Maternal-Fetal and Neonatal Endocrinology : Physiology, Pathophysiology, and Clinical Management

Cover Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management Copyright Contributors Preface Acknowledgments and Dedication Acknowledgments and Dedication by Cheri L. Deal When Endocrine Disorders Disrupt Pregnancy: Perspectives of Affected Mothers When you are Told That Your Fetus or Newborn has an Endocrine Condition: Perspectives of the Parents Section I - The Mother Part A: Normal Endocrine Physiology of the Mother During Pregnancy and Lactation 1 Normal Endocrine Physiology of Hypothalamic Hormones During Ovulation, Pregnancy, and Lactation Hypothalamic function during ovulation GnRH Pulsatility of GnRH GnRH Pulsatile Pattern Throughout the Ovulatory Cycle Kisspeptin Adaptive responses of hypothalamic hormones during pregnancy GnRH and Kisspeptin Maternal GnRH and Kisspeptin Placental GnRH Placental Kisspeptin GHRH and Somatostatin Antidiuretic Hormone Oxytocin Maternal OT Peripheral OT Insights from OT Deficiency Models Adaptive responses of hypothalamic hormones to lactation Lactation and Breastfeeding Breastfeeding and Amenorrhea References 2 The Pineal Gland and its Function in Pregnancy and Lactation Introduction Anatomy of the pineal gland Vascularization Innervation Cellular Composition Role of the pineal gland in human physiology Melatonin Melatonin Biosynthesis and Regulation Biosynthesis The Release and Metabolism of Melatonin Patterns and Regulation of Melatonin Secretion Central control Local control Melatonin Receptors Melatonin Effects on Reproductive Function through MT1 and MT2 Melatonin Receptors Melatonin and Biorhythms Circadian Rhythm Melatonin and Sleep During Pregnancy and Lactation Rhythmicity in the Female Reproductive Function Other Pineal Hormones Specific functions of the pineal gland during pregnancy and lactation Role of the Pineal Gland in Fertility and Reproduction Antioxidant Properties of Melatonin and Reproductive Function Role of Pineal in Pregnancy and Maternal-Fetal Communication Role of Pineal During Labor Role of Pineal in Lactation Conclusions References 3 Pituitary Physiology During Pregnancy and Lactation Anterior pituitary gland Introduction Anatomical Changes in Pituitary Gland Functional Changes of Pituitary Gland Hypothalamic-PRL Axis GHRH-Insulin-Like Growth Factor-I Axis HPA Axis and Pregnancy Hypothalamic-Pituitary-Thyroid (HPT) Axis Hypothalamic-Pituitary-Gonadal (HPG) Axis Posterior Pituitary Gland References 4 Thyroid Physiology During Pregnancy, Postpartum, and Lactation Introduction Pregnancy Early Adaptation of Thyroid Function Role of Iodine, Beta-HCG, and TBG Iodine Human Chorionic Gonadotropin Thyroxine-Binding Globulin Uteroplacental Transport Implications for Fetal Neurodevelopment Trimester-Specific TFTs and Interpretation Postpartum period and lactation References 5 Physiology of Calcium, Phosphorus, and Bone Metabolism During Pregnancy, Lactation, and Postweaning Introduction Skeletal and mineral physiology during pregnancy Changes in Mineral Ions and Calciotropic and Phosphotropic Hormones Calcium and Phosphorus Parathyroid Hormone PTH-Related Protein Calcitriol and Calcidiol Calcitonin Fibroblast Growth Factor-23 (FGF23) Sex Steroids and Other Hormones Upregulation of Intestinal Absorption of Calcium and Phosphorus Altered Renal Mineral Handling Altered Skeletal Turnover and Mineral Metabolism Skeletal and mineral physiology during lactation and postweaning recovery Changes in Mineral Ions and Calciotropic Hormones Calcium and Phosphorus Parathyroid Hormone Parathyroid Hormone-Related Protein Calcitriol and Calcidiol Calcitonin Fibroblast Growth Factor-23 Sex Steroids and Other Hormones Calcium Pumping and Secretion in Mammary Tissue Intestinal Mineral Absorption Reduced Renal Excretion of Calcium Increased Skeletal Resorption and Osteocytic Osteolysis During Lactation Breast-Brain-Bone Circuit-Controlling Bone Metabolism During Lactation Bone Formation and Skeletal Recovery Postweaning Conclusions References 6 Gestational Glucose Metabolism: Focus on the Role and Mechanisms of Insulin Resistance Introduction Gestational glucose metabolism and the role of insulin An Overview Glucose Homeostasis During the Stages of Pregnancy Insulin Sensitivity During the Stages of Pregnancy Cellular mechanisms for IR in pregnancy Placental Hormones and Adipocytokines in IR During Pregnancy Role of Reduced Glucose Transport Changes in the Insulin-Signaling Pathway Role of Adipose Tissue Role of β-cell adaptations in pregnancy β-Cell Response to Placental Lactogens Other Pathways Mediating β-Cell Expansion in Pregnancy Placental hormones and adipocytokines in the control of maternal metabolism Early Gestation to Midgestation Late Gestation Role of Adipocytokines Lactation: A postpregnancy challenge Future perspectives References 7 Gut Hormones in Pregnancy and Lactation Introduction to gut hormones Individual gut hormones during pregnancy and lactation Gastrin Ghrelin Leptin Somatostatin Secretin Cholecystokinin Motilin Gastric Inhibitory Peptide Glucagonlike Peptide-1 Glucagonlike Peptide-2 Oxyntomodulin Fibroblast Growth Factor 19 Conclusion References 8 Adrenal Cortex and Medulla Physiology During Pregnancy, Labor, and Puerperium Glucocorticoid physiology in pregnancy, labor, and puerperium Plasma CRH and CRH-bp: Origin and Roles During Pregnancy CRH Receptors Urocortin in Pregnancy: Their Origin and Possible Role Plasma ACTH: Origin and Roles During Pregnancy Cortisol-Binding Globulin: Changes in Levels and Isoforms During Pregnancy and its Possible Role in Pregnancy Total and Free Cortisol Levels During Pregnancy Diurnal Variation of the HPA Axis and the Feto-Placental Unit During Pregnancy Physiologic Hypercortisolism of Pregnancy: Particular Regulation of the HPA Axis During Pregnancy Specific Role of Glucocorticoids During Pregnancy and the Impact of Excessive Fetal Glucocorticoid Exposure Fetus Protection Against the High Maternal Glucocorticoids Levels During Pregnancy Change in the HPA Axis and Cortisol Levels During Parturition and in the Postpartum Mineralocorticoid physiology in pregnancy, labor, and puerperium RAS Modifications During Pregnancy Aldosterone Levels During Pregnancy Regulation of RAAS During Pregnancy Other Mineralocorticoids RAAS in the Postpartum Period RAAS in Pregnancy-Associated Hypertension Adrenal sex steroids during pregnancy Catecholamine physiology during pregnancy References 9 Ovarian Function During Pregnancy and Lactation Introduction Ovarian hormone changes during ovulation, luteinization, implantation, early pregnancy, and luteolysis Ovulation Formation of the Corpus Luteum Corpus luteum Regression Rescue of the Corpus Luteum Function of the Corpus Luteum Progesterone for Development of Lining, Promoting Quiescence, Delaying Transit, and Facilitating Implantation Shift from Ovary to Uterus/Placenta Ovarian hormones in pregnancy Ovarian structural changes with pregnancy Anatomic Changes to the Ovary During Pregnancy Ovarian Cysts of Pregnancy Lactation effects on the ovary Suppression Return of Ovulation Other Effects of Lactation on the Ovary Conclusion References 10 The Physiological Roles of the Renin-Angiotensin Aldosterone System and Vasopressin in Human Pregnancy Introduction Renin-angiotensin components and pathways for generation of angiotensin peptides Renin and Prorenin (Pro)renin Receptor Soluble (P)RR Angiotensinogen Angiotensin Converting Enzyme ACE2 ANG Peptides and their Receptors Actions of ANG Peptides Regulation and actions of the cRAAS and IRAS in pregnancy Changes in cRAAS in Human Pregnancy Prorenin and Renin Prorenin Receptor and s(P)RR Angiotensinogen ACE and ACE2 ANG II and ANG-(1-7) Regulation and Actions of the cRAAS in Pregnancy Ovarian Prorenin Relaxin Estrogens Actions of ANG Peptides in Pregnancy (Fig. 10.9) Vasopressin The Intrarenal RAS Reproductive tract RASs (Fig. 10.10) The Ovarian Renin-Angiotensin System Intrauterine RASs References 11 Central Role of Adipose Tissue in Pregnancy and Lactation Introduction Overview of maternal metabolism during pregnancy Glucose Metabolism Lipid Metabolism Protein Metabolism Changes in the Postpartum Period Role of adiposity in pregnancy Adipocytokines in pregnancy Leptin Adiponectin Resistin Tumor Necrosis Factor-α Adipocyte Fatty Acid-Binding Protein Vaspin Visfatin Angiopoietin-Like Protein 8 Other Adipokines Mechanisms of adaptive insulin resistance in pregnancy Adipokines and fetal growth Changes in maternal adiposity during lactation Maternal obesity and pregnancy outcomes Adipose tissue transcriptome and metabolomics in pregnancy Summary and conclusion REFERENCES 12 Hormonal Regulation of the Menstrual Cycle and Ovulation Introduction Function of the hypothalamus Function of the pituitary Ovaries Endometrium Fertilization/implantation References 13 Maintenance of Pregnancy and Parturition Establishment of pregnancy The cervix and its changes in pregnancy Maintaining quiescence in the pregnant uterus Human Chorionic Gonadotropin Progesterone Cyclic Adenosine Monophosphate Requirements for labor contractions in the uterus Corticotropin-Releasing Hormone Estrogen Oxytocin and the OTR Prostaglandins and Prostaglandin Receptors Calcium Signaling and Myometrial (Smooth Muscle) Contractility Gap Junctions Micro-RNA Inflammation in pregnancy Sterile and Nonsterile (Microbial) Inflammation and the Innate Immune System Inflammation in Parturition Other mechanisms involved in the activation of parturition Oxidative Stress, Aging, and Senescence Cell-Free Fetal Dna A summary of human parturition References 14 The Onset and Maintenance of Human Lactation and its Endocrine Regulation Breast development and lactogenesis Embryogenesis Puberty Pregnancy Lactogenesis I/Secretory Differentiation Endocrine regulation of breast development, LI, and colostrogenesis Estrogens and Progestogens Prolactin Other Endocrine Requirements for LI The colostral phase Lactogenesis II Lactose Biosynthesis Tight Junction Closure Clinical/Diagnostic Determinants of LII Endocrinology of LII Progesterone Glucocorticoids Insulin and Glucose Metabolism Oxytocin PRL and Growth Hormone Induction of Lactation Established lactation Breast Size and Milk Production Milk Synthesis and Composition Local Regulation of Milk Synthesis Oral Contraceptives Adaptations of maternal metabolism Food Intake Reproductive Function Glucose Metabolism Lipid Metabolism Calcium and Bone Metabolism References 15 Postpartum Lactational Amenorrhea and Recovery of Reproductive Function and Normal Ovulatory Menstruation Description of postpartum or lactational amenorrhea and relative infertility Anthropology and Epidemiology Endocrinology of Lactational Amenorrhea and Recovery Key Variables Related to Duration of Lactational Amenorrhea and of Ovulatory Disturbances Parallels with research on menstrual cycle recovery from amenorrhea of other causes Need for further research References Part B: Maternal Endocrine Disorders During Pregnancy and Lactation 16 Hypothalamic Disorders During Ovulation, Pregnancy, and Lactation Functional hypothalamic amenorrhea Physiopathology and Precipitating Factors Clinical Manifestations Diagnostic Evaluation and Differential Diagnosis Medical History and Physical Exam Laboratory Assessment Imaging Studies Management FHA: Pregnancy and Lactation Congenital hypogonadotropic hypogonadism Genetics Clinical Manifestations and Associated Phenotypes Hallmarks of CHH in Infancy Hallmarks of CHH in Childhood and Adolescence Hallmarks of CHH in Adulthood CHH Reversal CHH-Associated Phenotypes Diagnostic Evaluation and Differential Diagnosis Clinical Assessment Biochemical and Hormonal Testing Radiological Examination Differential Diagnosis Management Neonatal CHH in Females Induction of Female Secondary Sexual Characteristics Treatment of Hypogonadism in Adult Women Induction of Fertility in CHH Women CHH: Pregnancy and Lactation Organic lesions of the hypothalamus Tumors and Other Expansive Entities CP and Ovulation Disorders CP: Pregnancy and Lactation Other Hypothalamic Tumors and Links with Ovulation, Pregnancy, and Lactation Infiltrative and Inflammatory Disorders Hypothalamic Sarcoidosis and its Effect on Ovulation, Pregnancy, and Lactation LCH and its Effect on Ovulation, Pregnancy, and Lactation Iatrogenic Lesions Radiotherapy Cranial Irradiation and its Impact on Pregnancy and Lactation Postsurgery and Posttraumatic Drug-Related Ovulation induction in patients with HH of hypothalamic origin Pulsatile GnRH Treatment Gonadotropin Treatment The Role of Kisspeptin in the Ovulation Induction Treatment The Place of IVF in the Fertility Treatment of HH Patients Summary References 17 Pineal Gland Disorders and Circadian Rhythm Alterations in Pregnancy and Lactation Pineal gland pathology in pregnancy and lactation Pineal Tumors Pineal Parenchymal Tumors Pineal Glial Tumors Therapeutic Approaches Surgical Therapeutic Intervention Chemotherapy Mode of Delivery in Patients with Pineal Tumors Pineal Cysts Pineal Calcifications Pineal Vascular Lesions Melatonin deficiency in pregnancy and lactation Oxidative Stress Chronodisruption Chronodisruption During Pregnancy Chronodisruption During Lactation Impact on Fertility Risk of Miscarriage and Preterm Birth Preeclampsia/Eclampsia and FGR Potential clinical utility of melatonin in disorders of pregnancy and lactation Melatonin in Clinical Trials Safety and Pharmacokinetic Profile of Exogenous Melatonin Conclusions References 18 Pituitary Disorders During Pregnancy and Lactation Introduction and general approach Neuroimaging in Pregnancy Pituitary Adenoma Treatment During Pregnancy Pharmacological Treatment Pituitary Surgery During Pregnancy Outcomes of Pregnancies of 20-week Gestation Outcomes of Pregnancies of 21-39weeks Gestation Outcomes of Full-Term Pregnancy Prolactinomas Acromegaly Preconception Counseling and Prenatal Care Impact of Pregnancy on Acromegaly Impact of Acromegaly During Pregnancy GH-IGF-I Axis of Acromegaly During Pregnancy Hormonal Evaluation of Acromegaly During Pregnancy Treatment of Acromegaly During Pregnancy Practical Approach Cushing disease and pregnancy CS Diagnosis During Pregnancy Materno-Fetal Complications Treatment of CS During Pregnancy Clinically nonfunctioning pituitary adenomas TSH-secreting pituitary adenomas Pituitary insufficiency Hypopituitarism ACTH Deficiency TSH Deficiency GH Deficiency PRL Deficiency Sheehans syndrome Lymphocitic hypophysitis Diabetes insipidus during pregnancy Gestational Diabetes Insipidus Diagnosis of GDI Treatment Deficiency of oxytocin References 19 Thyroid Disorders During Pregnancy, Postpartum, and Lactation Introduction Biomarkers of thyroid autoimmunity Thyroperoxidase Antibody Thyroglobulin Antibody Thyroid Stimulating Hormone Receptor Antibody Primary subclinical hypothyroidism Overview Definition Burden of Disease Pathophysiology Pregnancy Pregnancy Outcomes in SCH and Isolated Hypothyroxinemia Thyroid Autoantibody Positivity Diagnosis Treatment Postpartum and Lactation Conclusion Overt hypothyroidism Overview Definition Pathophysiology Causes Pregnancy Preconception Diagnosis Treatment Monitoring Pregnancy Outcomes Postpartum and Lactation Isolated Hypothyroxinemia Secondary hypothyroidism (central hypothyroidism) Keywords Syndromes of reduced sensitivity to thyroid hormone Overview Keywords Incidence, Prevalence, and Inheritance Clinical Features and Maternal and Fetal Outcomes Treatment Hyperthyroidism Keywords Overview Differential Diagnosis of Hyperthyroidism in Pregnancy Graves Disease Overview Preconception Counseling and Care for Women with a History of GD Treatment of GD During Pregnancy ATDs Other agents Treatment targets Radioactive iodine Surgical management Monitoring of the Mother and Fetus Complications of Maternal GD in the Mother and Fetus Treatment and Monitoring of GD in the Postpartum Period and During Lactation Euthyroid Women with a History of Previously Treated GD Gestational Transient Thyrotoxicosis Toxic Adenomas and Toxic Multinodular Goiters Treatment of Nonautoimmune Hyperthyroidism Postpartum thyroid dysfunction Keywords Definition Epidemiology Screening for PPTD Pathophysiology and Clinical Course of PPTD Differential Diagnosis and Evaluation of PPTD Treatment of PPTD Postpartum Depression and its Association with PPTD Can PPTD be Prevented in Women with Positive TPO Abs? Thyroid emergencies: Thyroid storm and myxedema crisis Overview Thyroid Storm Key clinical findings Outline placeholder Thyroid Storm: Epidemiology, Precipitating Factors, and Clinical Outcomes Pathogenesis and Clinical Presentation Maternal Signs and Symptoms Concerning for Impending or Established TS Fetal Findings Diagnosis Treatment Myxedema Crisis/Coma Key clinical signs of myxedema crisis/coma include Outline placeholder Epidemiology, Pathogenesis, Precipitating Factors, and Clinical Course Diagnosis MC in Pregnancy Treatment References 20 Thyroid Cancer During Pregnancy and Lactation Introduction Epidemiology of nodular thyroid disease and thyroid cancer Nodular Thyroid Disease Thyroid Cancer Incidence of Thyroid Cancer in Pregnancy Effects of pregnancy on thyroid nodules Effects of Pregnancy Hormones on Thyroid Follicular Epithelium Physiology of Thyroid Nodules During Pregnancy Evaluation of a newly discovered thyroid nodule in pregnancy Effect of pregnancy on newly diagnosed thyroid cancer Impact on Prognosis Timing of Surgery Supportive Management in Pregnancy Planning for Radioiodine Therapy Preconception counseling of women with a prior history of thyroid cancer Establishment of Disease Status Risk of Recurrence Mitigating Pregnancy-Impacts of Prior Thyroid Cancer Treatment Levothyroxine Supplementation Radioiodine Hypoparathyroidism Surveillance and Monitoring Papillary Thyroid Microcarcinoma Germline RET Mutations Management of known residual structural disease in pregnancy Conclusion References 21 Disorders of Mineral and Bone Metabolism During Pregnancy and Lactation Introduction Disorders of bone and mineral metabolism during pregnancy Osteoporosis in Pregnancy Vertebral and Appendicular Fractures in Pregnancy Transient Osteoporosis of the Hip Investigations and Overall Management Considerations Nonpharmacological Treatment Pharmacological Therapy Surgical Therapy Primary Hyperparathyroidism Incidence and Epidemiology Clinical Presentation Approach and Management Conclusion: Surgical vs Medical Management? Familial Hypocalciuric Hypercalcemia Clinical Management Hypoparathyroidism Clinical Management Pseudohypoparathyroidism Clinical Management Pseudohyperparathyroidism Clinical Management Vitamin D Deficiency, Genetic Vitamin D Resistance, and 24-Hydroxylase Deficiency Animal Data: Vitamin D Deficiency and Genetic Vitamin D Resistance Animal Data: 24-Hydroxylase Deficiency Human Data: Vitamin D Deficiency and Genetic Vitamin D Resistance Clinical Management: Vitamin D Deficiency and Genetic Vitamin D Resistance Human Data: 24-Hydroxylase Deficiency Clinical Management: 24-Hydroxylase Deficiency Calcitonin Deficiency Low or High Calcium Intake Hypercalcemia of Malignancy Fibroblast Growth Factor 23 (FGF23)-Related Disorders Tocolytic Therapy with Magnesium Sulfate Clinical Management Disorders of bone and mineral metabolism during lactation Osteoporosis of Lactation Clinical Management Primary Hyperparathyroidism Clinical Management Familial Hypocalciuric Hypercalcemia Clinical Management Hypoparathyroidism Clinical Management Pseudohypoparathyroidism Clinical Management Pseudohyperparathyroidism Clinical Management Vitamin D Deficiency, Genetic Vitamin D Resistance, and 24-Hydroxylase Deficiency Vitamin D Deficiency and Genetic Vitamin D Resistance 24-Hydroxylase Deficiency Clinical Management: Vitamin D Deficiency and Genetic Vitamin D Resistance Clinical Management: 24-Hydroxylase Deficiency Calcitonin Deficiency Clinical Management Low or High Calcium Intake Clinical Management FGF23-Related Disorders Clinical Management Conclusions References 22 Gestational Diabetes and Type 2 Diabetes During Pregnancy Gestational diabetes Epidemiology Pathophysiology Adverse Pregnancy Outcomes Associated with GDM Screening for GDM Early Screening for GDM/T2DM in Pregnancy Diagnosis of GDM: One Step vs Two Step Management During Pregnancy Self-Management Frequency of monitoring and targets Lifestyle management Pharmacological Treatment Insulin Noninsulin antihyperglycemic agents Metformin. Glyburide. Alpha-glucosidase inhibitors. Other oral-antidiabetic agents. Intrapartum Postpartum Breastfeeding Fetal and Maternal Risks Considerations for future pregnancy planning Type 2 diabetes Epidemiology of T2DM in Pregnancy Prepregnancy Counseling Prepregnancy Counseling: BMI Antenatal Screening of Microvascular and Macrovascular Complications in T2DM Nephropathy Retinopathy Ischemic Heart Disease Obstructive Sleep Apnea Nonalcoholic Fatty Liver Disease Maternal Outcomes with T2DM Preeclampsia Obstetric Intervention Fetal/Perinatal Complications Pregnancy Loss Congenital Anomalies Factors Contributing to Congenital Anomalies in Women with T2DM Glycemic control Obesity Drugs Preterm Delivery Birth Weight and Peripartum Consequences Management What is expected at the first diabetes clinic visit in pregnancy for women with T2DM? Glucose Control and Glucose Monitoring Dietary Advice and Weight Gain Drugs/vitamin Supplementation Pharmacological Management of Pregnancy in Women with T2DM Aspirin Oral Hypoglycemic Agents Metformin Insulin Therapy in T2DM Pregnancy Concentrated basal insulin analogs Ultralong-acting basal insulin analogs Peripartum Monitoring: Maternal and Neonatal Postpartum: Insulin Doses and Breastfeeding Future Pregnancies Risk for Offspring REFERENCES 23 Type 1 Diabetes: During Preconception, Pregnancy, Postpartum, and Breastfeeding Prepregnancy Prepregnancy Care Importance of PPC in Women with Type 1 Diabetes Elements of PPC Optimization of Glycemic Control: Goals and Strategies Glucose Monitoring Insulin Dosing Nutrition and Physical Activity Prepregnancy Management of Diabetes Complications and Risk Assessment Diabetic Retinopathy Hypertension Diabetic Nephropathy Diabetic Neuropathy Cardiovascular Disease Smoking Cessation Thyroid Function Immunization Psychological Support Neonatal Complications Pregnancy Glycemic Management Throughout Pregnancy The Role of Physiologic Changes in Developing Management Strategies The Role of Dietary Strategies and Exercise in Glycemic Control Mode of Insulin Delivery MDI Injections The Insulin Pump MDIs vs the Insulin Pump Closed-Loop Insulin Delivery Types of Insulins and Oral Agents Bolus Insulins Intermediate and Long-Acting Basal Insulins Oral Agents Glycemic Measurements and Targets in Pregnancy Capillary Blood Glucose Monitoring Hemoglobin A1c in Pregnancy Limits of HbA1c in Pregnancy Targets for Women with Type 1 Diabetes Continuous Glucose Monitoring Other Measurements of Glycemic Control The Prevention and Management of Diabetes Complications Retinopathy Hypertension and Nephropathy Neuropathy Hypoglycemia Diabetic Ketoacidosis Fetal Surveillance and Timing of Delivery Management During Labour and Delivery Prior to Delivery Strategies for Insulin Delivery Management of IV Insulin Infusion During Labor and Delivery Vaginal Delivery Cesarean Section Management of the Insulin Pump During Labor and Delivery Vaginal Delivery Elective Cesarean Section Conclusions on Labor and Delivery Postpartum Physiological Changes and their Impact on Diabetes Management For Women on An IV Insulin Infusion for Labor and Delivery For Women on an IV Insulin Infusion for Labor and Delivery Insulin-Dosing Postpartum Recommendations Contraception Screening for Diabetes Complications Postpartum Thyroid Function Breastfeeding Challenges in Breastfeeding and Type 1 Diabetes Delayed Lactogenesis Impact of Dysglycemia on Milk Supply, Milk Content, and Infant Strategies to Help Establish and Maintain Breastfeeding Impact of Breastfeeding on Glycemic Control and Insulin Requirements Risks to Offspring References 24 Gut and Pancreatic Neuroendocrine Tumors in Pregnancy and Lactation Introduction Pregnancy planning and prospective management of gut and pancreatic NETs in women with history of such tumors Women with no Current Evidence of NETs Women with Active Gut or Pancreatic NETs Gut and pancreatic NETs found de novo during pregnancy Management of gut and pancreatic NETs during pregnancy and peripartum Management of Carcinoid Syndrome in Pregnancy and Peripartum Management of Insulinoma During Pregnancy and Peripartum Lactation in women with gut and pancreatic NETs Conclusions References 25 Adrenal Pathologies During Pregnancy and Postpartum Introduction Adrenal Insufficiency Epidemiology Etiologies Clinical Presentation Primary AI Secondary and Tertiary AI Diagnosis Random or Morning Cortisol Levels Cosyntropin Stimulation Test Differentiation Between Primary and Secondary-Tertiary AI Determining the Etiology of Primary or Secondary/Tertiary AI Morbidity and Complications Associated with AI in Pregnancy Therapy Glucocorticoid Replacement Mineralocorticoid Replacement Adrenal Crisis Management Cushings syndrome Etiologies of CS Clinical Presentation Morbidity Associated with CS in Pregnancy Diagnosis of CS During Pregnancy Biochemical Screening and Diagnosis of CS Establishing the Cause of the CS Therapy of CS During Pregnancy Surgical Therapy of CD Surgical Therapy of Adrenal CS Medical Treatment of CS Medical Treatment During Breastfeeding Treatment of Iatrogenic CS During Pregnancy Adrenocortical carcinoma Clinical Presentation Maternal and Fetal Morbidity Diagnosis Treatment Primary aldosteronism Etiologies of Hyperaldosteronism Clinical Presentation of PA in Pregnancy Maternal and Fetal Morbidity Associated with PA During Pregnancy Diagnosis of PA During Pregnancy Treatment of PA During Pregnancy and Breastfeeding Pheochromocytoma and paraganglioma (PPGL) Genetic Susceptibility to PPGL Clinical Manifestations of PPGL During Pregnancy Morbidity and Mortality Associated with PPGL During Pregnancy Diagnosis of PPGL During Pregnancy Biochemical Diagnosis Localization of the Tumor Treatment of Pheochromocytoma During Pregnancy Preoperative Medical Treatment Surgical Resection of the Tumor Medical Treatment of Acute Hypertensive crisis Special Considerations in Nursing Mothers Congenital adrenal hyperplasia Treatment of Pregnant Patients with 21-OH Congenital Adrenal Hyperplasia During Pregnancy, Labor, and Postpartum Genetics of 21-OH Congenital Adrenal Hyperplasia and Prenatal Genetic Counseling Prenatal Treatment to Prevent Virilization in Female Fetuses References 26 Hypertension in Pregnancy Introduction Prevalence and Clinical Significance of Hypertension in Pregnancy Physiological changes in normal pregnancy Altered Pregnancy Physiology in HDP Screening for and prevention of preeclampsia Assessment of the hypertensive pregnant woman Diagnostic Criteria for Hypertension in Pregnancy and Considerations Specific to the Measurement of Blood Pressur ... Diagnostic Criteria for Proteinuria in Pregnancy Fetal Assessment Differential Diagnosis of Preeclampsia Novel Diagnostic Tests-PLGF/sFlt-1 Classification of hypertensive disorders of pregnancy Preexisting Hypertension Gestational Hypertension Preeclampsia Preeclampsia Superimposed on Preexisting Hypertension Severe Preeclampsia Classification of Severity by Gestation at Onset Clinical Features of Severe Preeclampsia Complications of preeclampsia HELLP Syndrome Renal Dysfunction in Preeclampsia Pulmonary Edema Eclampsia Antenatal care of women with hypertensive disorders in pregnancy Periconceptual Care Antenatal Treatment of Chronic and Gestational Hypertension Choice of Antihypertensive Agents in Pregnancy Antenatal Monitoring in Gestational and Chronic Hypertension Timing of Delivery in Chronic and Gestational Hypertension Antenatal management of preeclampsia Inpatient or Outpatient Management? Treatment of severe preeclampsia Severe Hypertension Magnesium Sulfate for Women with Severe Preeclampsia Plasma Volume Expansion and Fluid Restriction HELLP Syndrome Acute Management of Eclampsia Timing and mode of delivery in preeclampsia Intrapartum care of hypertensive women Normal Intrapartum Hemodynamics and Physiological Changes Intrapartum Maternal and Fetal Monitoring Intrapartum Analgesia and Anesthetic Considerations Postnatal care and follow-up of women affected by hypertension in pregnancy Immediate Postpartum Management of Women Affected by HDP Choice of Antihypertensive in the Puerperium and Lactation Complications of Hypertensive Disease in the Puerperium Long-term implications of hypertension in pregnancy Future Pregnancies Longer-Term Maternal Health Implications Conclusion References 27 Preconception and Pregnancy in Women with Obesity, Postbariatric Surgery, and Polycystic Ovarian Syndrome OVERALL PERSPECTIVE Epidemiology of overweight and obesity among women during pregnancy Epidemiology of excessive gestational weight gain Overview of maternal complications related to overweight/obesity Care of the obese woman before and during pregnancy Preconception Early Pregnancy and Antepartum Care Antepartum Care Gestational Diabetes Intrapartum Care Prevention of Cesarean Delivery Prevention of Complications During Cesarean Delivery Visualization and preventing wound complications Postpartum Hemorrhage Anesthesia Thromboembolism Postpartum Care Long-Term Outcomes for Offspring Special considerations Women with History of Bariatric Surgery Polycystic Ovarian Syndrome Infertility and Conception Complications During Pregnancy Postpartum Conclusion References Part C: Transgendered Issues 28 Fertility, Pregnancy, and Chest Feeding in Transgendered Individuals Introduction Terminology and Transgender Identity Transgender Statistics Heath-Care Discrimination and Barriers to Care Reproductive desires Gender-affirming care and fertility Transgender Men and Fertility Tran __Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management__