A brief review of the role of endocrinologist in the management of patients with recurrent pregnancy loss

2. Definitions
ACOG
RCOG

3. Epidemiological vs Clinical
›
›
›
–

4. Causes of Bad obstetric history
Ford, Holly B.; Schust, Danny J. (2009): Recurrent pregnancy loss. Etiology, diagnosis, and therapy. In
Reviews in obstetrics & gynecology 2 (2), pp. 76–83.

5. Endocrine Causes of BOH
›
–
–
›
›
›
›

9. Korevaar, Tim I. M. et al. Thyroid autoimmunity impairs the thyroidal response to human chorionic
gonadotropin: two population-based prospective cohort studies. J. Clin. Endocrinol. Metab. 102,
69–77 (2016)

10. ›
–
›
›
–
›
›
›
›
›

11. ›
–
–
›
–
–

12. ›
–
–
›
›

13. Recommendation TPO positive TPO negative
Is recommended
(strong)
Greater than pregnancy
specific range
Moderate
>10 mIU/L
Low
May be considered
(weak)
>2.5 mIU/L but lower
than pregnancy
specific range
Moderate
Between 10 mIU/L and
pregnancy specific range
Low
Not recommended
(strong)
Within pregnancy specific
range
high
• Isolated hypothyroxinemia need not be treated

14. ATA 2017 & Endocrine Society for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum

15. ›
›
›
›

17. Goal of treatment
›
›

18. When not to treat?
›
›
›
›

19. Gestational transient thyrotoxicosis
›
›
›
›
›
›
›

20. ›
›
–
–
–
›
›
Hyperthyroidism before pregnancy

21. ›
–
–
–
–
–
–
›
Hyperthyroidism treatment

22. ›
›
›
›
›
Anti-thyroid drugs
PTU- Propylthiouracil
MMI - Methimazole

23. ›
›
–
–
–
–
Anti-thyroid drugs contd

24. ›
–
–
–
›
›
›
Thyroidectomy

25. Monitoring TRAb
›
–
–
–
–

26. When to measure?
›
›
›

27. Post partum
›
›
›

29. Diabetes
›
›
›
›

30. ›
›
›
›
›
›
Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and
metaanalysis.Balsells M, García-Patterson A, Gich I, Corcoy R .J Clin Endocrinol Metab. 2009 Nov;94(11):4284-91.

31. Risks
Fetus Mother
Congenital malformation Miscarriage
Prematurity Preeclampsia
Macrosomia Polyhydramnios
Growth restriction Preterm delivery
Neonatal medical complications Caesarean delivery
Perinatal mortality DKA
Long term outcomes Progression of vascular disease
Neuropathy

32. Bell R, Glinianaia SV, Tennant PW, et al. Peri-conception hyperglycaemia and nephropathy are associated
with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study.
Diabetologia 2012; 55:936

33. Management -Preconception
›
›
›
›
›

34. Glycemic control -targets
›
›
›
›

35. Medication management
›
›
–
–
–
–
–
›
›

36. Blood pressure and lipids
›
›
›
–
–
–

37. Watch out for other complications
›
›
›
›
›

38. SMBG
›
›
›
›

39. Glycemic targets (ACOG &ADA)
›
›
›
›
›
›
›

40. Weight management
Prepregnancy BMI Total Weight gain (kg) Rate of weight gain kg/week
Underweight (<18.5 kg/m2) 12.5 to 18 0.51 (0.44 to 0.58)
Normal weight (18.5 to 24.9
kg/m2)
11.5 to 16 0.42 (0.35 to 0.50)
Overweight (25.0 to 29.9
kg/m2)
7 to 11.5 0.28 (0.23 to 0.33)
Obese (≥30.0 kg/m2) 5 to 9 0.22 (0.17 to 0.27)
Weight Gain During Pregnancy: Reexamining the Guidelines. Institute of Medicine (US) and
National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines,
Rasmussen KM, Yaktine AL (Eds), National Academies Press (US), The National Academies
Collection: Reports funded by National Institutes of Health, Washington (DC) 2009

41. Intrapartum management
Glucose requirement Insulin requirement
Latent phase 50% caloric intake No* (For GDM & Type 2)
Active phase 2.5 mg/kg/min No (even in type 1,
requirement is lower)

42. Monitoring and goals
›
›
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›

44. PCOS

45. Metformin &PCOS
Kamalanathan, Sadishkumar; Sahoo, Jaya Prakash; Sathyapalan, Thozhukat (2013): Pregnancy in polycystic
ovary syndrome. In Indian journal of endocrinology and metabolism 17 (1), pp. 37–43.

47. Definition
›
›

48. Hyperprolactinemia - mechanisms
›
›
›

49. Hyperprolactinemia - concerns
Gonzales JG, Elizondo G, Saldivar D, et al. Pituitary gland growth during normal pregnancy: an in vivo
study using magnetic resonance imaging. Am J Med 1988; 85:217.

50. Treatment
›
›
–
–
–
›

51. Monitoring
›
›
›
–
–

52. Feeding
Tyson JE, Ito P, Guyda H, et al. Studies of prolactin secretion in human pregnancy. Am J Obstet
Gynecol 1972; 113:14

53. Continuation of therapy
›
›

54. Luteal phase defect
›
–
–
–
–
–
–
–

55. Should we give progesterone?
›
Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane Database Syst Rev
2008;(2):CD00351

56. Should we give progesterone?
Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane Database Syst Rev
2008;(2):CD00351

57. Summary
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