Hello and welcome to the zero to finals podcast. My name is Tom and in this episode I'm going to be

talking to you about chronic conditions in pregnancy. And you can find written notes on this topic

at zero to finals.com slash chronic conditions in pregnancy or in the antinatal care section of the zero

definals obstetrics and gynecology book so let's get straight into it women with existing health

conditions may need additional management of both the existing health condition and the pregnancy

they're generally managed jointly by the existing health condition and the pregnancy.

They're generally managed jointly by the obstetric team and the specialist in their health condition.

Let's start by talking about hypothyroidism in pregnancy.

Untreated or under-treated hypothyroidism in pregnancy can lead to several adverse pregnancy outcomes,

including miscarriage, anemia, small for gestational age and preeclampsia.

Hypothyroidism is treated with levothoroxine, which is T4.

Levothoroxine can cross the placenta and provides thyroid hormone to the developing fetus.

The levothoroxine dose needs to be increased during pregnancy, usually by at least 25 to 50 micrograms or 30 to 50 percent.

Treatment is titrated based on the Tsh or thyroid-stimulating hormone level, aiming for a low normal TSAH level.

Next let's talk about hypertension in pregnancy.

Women who have existing hypertension or raised blood pressure may need changes to their medications.

Medications that should be stopped as they may cause congenital abnormalities include ACE inhibitors, for example

ramapril, angiotensin receptor blockers, for example Losartan, and thiazide and

thyazide-like diuretics, for example in dappamide. Medications that are not known to be harmful include labetol, which is a

beta blocker, although other beta blockers may have adverse effects in pregnancy, calcium channel

blockers, for example nephedapine, and alpha blockers, for example, doxazacin.

Next, let's talk about epilepsy in pregnancy.

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