Maternal Health Information
Intrahepatic Cholestasis of Pregnancy (ICP)
Intrahepatic Cholestasis of Pregnancy (ICP) is a liver condition unique to pregnancy. It disrupts normal bile flow from the liver, causing bile acids to spill into the bloodstream. While uncommon, this condition can pose significant risks to the unborn baby.
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Thyroid hormones supplementation in pregnant women with Hashimoto’s thyroiditis
Thyroid hormones supplementation 50 mcg daily did not improve pregnancy outcomes in women with Hashimoto’s thyroiditis in the presence of normal thyroid function. Hashimoto’s thyroiditis was confirmed by elevated TPO antibodies at study entry. About 1,000 pregnant women were followed through full term. This is an important study as it defies the current medical opinion of poorer pregnancy outcomes in euthyroid Hashimoto’s thyroiditis. GT
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Metformin found to be safe during pregnancy
The study found no major adverse events of metformin during pregnancy. This is good news as metformin is an important intervention for hyperglycemia of pregnancy. The following birth outcomes were assessed: cesarean section, neonatal weight, and serious neonatal adverse events. GT
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Congenital malformations in Grave’s disease
Traditional approach is to use propylthiouracil (PTU) for Grave’s disease during the first trimester. This article points otherwise, that both methimazole and PTU can increase the risk of congenital malformations when used in the first three months of pregnancy. I suspect more research would be needed before changing guidelines or standard of care. GT
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Low dose aspirin can help with pregnancy
An important study showing that low-dose aspirin (LDA) 81 mg/day can increase fertility and successful pregnancy in women with mild chronic inflammation and prior miscarriage. Chronic inflammation is documented by elevated hsCRP. A clinical implication could be checking hsCRP in women with history of pregnancy loss, and if elevated to prescribe low-dose aspirin. LDA has been found safe during pregnancy, while full-dose aspirin should be avoided during the third trimester. GT
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Glyburide vs. Metformin during pregnancy
This randomized controlled study shows that glyburide and metformin are comparable in management of gestational diabetes. There is tendency for metformin to be somewhat superior however, given less insulin use as second line therapy. GT
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Subclinical Hypothyroidism and Hypothyroxinemia during pregnancy
Pregnant women with subclinical hypothyroidism or hypothyroxinemia received thyroid hormone supplementation or placebo. Compared to placebo, thyroid hormone did not improve children’s cognition at age five. Although results are negative, the study is incomplete for two reasons: Levothyroxine was not initiated until week 17 of gestation. For more meaningful results, thyroid hormone should be started before pregnancy or very early in the first trimester.Longer follow up of 10-15 years would be more appropriate in evaluating…
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2017 ATA Guidelines: Thyroid & Pregnancy (Part 2)
ATA has “developed evidence-based recommendations to inform clinical decision making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders” Part 2 of recommendations are listed with slightly modified wording for easier and succinct reading: GT
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Categorized as Blog, Clinical Guidelines, Insights from Dr. Tashko, Maternal Health Information, Thyroid Health
2017 ATA Guidelines: Thyroid & Pregnancy (part 1)
ATA has “developed evidence-based recommendations to inform clinical decision making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders” Part 1 of recommendations are listed with slightly modified wording for easier and succinct reading: GT
Published
Categorized as Blog, Clinical Guidelines, Insights from Dr. Tashko, Maternal Health Information, Thyroid Health