First, let’s have a gist about the field of endocrinology. It is one of the least competitive internal medicine subspecialties. Those who work as endocrinologist have very nice working hours because there are very few endocrine emergencies. Furthermore, most patients can simply be seen during working hours the next day, or as outpatients in the clinic. Some endocrinologists choose to specialize yet further e.g. gynaecology endocrinology, etc.
Very often obstetrics is combined with gynecology as a medical specialty. There’s a big difference between obstetric and gynaecology. Obstetrics is an important branch in medicine that specializes in pregnancy and infant birth whereas gynaecology refers to the surgical specialty dealing with health of the female reproductive system. Simply speaking, it is “the science of women”. Almost all modern gynaecologists are also obstetricians.
It is a crime for obstetricians to neglect the basics of endocrinology in their field because the patients who come to them are women with raging level of hormones. Many problems occurring during pregnancy and post partum period are caused by changes in the harmony of hormones.
Some of hormone-related problem which can arise during pregnancy is the ever so notorious gestational diabetes mellitus (GDM). It is a type of diabetes that happens for the first time when a woman is pregnant. It disappears after the child is born. However, diabetes is diabetes. And therefore, poses a threat to both mother and fetus. The hallmark of GDM is increased insulin resistance. Interestingly, insulin resistance is a normal phenomenon emerging in the second trimester of pregnancy and it works as a favor for the growing fetus. This is because as the mother’s tissue reduces uptake of glucose, glucose passes to the fetus to supply it. Women with GDM however have an insulin resistance they cannot compensate with increased production in the ?-cells of the pancreas. Placental hormones, and to a lesser extent increased fat deposits during pregnancy, seem to mediate insulin resistance during pregnancy. Because glucose travels across the placenta, the fetus is exposed to higher glucose levels. This leads to increased fetal levels of insulin (insulin itself cannot cross the placenta). The growth-stimulating effects of insulin can lead to excessive growth and a large body (macrosomia). After birth, the high glucose environment disappears, leaving these newborns with ongoing high insulin production and susceptibility to low blood glucose levels (hypoglycemia) and this may lead to coma and subsequently, death.
Another important endocrinology point in obstetric is as regards the calcium level of a pregnant lady. Since calcium is utilized by the fetus for the growth of their bones, scientists wonder whether pregnancy predisposes to osteoporosis. A number of cases have occurred where pregnant lady complains from back pain (signs of osteoporosis). However, Studies surrounding pregnancy and bone have offered conflicting results. It appears that if pregnancy-associated osteoporosis is rare. It is also a condition that is difficult to adequately investigate, given the inability to perform maternal radiologic exams. Theoretically, pregnancy-associated osteoporosis is believed to occur because of the stress on maternal calcium stores and an increase in urinary calcium excretion. Yet, the intestinal absorption of calcium is increased during pregnancy–especially in the second and third trimesters. The body also responds to fetal calcium demands by increasing total 1,25-dihydroxyvitamin D levels. These two mechanisms help to satisfy the increased demand for calcium during pregnancy.
Other physiologic changes during pregnancy that may actually be protective of bone include the third trimester estrogen surge and increased bone-loading due to weight gain. Clearly, there is much to be learned about bone remodeling during pregnancy and why some women become prone to bone loss and even fracture. It appears that lactation contributes more to osteoporosis because the source of calcium in milk is derived from demineralization of the skeleton. Also, the increase in prolactin secretion during lactation suppresses the action of gonadotropin on ovaries leading to hypo-estrogenemia (Estrogen helps bone formation by increasing osteoblastic activity).
It can be especially helpful to know about three of the many hormones involved with reproduction: oxytocin, endorphin, and adrenaline. These hormones play a major role in regulating the process of labor and birth.
Oxytocin stimulates contractions, which help to dilate the cervix, move the baby down and out of her body, give birth to her placenta, and limit bleeding at the site of the placenta.
Endorphins are calming and pain-relieving hormones that people produce in response to stress and pain. The level of this natural morphine-like substance may rise toward the end of pregnancy, and then rises steadily and steeply during unmedicated labors. (Most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.) High endorphin levels during labor and birth can produce an altered state of consciousness that helps women flow with the process, even when it is long and arduous. Despite the hard work of labor and birth, a woman with high endorphin levels can feel alert, attentive, and even euphoric as she begins to get to know and care for her baby after birth. Endorphins may play a role in strengthening the mother-infant relationship at this time. A drop in endorphin levels in the days after birth may contribute to the “blues” that many women experience at this time.
Adrenaline is the “fight or flight” hormone that humans produce to help ensure survival. Women who feel threatened during labor (for example by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labor or stop it altogether. This can be a sort of distress and yet at the same time can be a blessing in disguise. It is stressful because it leads to prolongation of duration of labor and may lead to forbidding consequences such as haemorrhage. It works as a blessing if the birthing women have to move from a place unsuitable for childbirth to another place that offers more comfort.
~ Izzati Syahirah, 3rd year ~