Medical Conditions affecting Pregnancy
Many chronic medical conditions may have implications for pregnancy outcomes and should be optimally managed before and during pregnancy.
Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should be optimally managed before and during pregnancy.
Some health conditions may increase the risk of problems for the fetus, such as birth defects.
Other conditions may increase the risk of health problems for you.
Having one of these conditions does not mean that you cannot have a healthy pregnancy or baby. But good care before pregnancy may reduce pregnancy-related risks. Getting health problems under control before and during pregnancy reduces the risk of miscarriage and stillbirth as well as other health problems for the infant.
Chronic Hypertension
In chronic hypertension, high blood pressure develops either before pregnancy or during the first 20 weeks of pregnancy. Because high blood pressure usually doesn’t have symptoms, it might be hard to know exactly when it began.
Treatment is important…
High blood pressure can increase you’re the risk of heart attack, stroke and other major complications. In pregnancy high blood pressure can be dangerous for your baby.
If you need medication to control your blood pressure during pregnancy, our health care providers will prescribe the safest medication and dose. Take the medication exactly as prescribed. Don’t stop taking it or change the dose on your own.
Low-dose daily aspirin
Low-dose daily aspirin often is recommended to lower the risk of preeclampsia in those who are at high risk. Studies have found aspirin to be safe during pregnancy.
Some blood pressure medications are considered safe to use during pregnancy. However, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and renin inhibitors need to be avoided during pregnancy.
If you need medication to control your blood pressure during pregnancy, our health care provider will prescribe the safest medication and dose. Take the medication exactly as prescribed. Don’t stop taking it or change the dose on your own.
Chronic hypertension can increase a pregnant womans risk of developing superimposed pregnancy induced hypertension and preeclampsia.
High blood pressure during pregnancy poses the following risks
If the placenta doesn’t get enough blood, the fetus might receive less oxygen and fewer nutrients. This can lead to slow growth (intrauterine growth restriction), low birth weight or premature birth. Babies born early can have breathing problems, increased risk of infection and other complications.
In this condition, the placenta separates from the inner wall of the uterus before delivery. Preeclampsia and high blood pressure increase the risk of placental abruption. Severe abruption can cause heavy bleeding, which can be life-threatening for you and your baby.
Sometimes an early delivery is needed to prevent life-threatening complications from high blood pressure during pregnancy.
If you have high blood pressure, schedule a preconception appointment one of our provider who has expertise in managing pregnancies complicated by hypertensive disorders.
Insulin Dependent/ Juvenile onset Diabetes
Good sugar control before and during pregnancy is extremely important to reduce risk of birth defects. You should have a HbA1c of <6.5% before even attempting pregnancy.
High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth.
High blood glucose also can increase the chance that you will have a miscarriage or a stillborn baby.
You also have a greater chance of developing preeclampsia
Staying in your target range during pregnancy, which may be different than when you aren’t pregnant, is also important.
High blood glucose, also called blood sugar, can harm your baby during the first weeks of pregnancy, even before you know you are pregnant.
If you have diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage your diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.
A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful during this early stage and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine.
High blood glucose levels during pregnancy can also increase the chance:
- Preterm or Premature Delivery
- Large Baby
- Respiratory Distress
- Hypoglycemia
- Miscarriage
- Still Birth
- Pregnancy Induced Hypertension/Preeclampsia
Hypothyroidism
Thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of:
- Miscarriage
- Placental Abruption (premature separation of the placenta)
- Pregnancy Induced Hypertension/Preeclampsia
- Fetal Growth Restriction.
Hypothyroidism can prevent the release of the egg from the ovary (ovulation).
Typically, for women who have periods (menstruate) each month, an egg is released from the ovary each month. But women who have hypothyroidism may release an egg less frequently or not at all.
Hypothyroidism can prevent the release of the egg from the ovary (ovulation). Typically, for women who have periods (menstruate) each month, an egg is released from the ovary each month.
But women who have hypothyroidism may release an egg less frequently or not at all.
Hypothyroidism can also interfere with the development of an embryo (fertilized egg). This increases the risk of miscarriage.
Also, if you are pregnant and your hypothyroidism is not treated, your baby may be born prematurely (before the predicted due date), weigh less than normal, and have lowered mental capacity.
It is very important for patients to have their thyroid hormones checked and receive appropriate treatment if they wish to have a baby or are already pregnant.
Bariatric Surgery
Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age.
Weight loss influences fertility positively and can resolve hormonal imbalance. Rapid weight loss after bariatric surgery may reduce symptoms such as anovulation or cycle irregularities.
Obstetrical complications such as gestational diabetes and pregnancy induced hypertension/preeclampsia are decreased with weight loss following bariatric surgery.
Guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12–24 months after surgery. Pregnancy planning and waiting until time after maximum weight loss allowing for optimization of nutritional supply (e.g., folic acid) before conception is ideal. Vitamin K, A, B12, folate acid, and iron Calcium depletion were seen following bariatric surgery.
Speak with your bariatric surgeon about what vitamins you should be on when you want to conceive
Seizure disorder
Epilepsy alone doesn’t have an effect on your ability to get pregnant. If you’re thinking about having a baby, ask your health care provider if you need to make changes to your medication.
The medication you take during pregnancy can affect your baby and increase the risk of Birth defects:
- cleft palate
- neural tube defects (spina bifida)
- skeletal problems
- heart developmental devects
- urinary tract developmental defects
The risk seems to increase with higher doses and if you take more than one anti-seizure medication.
If you haven’t had a seizure for nine months before you conceive, you’re less likely to have a seizure during your pregnancy.
If you haven’t had a seizure for 2 to 4 years, you might be able to taper off medications before you conceive to see if you remain seizure-free.
Talk to your health care provider before you stop taking any of your medications.
For most people, it’s best to continue epilepsy treatment during pregnancy. To minimize the risks, your health care provider will prescribe the safest medication and dosage that’s effective for your type of seizures. Seizure medication levels may be monitored throughout your pregnancy.
Folic Acid
Folic acid helps prevent serious problems with the brain and spinal cord called neural tube defects.
We recommend a higher dose of folic acid (5mg l-methyl folate) which should be started three months before you get pregnant.
Autoimmune Disorders
Autoimmune disorders are 5 times more common among women, and incidence tends to peak during reproductive years. Thus, these disorders commonly occur in pregnant women.
A healthy, normally-functioning immune system is designed to fight off harmful invaders, like bacteria or viruses.
An autoimmune disorder or autoimmune disease is a condition in which the body’s immune system attacks your own healthy cells.
There are many ways that pregnancy and autoimmune disorders can interact.
In some cases, pregnancy may have a profound effect on the symptoms of autoimmune diseases, such as in the case of Rheumatoid arthritis and multiple sclerosis.
Pregnancy may trigger an autoimmune disorder.
An existing autoimmune disorder can interfere with pregnancy, causing harm to the fetus.
The antibodies that the mother produces can enter the fetus’s system, affecting its growth.
- Antibodies and antigens join to form a floating immune complex, which circulates in maternal blood and can clog the filter of the placenta, causing it to become partially blocked.
- If the amount and number of nutrients crossing the fetal membrane decreases, the baby will be smaller. These moms have to be watched—especially in the late second and entire third trimester—for early placental dysfunction.
- Trouble starts when a woman develops placental vasculitis, an inflammation of the capillaries.
- WBCs come in and try to clean up the problem, but they heal by scarring. This often leads to cell death within the placenta and decreases placental function.
Women with vasculitis are at increased risk of preterm delivery and small-for-gestational-age infants.
Women whose autoimmune conditions are in remission typically have a reduced risk of pregnancy complications and symptom flare-ups.
Women with lupus can safely become pregnant. If your disease is under control, pregnancy is unlikely to cause flares. However, you will need to start planning for pregnancy well before you get pregnant. The systemic lupus erythematosus (SLE) may first appear during pregnancy. Women who have had an unexplained 2nd-trimester stillbirth, a fetus with growth restriction, preterm delivery, or recurrent spontaneous abortions are often later diagnosed with SLE.
Getting pregnant when your lupus is active could result in miscarriage, stillbirth, or other serious health problems for you or your baby. Your disease should be under control or in remission for six months before you get pregnant.
Pregnancy can be more complicated and riskier in women with SLE induced high blood pressure, lung disease, heart failure, chronic kidney failure, kidney disease, or a history of preeclampsia. It also may include women who have had a stroke or a lupus flare within the past six months.
Lupus flare-ups are more likely to occur immediately after giving birth.
Some women may develop rheumatoid arthritis during pregnancy, or in the weeks following delivery. Rheumatoid arthritis will not affect the fetus, but it can cause pain, stiffness, weakness, fatigue, and swelling for the mother. If the lower spine or hip joints have been affected, this can make delivery more challenging.
If you already have rheumatoid arthritis, your symptoms may become less severe during pregnancy, only to return to their previous severity after birth.
Flare-ups can be treated during pregnancy with prednisone, a corticosteroid.
If you think you’d like to start a family, it’s important to wait at least three years after your scleroderma diagnosis to become pregnant. During the first three years, the course of the disease can be unpredictable, and flares are more likely.
Scleroderma occurs when the immune system, which normally fights infection, instead attacks the body, causing the skin and blood vessels to thicken and tighten, and scars to form on the kidneys and lungs. Localized scleroderma affects the skin, and the systemic type affects the organs and connective tissue, the fibers that bind and support the body’s cells, organs, and tissues. Systemic scleroderma can damage ligaments, nerves, muscles, and tendons and may cause hypertension, or high blood pressure.
Planning should also include an evaluation of factors that could make pregnancy riskier. They include the presence of two autoantibodies, anti-Ro (SSA) and/or anti-La (SSB), which occur in 8% to 10% of women with scleroderma. The antibodies are associated with a low risk of congenital heart block (CHB), an abnormality in the rate or rhythm of the fetal heart. Higher antibody levels are associated with a greater risk of CHB. Third-degree or complete heart block, the most severe form, usually isn’t reversible.
Outcomes of babies born to moms with scleroderma have been generally positive. However, low-birthweight babies – defined as below the 10th percentile for their gestational age – are more common in mothers with scleroderma. This is due an increased risk of a condition called placental insufficiency, where the blood supply to the fetus is decreased.
Women with systemic forms of scleroderma are at risk of developing preeclampsia, which refers to pregnancy-induced high blood pressure and protein leakage in the kidneys, preterm labor, and other kidney problems. Localized scleroderma rarely affects pregnancy.
In Sjogren’s syndrome, the body’s white blood cells, which fight infection, attack the glands that produce moisture, such as those in the eyes and mouth. Diagnosed most often in women, the condition can cause dry and burning eyes, dry mouth, difficulty swallowing, swollen neck glands, and even vaginal dryness. It can also affect the blood vessels, central nervous system, gastrointestinal system, kidneys, liver, lungs, and pancreas.
Sjögren syndrome is likely to worsen during pregnancy and more so in the postpartum period. This is because the disease is sometimes complicated by pulmonary hypertension, which frequently worsens during pregnancy and in the postpartum period.
Women with Sjögren syndrome planning to conceive must undergo good counseling regarding all specific risks and complications involved, medications that are contraindicated during pregnancy, and whether the patient is in the best condition to get pregnant according to underlying disease activity and complications. Ideally, the disease should be well under control three to six months before conception.
Some pregnant women with Sjogren’s syndrome have a higher risk of miscarriage. Women with Sjogren’s syndrome who have anti-Ro (SS-A) or anti-La (SS-B) autoantibodies—substances in the blood that mistakenly attack the body’s own tissues—are at a higher risk of having a baby born with congenital heart block, a potentially life-threatening condition in which the baby’s heart becomes scarred and beats more slowly. The reported prevalence of CHB in the offspring of an anti-SS-A-positive woman is 1% to 2%.
Antiphospholipid syndrome is an autoimmune disease. This happens when your immune system fights against normal cells. In this condition, your body makes antibodies that attack a kind of fat (phospholipids) in cells. This causes many problems. It makes your blood clot too easily. Your body may also make anticardiolipin antibodies. Cardiolipin is a type of fat in cells.
This disease often causes:
- This happens when blood clots form in your arteries or veins, especially in your legs. If clots form in the blood vessels in your brain, you could have a stroke. Clots can also cause a blockage in the arteries to the lungs. This can be life-threatening.
- This happens when your blood is low in platelets. Platelets are cells that are needed for your blood to clot.
- Pregnancy loss (miscarriage). This may happen more than once. This disorder causes excessive clotting of the blood.
- Complicated pregnancy. It increases the mother’s risk of developing hypertension (high blood pressure) and preeclampsia and increases the baby’s risk of IUGR, miscarriage, and stillbirth.
A pregnant patient with antiphospholipid syndrome can typically be treated with low-dose aspirin and anticoagulants throughout the pregnancy, until about six weeks after childbirth. This can decrease the amount of clotting as well as the risk of complications.