Endocrinology of Pregnancy Practice Questions

Q: Which of the following are correct about endocrine changes in normal pregnancy? 1. Increase in levels of maternal serum iodine 2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH) 3. Increase in serum levels of aldosterone Select the answer using the code given below.

2 and 3 only. ***2 and 3 only*** - **Corticotropin-releasing hormone (CRH)** levels increase dramatically during pregnancy, produced by the **placenta**, influencing the timing of labor and fetal development. - **Aldosterone** levels significantly increase during pregnancy to help maintain **fluid balance** and counteract the natriuretic effects of increased progesterone and vasodilation. *1 and 2 only* - While CRH levels do increase, **maternal serum iodine levels do not increase**; rather, there is an increased demand for iodine and a decrease in serum iodine concentration due to increased renal clearance and transfer to the fetus. - This option incorrectly states an increase in maternal serum iodine. *1 and 3 only* - Although aldosterone levels increase, **maternal serum iodine levels do not increase** during normal pregnancy. - This option incorrectly implies an increase in serum iodine while correctly identifying an increase in aldosterone. *1, 2 and 3* - This option is incorrect because **maternal serum iodine levels do not increase** in normal pregnancy; instead, there is often a relative iodine deficiency due to increased demand and excretion. - Only CRH and aldosterone levels increase among the choices provided.

Q: Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?

1, 2 and 3. ***Correct: 1, 2 and 3*** - **Human Chorionic Gonadotropin (HCG)** is a **glycoprotein hormone** composed of **alpha (α) and beta (β) subunits**, making statement 1 correct - HCG is primarily secreted by the **syncytiotrophoblast** cells of the placenta, confirming statement 3 - In a normal pregnancy, HCG levels typically **peak between 60-70 days (8-10 weeks)** after the last menstrual period, supporting statement 2 - All three statements are factually accurate regarding HCG structure, secretion, and physiological levels *Incorrect: 2 and 3 only* - This option incorrectly excludes statement 1 about HCG being a glycoprotein with α and β subunits - The structural composition of HCG as a heterodimeric glycoprotein is a fundamental characteristic *Incorrect: 1 and 2 only* - This option incorrectly excludes statement 3 about syncytiotrophoblast being the source of HCG - The syncytiotrophoblast is the outer layer of the trophoblast responsible for HCG secretion *Incorrect: 1 and 3 only* - This option incorrectly excludes statement 2 about HCG peak timing during pregnancy - Understanding that HCG peaks at 8-10 weeks (60-70 days) is crucial for monitoring early pregnancy

Q: Which of the following hormones is the best indicator of maternal-fetal placental unit?

Estriol. ***Estriol*** - **Estriol** is the **best indicator of the maternal-fetal placental unit** because its production requires the integrated function of **all three components**: - **Fetal adrenal glands** produce DHEA-S (dehydroepiandrosterone sulfate) - **Fetal liver** performs 16α-hydroxylation of DHEA-S - **Placenta** converts 16α-OH-DHEA-S to estriol through aromatization - Any dysfunction in the fetus, placenta, or their interaction will be reflected in **decreased estriol levels**, making it the most comprehensive indicator of the **complete fetoplacental unit**. - Clinically used to assess fetal well-being, especially in conditions like **placental insufficiency** or **fetal adrenal hypoplasia**. *Human placental lactogen* - **hPL** is solely produced by the **syncytiotrophoblast** of the placenta and reflects **placental mass** and function. - While it correlates with placental viability, it does **not require fetal contribution** and therefore only indicates **placental function alone**, not the integrated maternal-fetal-placental unit. - Useful for assessing placental sufficiency but less comprehensive than estriol for evaluating the complete unit. *Progesterone* - **Progesterone** is initially produced by the **corpus luteum** (first 8-10 weeks) and later by the **placenta**. - Essential for maintaining pregnancy through uterine relaxation and endometrial support, but its levels reflect **placental function** rather than the integrated fetal-placental unit. - Does not require fetal contribution for its synthesis. *Prolactin* - **Prolactin** is primarily produced by the **maternal anterior pituitary gland**, with smaller amounts from the decidua. - Involved in mammary gland development and lactation preparation but is **not a product of the fetoplacental unit**. - Does not indicate the functioning of the maternal-fetal placental unit.

Q: The peak level of human chorionic gonadotropin in normal pregnancy occurs between:

60 to 70 days after pregnancy. ***60 to 70 days after pregnancy*** - Peak **hCG levels** in normal singleton pregnancies are typically observed between **9-10 weeks of gestation**, which corresponds to approximately **63-70 days after the last menstrual period (LMP)** or fertilization. - This period marks the highest physiological levels of hCG, crucial for maintaining the **corpus luteum** and early pregnancy. *30 to 40 days after pregnancy* - At this stage (approximately 4-5 weeks gestation), hCG levels are **rising rapidly** but have not yet reached their peak. - While detectable and increasing, the concentration of hCG is significantly lower than what is observed at 9-10 weeks. *100 to 120 days after pregnancy* - By this time (approximately 14-17 weeks gestation), **hCG levels have already peaked** and are typically declining to a lower, somewhat stable plateau for the remainder of the pregnancy. - This period is well past the peak hCG concentration. *10 to 12 days after pregnancy* - This period roughly corresponds to the time of **implantation** and the very early stages of hCG production, making levels **relatively low** but detectable. - HCG levels are just beginning their rapid ascent following implantation and are far from their peak concentration.

Q: The placenta synthesizes all EXCEPT:

Dehydroepiandrosterone. ***Dehydroepiandrosterone*** - **Dehydroepiandrosterone (DHEA)** is primarily synthesized in the **adrenal cortex** of both the fetus and the mother. - The placenta primarily converts DHEA into other steroids, such as **estrogens**, rather than synthesizing DHEA itself. *Oestriol* - The placenta plays a crucial role in synthesizing **oestriol**, particularly by utilizing **androgen precursors** from the fetal adrenal gland. - This synthesis is a key indicator of **feto-placental unit** well-being. *Corticotrophin releasing hormone* - The placenta extensively synthesizes **Corticotropin-releasing hormone (CRH)**, which gradually increases throughout pregnancy. - Placental CRH is thought to be involved in the **timing of parturition** and the regulation of fetal adrenal development. *PAPP-A (Pregnancy Associated Plasma Protein A)* - **PAPP-A** is a glycoprotein synthesized by the **syncytiotrophoblast** cells of the placenta. - It serves as an important biochemical marker in **combined first-trimester screening** for chromosomal abnormalities like Down syndrome.

Q: Which hormone is secreted by the placenta?

hCG. ***hCG*** - **Human Chorionic Gonadotropin (hCG)** is produced by the **syncytiotrophoblast** of the placenta shortly after implantation. - Its primary role is to maintain the **corpus luteum**, ensuring continued production of **progesterone** to support the pregnancy. *GnRH* - **Gonadotropin-releasing hormone (GnRH)** is secreted by the **hypothalamus** in the brain, not the placenta. - It stimulates the pituitary gland to release FSH and LH. *FSH* - **Follicle-stimulating hormone (FSH)** is produced by the **anterior pituitary gland**. - It plays a crucial role in ovarian follicular development in females and spermatogenesis in males. *LH* - **Luteinizing hormone (LH)** is also secreted by the **anterior pituitary gland**. - Its functions include triggering ovulation in females and stimulating testosterone production in males.

Q: hCG is secreted by?

Syncytiotrophoblast. ***Syncytiotrophoblast*** - The **syncytiotrophoblast** is the outer layer of the trophoblast that invades the uterine wall and is responsible for producing human chorionic gonadotropin (**hCG**). - Production of **hCG** by the **syncytiotrophoblast** begins shortly after implantation and is crucial for maintaining the **corpus luteum** and thus **progesterone** secretion during early pregnancy. *Cytotrophoblast* - The **cytotrophoblast** is the inner layer of the trophoblast that proliferates and differentiates into the **syncytiotrophoblast**. - While essential for placental development, the **cytotrophoblast** itself does not directly secrete **hCG**. *Yolk sac* - The **yolk sac** is involved in early nourishment of the embryo and plays a role in the formation of **primitive blood cells** and **germ cells**. - It does not produce **hCG**; its main functions are related to nutrition and hematopoiesis before the placenta is fully functional. *Decidua* - The **decidua** is the modified endometrial lining of the uterus during pregnancy, derived from **maternal tissue**. - It does not produce **hCG** as it is maternal in origin, whereas **hCG** is produced by fetal-derived **trophoblastic cells**.

Question 1

A 32 y/o pregnant woman presents for her routine antenatal check-up at 28 weeks gestation. She has a history of obesity but no previous history of diabetes. Her fasting plasma glucose level is 104 mg/dL, and her 2-hour plasma glucose level after a 75g Oral Glucose Tolerance Test (OGTT) is 167 mg/dL. Based on these findings, what is the most appropriate next step?

Accepted Answer

Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.

Answer

Start lifestyle modifications and repeat OGTT at 32 weeks gestation.

Answer

Monitor her closely without intervention since her glucose levels are borderline.

Answer

Diagnose her with pre-existing diabetes and initiate insulin therapy.

Question 2

Which of the following are correct about endocrine changes in normal pregnancy?

1. Increase in levels of maternal serum iodine
2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH)
3. Increase in serum levels of aldosterone Select the answer using the code given below.

Accepted Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 3 only

Answer

1, 2 and 3

Question 3

Consider the following statements regarding HCG :

1. HCG is a glycoprotein with two subunits α and β.

2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy.

3. HCG is secreted by the syncytiotrophoblast.
Which of the statements given above is/are correct ?

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 3 only

Question 4

Which of the following hormones is the best indicator of maternal-fetal placental unit?

Accepted Answer

Estriol

Answer

Progesterone

Answer

Human placental lactogen

Answer

Prolactin

Question 5

Which of the following statements is false?

Accepted Answer

Gestational diabetes is always transient and cured after delivery.

Answer

Gestational diabetes is a risk factor for diabetes in children born to mothers with GDM.

Answer

Screening for gestational diabetes should be included in antenatal care.

Answer

Gestational diabetes can lead to Type-II diabetes after delivery.

Question 6

The peak level of human chorionic gonadotropin in normal pregnancy occurs between:

Accepted Answer

60 to 70 days after pregnancy

Answer

30 to 40 days after pregnancy

Answer

100 to 120 days after pregnancy

Answer

10 to 12 days after pregnancy

Question 7

The placenta synthesizes all EXCEPT:

Accepted Answer

Dehydroepiandrosterone

Answer

Oestriol

Answer

Corticotrophin releasing hormone

Answer

PAPP-A (Pregnancy Associated Plasma Protein A)

Question 8

Which hormone is secreted by the placenta?

Accepted Answer

hCG

Answer

GnRH

Answer

FSH

Answer

LH

Question 9

Which of the following is false regarding management of diabetes in pregnancy?

Accepted Answer

Elective C-section has no role in reducing incidence of brachial plexus injury

Answer

In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL

Answer

In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld

Answer

Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL

Question 10

hCG is secreted by?

Accepted Answer

Syncytiotrophoblast

Answer

Cytotrophoblast

Answer

Yolk sac

Answer

Decidua

Endocrinology of Pregnancy — MCQs

Endocrinology of Pregnancy — MCQs

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