Programs and Disease Treatment

Endocrine Issues in Pregnancy

Diabetes and thyroid disease are the two major endocrine issues women face during pregnancy. Medical College of Wisconsin endocrinologists are experts at diagnosing and treating hormonal problems before, during and after pregnancy to optimize the health of both mother and baby.

During pregnancy, diabetes control needs to be more aggressive to prevent health complications to the mother and her developing infant. There are two types of diabetes during pregnancy:

Pre-gestational diabetes (Type 1 or Type 2), which means a woman has diabetes before becoming pregnant.
Gestational diabetes, which is diagnosed during pregnancy and occurs in about 4 percent of pregnant women.

The Endocrine Disorders in Pregnancy Clinic, based at Froedtert & The Medical College of Wisconsin, provides high-level consultation for pregnant women with Type 1, Type 2 and gestational diabetes as well as other endocrine disorders such as pituitary tumors, thyroid disease and congenital adrenal hyperplasia.

Pregnant women with diabetes receive a treatment plan aimed at keeping their blood sugar, nutrition and exercise in balance. They benefit from the latest technology including insulin pump therapy and continuous glucose monitoring. Medical College of Wisconsin endocrinologists work with both Medical College of Wisconsin perinatologists as well as obstetrician/gynecologists in the area to manage endocrine disorders in pregnant women.

Care for Women with Pre-gestational Diabetes (Type 1 or Type 2 diabetes)

Keeping blood glucose levels as close to normal as possible before getting pregnant as well as during pregnancy is very important for the health of a woman and her baby.

Poorly controlled diabetes can cause malformations to a developing fetus. These typically occur before the seventh week of gestation. Research has shown that when women with diabetes keep blood glucose levels under control before and during pregnancy, the risk of birth defects is about the same as in babies born to women who don’t have diabetes.

It’s important for a diabetic woman to plan her pregnancy, with care beginning before she conceives. All of our female patients receive extensive pregnancy counseling, starting at age 18, even if a woman may not be considering having children for many years. Team members who provide counseling include an endocrinologist, a nurse practitioner, and a nurse and dietitian who are certified diabetes educators. Team members work closely with each woman’s obstetrician/gynecologist.

In the Endocrine Disorders in Pregnancy Clinic, women are screened for possible complications of diabetes, such as retinopathy, nerve damage and kidney damage that can make pregnancy more risky for the woman and baby.

During pregnancy, women with diabetes need to keep their blood glucose within strict limits. Their blood glucose is strictly monitored during biweekly visits to the Endocrine Disorders in Pregnancy Clinic. When at home, women need to check their blood sugar a minimum of seven times a day to ensure it falls within certain limits.

Women’s spouses or partners are encouraged to join them during clinic visits. They play an important role in supporting and encouraging women during pregnancy and understanding what they need to manage their diabetes. A woman may be at risk for hypoglycemia during pregnancy, and her spouse/partner needs to recognize the signs and know how to treat them.

There are predictable changes in insulin needs throughout pregnancy. Immediately after giving birth, a woman’s insulin need drops. Clinic team members teach women about reducing their insulin doses during this time, and monitor each woman’s diabetes control for several months after giving birth. There are also special considerations for breastfeeding, which requires an adjustment in the mother’s diet and possibly an adjustment in insulin dosages. Frequent monitoring of blood sugar levels is necessary during the time a woman is breastfeeding.

Care for Women with Gestational Diabetes (diabetes that develops during pregnancy)

About 4 percent of pregnant women develop gestational diabetes, which may be diagnosed at any time during pregnancy.

During weeks 23 to 28 of pregnancy, a screening test is done to check for the presence of gestational diabetes. Usually performed at a routine obstetric office visit, a woman’s blood glucose is checked one hour after she drinks 50 grams of sweet-tasting liquid containing glucose. If the woman’s blood glucose is higher than 140 mg/dL, she is asked to return on another day soon after for a formal three hour oral glucose tolerance test (OGTT) This test involves drinking 100 grams of glucose in liquid, and checking blood glucose levels one, two, and three hours later.

The three hour OGTT is performed in the Froedtert and Medical College Endocrine Diagnostic Unit, located within the Endocrine Clinic. A nurse checks the blood glucose levels immediately. If two of the four glucose values are abnormal, this indicates gestational diabetes. The woman will then meet that same day with a diabetes nurse educator for diabetes education and she will be provided with a blood glucose monitoring device. She will also meet with a dietitian for extensive counseling on medical nutritional therapy.

Nutrition and diet play an important role in helping people with diabetes manage their health. Proper diet and nutrition can help prevent and reduce complications for the mother and baby. This includes an initial assessment of nutrition and lifestyle, nutritional counseling (especially carbohydrate control), information on managing lifestyle factors that affect diet, and follow-up visits to monitor progress.

If a woman with gestational diabetes is unable to control her diabetes with diet, she will need insulin injections or, in some cases, oral medications that stimulate the pancreas to release more insulin. Daily blood glucose monitoring will also be needed, along with regular visits to the Endocrine Disorders in Pregnancy Clinic for monitoring.

About six weeks after giving birth, another oral glucose tolerance test may be done to establish that the woman had true gestational diabetes, and not undiagnosed Type 2 diabetes.

Care for Women with Thyroid Disease during Pregnancy

Hypothyroidism (underactive thyroid gland) — a developing fetus does not make its own thyroid hormone until about 20 weeks. Therefore, the baby depends on the mother’s thyroid hormone during the first half of pregnancy. Women with hypothyroidism need careful monitoring (with TSH blood tests) before pregnancy as well as during pregnancy.

Women at risk for developing thyroid disease include those with a goiter (an abnormally enlarged thyroid gland) or a strong family history of thyroid disease. They are screened before or early in pregnancy for hypothyroidism.

For a pregnant woman with preexisting hypothyroidism, her dose of thyroid medication may need to be increased by 30 percent to 50 percent during the first trimester of pregnancy to keep it as close to normal as possible.

Research has shown that if women with hypothyroidism are not treated adequately during pregnancy, their children may score lower on IQ tests at ages 5-6.

Hyperthyroidism (overactive thyroid) — a condition in which the thyroid gland produces too much thyroid hormone. Hyperthyroidism can significantly accelerate the body’s metabolism, causing sudden weight loss, a rapid or irregular heartbeat, sweating and anxious feelings. Hyperthyroidism that occurs during pregnancy can be harmful to the mother and baby. If hyperthyroidism has been diagnosed (with a blood test), it can be treated with medication that blocks the production of thyroid hormone. The medication dose will need to be adjusted throughout pregnancy.

Postpartum thyroiditis (inflammation of the thyroid gland) — a common problem that occurs one to two months after giving birth in women who are predisposed to developing autoimmune thyroid disease. This may occur as either an overactive or underactive thyroid. Since symptoms are often attributed to being postpartum and the stress of having a new baby, a diagnosis of postpartum thyroiditis is often missed.

Symptoms of hyperthyroidism include palpitations, feeling anxious, tremors, rapid weight loss, and mood changes. Symptoms of hypothyroidism include fatigue, dry skin, constipation, intolerance to cold and mood changes. Women who have symptoms are screened with a blood test. Postpartum thyroiditis is usually a self-limited condition which resolves within a few weeks to months. Treatment may be needed temporarily, based on symptoms.

Last Review Date: August 24, 2009