A Woman With Thyroid Dysfunction

 As a normal effect of pregnancy, the thyroid gland

enlarges slightly because of increased vascularity and
blood flow. A woman with pre-existing thyroid
problems may have difficulties making this pregnancy
transition.
A Woman With Hypothyroidism
 Hypothyroidism is when your thyroid does not
produce enough hormones, a rare condition in young
adults and especially in pregnancy.
 Women with symptoms of hypothyroidism are often
anovulatory and unable to conceive.
 Women who have this disease take levothyroxine
(Synthroid) to supplement their lack of hormone.
 Women should separate thyroxine ingestion from any
medication containing iron, calcium, or soy products
to be sure that there is no problem with the absorption
of thyroxine.
Signs and symptoms of Hypothyroidism
 Fatigue Easily
 Tend to be obese
 Dry skin (myxedema)
 Little tolerance for cold
 Nausea and vomiting (hyperemesis gravidarum)
A Woman With Hyperthyroidism
 Hyperthyroidism (Grave’s disease) is the
overproduction of hormones.
 It is more apt to be seen in pregnancy than
hypothyroidism.
 If undiagnosed, a woman may develop heart failure
during pregnancy because her heart rate, already high
at the beginning of pregnancy, cannot increase enough
to handle the increasing blood volume.
 Hypothyroidism is treated with thioamides
(methimazole) or propylthiouracil (PTU) which
reduces thyroid activity.
Signs and Symptoms of Hyperthyroidism
 Rapid heart rate
 Exopthalmos (protruding eyeballs)
 Heart intolerance
 Nervousness
 Heart palpitations
 Weight Loss
A Woman With Diabetes Mellitus
 Diabetes Mellitus is an endocrine disorder in which
the pancreas cannot produce adequate insulin to
regulate body glucose levels.
 The Primary problem of any woman with this disorder
is controlling the balance between insulin and blood
glucose levels to prevent hyperglycemia or
hypoglycemia.
Classification of Diabetes Mellitus
 Type 1
- known as insulin-dependent diabetes mellitus
- characterized by destruction of beta cells in the pancreas that
leads to insulin deficiency
a. Immune-mediated diabetes mellitus results from autoimmune
destruction of beta cells.
• Type 2
- known as non-insulin dependent diabetes mellitus
- usually arises because of insulin resistance combined w/ a
relative deficiency in the production of insulin.
• Gestational Diabetes
• - a condition of abnormal glucose metabolism that arises during

pregnancy.
• - Possible sign of an incresased risk for type 2 diabetes later in
life.
Classification of Diabetes Mellitus
 Impaired glucose homeostasis
- A state between “normal” and “diabetes” in
which the body is no longer using and/or secreting
insulin properly.
a. Impaired fasting glucose: a state when fasting a
plasma glucose is at least 110 but under 126 mg/dl.
b. Impaired glucose tolerance: A state when results of
oral glucose tolerance test are at least 140 but under
200 mg/dl in the 2-hour sample.
Dangers of Disease
 Pancreas malfunction
 Ketoacidosis
 Protein In Urine
 Stomach Problems
 Foot problems
 Heart disease
 Stroke
 Cataracts and glaucoma
Therapeutic management for Diabetes Mellitus
 Insulin
- Early in pregnancy, a woman w/diabetes may need
less insulin than before pregnancy because the fetus is
using so much glucose for rapid cell growth.
- Later in pregnancy, she will need an increased
amount because her metabolic rate and need increase.
- The type of insulin chosen is short-acting combined
w/ an intermediate type. Two thirds of the total amount of
day’s insulin is given in the morning, the other is in the
evening.
- It is self- administered 30mins. Before breakfast in a
ratio of 2:1 and again just before dinner in a ratio of 1:1.
 - Human Insulin is recommended because it has
the potential for provoking a lesser antibody response
than beef or pork insulins.
- Women should eat almost immediately after
injecting these short-acting insulins to prevent
hypoglycemia before mealtimes.
- Because insulin is absorbed more slowly from
the thigh than the upper arm, a woman should
maintain a consistent rotating injection routine to
maintain as consistent a level of absorption as
possible.
 Blood Glucose Monitoring
- All women w/ diabetes need to do blood glucose
monitoring to determine whether hyperglycemia or
hypoglycemia exists.
- For this, a woman uses a finger stick technique,
using one of her fingertips as the site for lancet
puncture.
- When a woman discovers that hypoglycemia is
present, she should ingest some form of sustained
carbohydrate such as a glass of milk and some
crackers. This helps prevent a rebound phenomenon
in w/c a high glucose level is created that produces
even more pronounced hypoglycemia.
 - If a woman discovers an elevated blood glucose
level, she should assess her urine for ketones.
- Acidosis during pregnancy must be prevented
because maternal acidosis leads to fetal anoxia because
of fetal inability to use oxygen when body cells are
acidotic.
 Insulin Pump Therapy (Continuous Subcutaneous
Insulin Fusion)
- a method to keep serum glucose constant.
- it is an automatic pump about the size of an mp3
player.
- A syringe of regular insulin is placed in the pump
chamber and a small-gauge needle is attached to a
length of thin polyethylene tubing and implanted into
the subcutaneous tissue of a woman’s abdomen/thigh.
- The pump must not be allowed to become wet.
Therefore, it should be removed( not the syringe and
tubing) when showering and the complete apparatus
when bathing or going for a swim.
 Tests for Placental Function and Fetal Well-Being
- Because a woman w/ diabetes tend to have infants w/
a higher-than-normal incidence of birth anomalies, a
woman will have a serum alpha- fetoprotein level obtained
at 15-17 weeks to assess for a neural tube defect and an
ultrasound examination performed at 18-20 weeks to detect
gross abnormalities.
- Ultrasounds may be taken at week 28 and then again
at week 36-38 to determine fetal growth, amniotic fluid
vol. , placental location and biparietal diameter.
- A woman may be asked to self- monitor fetal well-
being by recording how many movements occur an hour.
 Timing for birth
- Among the most hazardous times for a fetus are
weeks 36-40 of pregnancy when it is draws large stores
of maternal nutrients because of its large size.
- Cesarean birth is routinely performed in
pregnant diabetic women at 37 weeks’ gestation as it is
difficult to induce labor this early in pregnancy
because the cervix is not yet ripe/ responsive to labor
contractions.
 Postpartum Adjustment
- During postpartum period, a woman who came
into pregnancy w/ diabetes must undergo another
readjustment to insulin regulation.
- One-or-2 hour postprandial blood glucose
determinations help to regulate how much insulin she
needs.
- A woman w/ gestational diabetes usually
demonstrates normal glucose values by 24hrs. After
birth and needs no further diet/insulin therapy.
- Women w/ diabetes may breastfeed because
insulin is one of the few substances that does not pass
into breast milk from the bloodstream.
Mental Illness and Pregnancy
 Mental illness may precede or occur during pregnancy.
 Schizophrenia tends to have a higher incidence in
adolescents ,young adults and in young pregnant women.
 Depression occurs almost four times more commonly in
women than in men and is the most common mental
illness seen in pregnant women.
 Pregnancy/ Childbirth may be the additional stress that
reveals mental illness for the first time.
 A woman w/psychiatric disorder should be cared for by
both a psychiatric care team and a prenatal care group to
ensure that stress, distorted perceptions or depression do
not complicate pregnancy.
 Mental Illness and Pregnancy
 Medications:
 Antidepressants (Tricyclic antidepressants/TCAs,
fluoxetine [Prozac], selective serotonin reuptake
inhibitor/SSRI are known to have teratogenic effects)
 Mood Stabilizing Agents ( Lithium, valproic acid
[Depakene] and carbamazepine [Tegretol]) cause
hypoplasia of the right ventricle
 Antipsychotic agents (high-potency agents such as
haloperidol [Haldol], low-potency such as
chlopromazine [Thorazine] have harmful effects to
fetus.
 Mental Illness and Pregnancy
 Non pharmacologic methods:
 Cognitive behavior therapy
 Interpersonal psychotherapy