Pregnancy and Endocrinology
Pregnancy involves a “hormonal storm” for women. It causes important endocrine changes and modifies previous hormonal and/or metabolic disorders
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It is a proved fact that, whenever a pregnant woman has diabetes, thyroid disease, body weight disorders or other endocrine diseases, prognosis for the mother and the foetus worsens because of the risk of birth defects and other associated problems. Yet, prognosis can be improved with monitoring and a specific treatment, and thus resemble the prognosis for a normal pregnancy.
For this reason, it is important to address early hormonal and metabolic problems (diabetes, thyroid disease, polycystic ovaries, body weight disorders, or prior obesity surgery, as well as less frequent problems, such as prolactinomas, congenital adrenal hyperplasia, diabetes insipidus, Cushing’s syndrome, Addison’s disease,…) in order to optimise the treatment before becoming pregnant (preconception check-up), monitoring their evolution during pregnancy, and adjust the treatment before and immediately after delivery, as the disappearance of the baby and the placenta after delivery will involve another “storm of hormonal changes” that needs to be kept in mind.
Our Department offers pre-pregnancy assessment at our Preconception Consultation Office, where we carry out nutritional and endocrinological assessments of our patients before pregnancy and monitor their evolution during pregnancy and after delivery so as to achieve the best possible results for both the babies and their mothers.
In addition, we test all of our pregnant patients for Gestational Diabetes and Thyroid Disorders associated with pregnancy. Treatment and the necessary examinations to prevent complications are started as soon as it becomes possible, as well as reclassification of metabolic disorders after delivery and long-term prognosis for the mother.
Our team of obstetricians will adequately monitor the nutritional requirements and the vitamin supplements needed during each stage of pregnancy (preconception, pregnancy and breastfeeding) and will advise nutritional and endocrinological assessment where necessary.
Our Endocrinology Centre also provides assessment in cases of severe obesity (morbid obesity) before and after obesity surgery in women who wish to become pregnant.
“Every fertile woman with diabetes should plan her pregnancies.”
Pregnancy in women with diabetes is considered “high risk”. Thus, pre-pregnancy endocrinological assessments are advised in order to assess the existing associated complications and potential pregnancy risks and optimise metabolic monitoring before pregnancy.
(pre-pregnancy assessment). Excellent monitoring after achieving pregnancy (during gestation and after delivery) will help to minimise the risks for both the mother and the baby.
Gestational diabetes is a disorder in glucose metabolism that is normally found for the first time during pregnancy. It affects up to 10% of pregnant women.
We increasingly find a subgroup of women with no previous known history of diabetes who test positive for diabetes in their first pregnancy test.
These are women with previous diabetes. This group, called “Manifest Diabetes”, has a higher risk of suffering from traditional Gestational Diabetes. For this reason, they need to be referred to an endocrinology centre to start an early treatment.
Diagnosis is done by performing the O’Sullivantest on every pregnant woman and, where necessary, an Oral Glucose Tolerance Test (OGTT).
To detect Manifest Diabetes, analyses of glucosylated haemoglobin (HbA1c) can also be performed, since they detect disorders of glucose over a period of three months before the test.
Our Endocrinology Centre offers specialised monitoring and writes a report for the time of delivery where recommendations are given for the post-partum period. A laboratory test becomes necessary from the sixth week after delivery for the purposes of post-partum reclassification and long-term follow-up.
“A thyroid pathology that is not properly monitored during the periconceptional period will unavoidably result in risks of spontaneous miscarriage and potential neurological damage to the foetus.”
Our Nutrition Centre performs the following procedures for women with thyroid disease diagnosed before pregnancy:
- Pre-pregnancy assessment of hormonal and immunological status.
- Periconceptional treatment adjustment.
- Quarterly adjustments during pregnancy.
- Assessment of risks of thyroid disorders in the newborn (report for the neonatologist).
- Post-partum treatment.
At Instituto Bernabeu, we systematically check the thyroid function of every woman who wishes to become pregnant in order to detect hypothyroidism associated with pregnancy and the possible presence of thyroid autoimmunity. Our goal is to provide an adequate treatment that increases the chances of achieving pregnancy and prevents the possible associated complications.
“Every hormonal disorder is altered by the endocrine-metabolic changes that occur during pregnancy. For this reason, such disorders must be assessed and monitored before pregnancy in order to prevent problems for the mother and the foetus.”
Some endocrinological disorders that may be found in women who wish to become pregnant are: hyperprolactinaemias, polycystic ovarian syndrome, adrenal insufficiency, Cushing’s syndrome, parathyroid disorders, congenital adrenal hyperplasia, and diabetes insipidus, among others.