
Effect of disease on pregnancy
•
Management
 – 
Prevention of complications
 – 
Monitoring
•
Post natal issues
 
 
Medical complications inPregnancyDiabetes
 
 
Diabetes in pregnancy
•
Glycaemic control
 – 
insulin
 – 
diet
•
Monitor complications
 – 
retinopathy
 – 
nephropathy
•
Preventative advice for GDM
 
Medical Complications of Pregnancy15
th
Jan 2009Rob Bradley2
 
Diabetes in pregnancy
•
Fetal malformation
•
Fetal macrosomia
•
Intrauterine death
 
 
Diabetes in pregnancy
•
Screening for GDM
•
Glycaemic control
 – 
pre-conception
 – 
during pregnancy
•
 Anomaly screening
•
Fetal growth assessment
•
Delivery planning
 – 
gestation
 – 
mode
 
 
Medical complications inPregnancyThyroid
 
 
Thyroid in pregnancy
Hypothyroid
•
Pregnancy has little effect on disease
 – 
no monitoring if good control pre-pregnancy
•
Severe untreated hypothyroidism
 – 
infertility, menstrual disturbance
 – 
miscarriage, PET, LBW
 
 
Thyroid in pregnancy
Hyperthyroid
•
95% Graves
 – 
TSH stimulating antibodies
•
May improve with pregnancy
•
Severe untreated hyperthyroidism
 – 
infertility, menstrual disturbance
 – 
miscarriage, IUGR, preterm labour
•
Poor control may result in thyroid crisis
•
Good outcome with adequate control
 
 
Thyroid in pregnancy
Hyperthyroid
•
Treat with PTU or carbimazole
 – 
PTU for new cases
 – 
lowest effective dose
•
Thyroid stimulating Ab measurement
 – 
neonatal observation for up to a week 
•
Beta blockers for severe symptoms
•
Neonatal TFTs
 – 
cord and at 2 weeks
 
Medical Complications of Pregnancy15
th
Jan 2009Rob Bradley3
 
Medical complications inPregnancy Asthma
 
 
 Asthma in pregnancy
•
Usually no significant change
•
Continue medication
 – 
reassure re safety
 
 
Medical complications inPregnancyEpilepsy
 
 
Epilepsy in pregnancy
•
Some worsen, most stable
•
Teratogenesis
(background 2-3%)
 – 
National Teratology Unit 0191 232 1525
 – 
6% one drug, 15% two, 50% three
 – 
NTDs (valproate & carbamazepine)
 – 
orofacial clefts (phenytoin)
 – 
heart defects (phenytoin & valproate)
 
 
Epilepsy in pregnancy
•
Folic acid 5mg -conception +/-12 wks
•
Rationalise drug therapy
•
 Anomaly scans (NB heart)
•
Drug levels if control worsens
•
 Vitamin K (10mg po od) from 36/40
•
Neonatal vitamin K 
 
 
Medical complications inPregnancyRenal
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