ENDOCRINE DISORDERS AND PREGNANCY

reduce thyroid activity. These drugs are, unfortunately,

Outline teratogens.
I Endocrine System
II A Woman with Thyroid Dysfunction
HYPOTHYROID HYPERTHYROID
i Hypothyroidism
ii Hyperthyroidism Hair loss Fine, brittle hair
III A Woman with Diabetes Mellitus Fatigue Trouble sleeping
IV OGTT Sensitivity to cold Excessive sweating
Constipation Weight loss
Increased Cholesterol High blood pressure
ENDOCRINE SYSTEM Weight Gain Anxiety
 Functions: Dry Skin Moist skin
o Metabolism Underactive thyroid Overactive thyroid
o Control of Food Intake and Digestion Under-produces the Thyroid Over-produces the Thyroid
o Control of Blood Glucose and other nutrients Stimulating Hormone Stimulating Hormone
o Immune System Regulation
A WOMAN WITH DIABETES MELLITUS
A WOMAN WITH A THYROID DYSFUNCTION  Diabetes mellitus is an endocrine disorder in which the
 As a normal effect of pregnancy, the thyroid gland pancreas cannot produce adequate insulin to regulate
enlarges (hypertrophies) slightly because of increased body glucose levels.
vascularity and blood flow.
 A woman with pre-existing thyroid problems may have CLASSIFICATIONS
difficulty making this pregnancy transition.  TYPE 1
 Thyroid disorders can range from a harmless goiter (or o Formerly known as insulin-dependent diabetes
enlarged gland) that needs no treatment at all to life- mellitus.
threatening thyroid cancer o A state characterized by the destruction of the beta
 T3 (triiodothyronine) and T4 (thyroxine) are hormones cells in the pancreas that usually leads to absolute
that the thyroid gland produces to control the body's insulin deficiency.
energy use.  TYPE 2
A WOMAN WITH HYPOTHYROIDISM o Formerly known as non-insulin-dependent diabetes
 Hypothyroidism is a rare condition in young adults and mellitus.
especially in pregnancy, because women with symptoms o A state that usually arises because of insulin
of untreated hypothyroidism are often anovulatory and resistance combined with a relative deficiency in the
unable to conceive. production of insulin.
 This can lead to early spontaneous miscarriage.  GESTATIONAL DIABETES
 Women with hypothyroidism fatigue easily and tend to be o A condition of abnormal glucose metabolism that
obese; their skin is dry (myxedema), and they have little arises during pregnancy.
tolerance for cold. It may be associated with an increased o Possible signal of an increased risk for type 2
incidence of extreme nausea and vomiting (hyperemesis diabetes later in life.
gravidarum)  IMPAIRED GLUCOSE HEMEOSTASIS
 Most women with hypothyroidism take levothyroxine o A state between “normal” and “diabetes” in which the
(Synthroid) to supplement their lack of thyroid hormone body is no longer using and/or secreting insulin
A WOMAN WITH HYPERTHYROIDISM properly
 Hyperthyroidism, or overproduction of thyroid hormone,
causes symptoms such as: RISK FACTORS FOR GESTATIONAL DIABETES
o Rapid heart rate INCLUDE:
o Exophthalmos (protruding eyeballs)  Obesity
o Heat intolerance  Age over 25 years
o Nervousness  History of large babies (10 lb or more)
o Heart palpitations  History of unexplained fetal or perinatal loss
o Weight loss  History of congenital anomalies in previous pregnancies
 Hyperthyroidism (Graves’ disease) is more apt to be seen  History of polycystic ovary syndrome
in pregnancy than hypothyroidism.  Family history of diabetes (one close relative or two distant
 Prone to symptoms of hypertension of pregnancy, fetal ones)
growth restriction, and preterm labor than the average  Member of a population with a high risk for diabetes
woman. (Native American, Hispanic, Asian)
Treatment for hyperthyroidism is with thioamides
(methimazole [Tapazole] or propylthiouracil [PTU]), which CAUSE

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 Gestational diabetes comes from hormonal changes and length of thin polyethylene tubing and implanted into
the way our bodies convert food into energy the subcutaneous tissue of a woman’s abdomen or
thigh
 Tests for Placental Function and Fetal Well-Being
POSSIBLE COMPLICATIONS FOR THE BABY o Monitoring of fetal well-being is individualized
INCLUDE: depending on the woman’s overall health. Because
 Stillbirth (fetal death) women with diabetes tend to have infants with a
 Birth defects higher-than-normal incidence of birth anomalies
 Macrosomia o A woman may be asked to self-monitor fetal well-
 Birth injury being by recording how many movements occur an
 Hypoglycemia. hour
 Trouble breathing (respiratory distress).  Timing for Birth
o Before women with diabetes were managed with
 Preeclampsia
maximum control during pregnancy, the timing of birth
was a chief concern
ASSESSMENT FOR A PREGNANT WOMAN WITH
o A woman’s glucose level is regulated during labor by
DIABETES MELLITUS an intravenous infusion of regular insulin, with a blood
 Dizziness (IF HYPOGLYCEMIC) glucose assay every hour
 Confusion (IF HYPERGLYCEMIC)
 Thirst
 Glycosuria, Polyuria OGTT
 Macrosomia ORAL GLUCOSE TOLERANCE TEST
 Poor FHT variability and rate  measures the body's ability to use a type of sugar, called
 Hyperglycemia glucose, which is the body's primary source of energy. An
 Congenital anomalies OGTT can be used to diagnose prediabetes and diabetes.
 Increased risk of pregnancy induced hypertension An OGTT is most commonly done to check for diabetes
 Hydramnios that occurs with pregnancy (gestational diabetes).
 Possibility of Increased monilial infection.  the test is more involved and requires you to fast (no
eating or drinking for several hours before the test).
NURSING DIAGNOSES AND RELATED  this test diagnoses gestational diabetes
INTERVENTIONS  sometimes called a three-hour glucose test.
 Imbalanced nutrition, less than body requirements, related
to inability to use glucose GLUCOSE CHALLENGE TEST
 Risk for ineffective coping related to required change in  Glucose screening test
lifestyle  is a screening, which means it detects an increased
 Risk for infection related to impaired healing probability of gestational diabetes.
accompanying condition  it doesn’t diagnose gestational diabetes.
 Deficient knowledge related to complex health problem

RELATED INTERVENTIONS
 Education Regarding Nutrition During Pregnancy
 Education Regarding Exercise During Pregnancy

THERAPEUTIC MANAGEMENT
 Insulin
o Early in pregnancy, a woman with diabetes may need
less insulin than before pregnancy because the fetus
is using so much glucose for rapid cell growth.
o Later in pregnancy, she will need an increased
amount because her metabolic rate and need
increase.
 Blood Glucose Monitoring
o All women with diabetes need to do blood glucose
monitoring to determine whether hyperglycemia or
hypoglycemia exists.
 Insulin Pump Therapy (Continuous Subcutaneous
Insulin Infusion)
o An insulin pump is an automatic pump about the size
of an mp3 player.
o A syringe of regular insulin is placed in the pump
chamber and a small gauge needle is attached to a

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