Managing chronic conditions during pregnancy



What if you have diabetes or high blood pressure or an autoimmune disease like lupus or rheumatoid arthritis and you want to get pregnant? Or what if you become pregnant and have one of those chronic conditions?

If so, you probably have lots of questions. Jade Elliott spoke with  Dr. Helen Feltovich, a maternal fetal medicine physician with Intermountain Healthcare who manages high-risk pregnancies, to discuss chronic conditions.

How common are chronic conditions among pregnant women?

The most common chronic conditions among American women are overweight/obesity (>50%), pregestational (type 1 or 2) diabetes (1-2%), high blood pressure (1-1.5%), and, less commonly, autoimmune diseases like lupus or rheumatoid arthritis.

What should women who have a chronic condition know and do before they get pregnant?

If you have a chronic condition, including obesity it’s best to get a pre-pregnancy consultation with a maternal fetal medicine specialist if you want to get pregnant. If you’re already pregnant and have a chronic condition, see a specialist as early as possible in your pregnancy, since that will lead to better outcomes for you and your baby.

How can maternal fetal medicine specialists help pregnant women who have these conditions?

Women with medical conditions that put them at increased pregnancy risks usually are managed by both high-risk pregnancy specialists and their regular obstetric provider. Every woman and every pregnancy is different. Sometimes a pregnant patient will see her high-risk obstetrician just once during a pregnancy, to design a management plan for monitoring her and her fetus. Other times she will be co-managed, which means she’ll see both her high-risk and regular provider throughout her whole pregnancy, for instance if she needs specialized tests like Doppler ultrasound or interventions like in-utero surgery.

Can chronic conditions affect your pregnancy or the baby?

Yes. It depends on the type of chronic condition. That’s why it’s so important to see a maternal fetal medicine specialist.

Why is it important to manage diabetes during pregnancy?

Having diabetes during pregnancy can lead to increased risks or complications for the mom or baby. When moms have diabetes, their babies are more likely to have a larger than normal birthweight, which can lead to delivery complications. Their babies are also at increased risk for birth defects, stillbirths, respiratory distress and low blood sugar.

For pregnant moms, most complications occur in women who have diabetes before they are pregnant. Pregnant women with diabetes are at increased risk for high blood pressure or preeclampsia, as well as preterm birth, cesarean delivery and other problems.

What are the signs of diabetes?

  •  Excessive thirst.
  • Frequent urination.
  • Extreme hunger.
  • Unexplained weight loss.
  •  Fatigue.
  •  Irritability.
  • Blurred vision.
  •  Presence of ketones in the urine (can be detected through lab tests)

What’s the difference between Type 1 and Type 2 diabetes and gestational diabetes?

They are different in terms of risk factors and onset. Type 1 or 2 diabetes is pregestational, or diabetes that exists before pregnancy. Pregnancy can complicate diabetes in these women, and outcomes are closely tied to degree of glucose control during pregnancy.

Gestational diabetes is defined as a new onset of diabetes that occurs during pregnancy. However, some women diagnosed with gestational diabetes actually have undiagnosed pre-gestational type 2 diabetes. Like type 1 and type 2 diabetes, outcomes are closely tied to the degree of glucose control. This is part of why it’s important to learn what is in your genes and understand your health before you get pregnant.

Why is it important to manage high blood pressure during pregnancy?

Complications can include:

  • Preeclampsia, when high blood pressure can lead to organ damage in the mother.
  • A stroke due to very high blood pressure.
  • Decreased blood flow to the placenta can lead to baby receiving less oxygen and fewer nutrients, causing low birth weight or premature birth.

Why does obesity add risk to your pregnancy?

Obesity is defined as a body mass index (BMI) over 30, and BMI over 40 in particular, poses risk to a pregnancy. Fetal complications include a higher chance of miscarriage, birth defects, abnormal fetal growth (usually overgrowth), abnormal fluid (usually too much fluid), and rarely, stillbirth. Preterm birth is more likely in obese women, either spontaneously or medically-indicated because of maternal complications such as gestational hypertension or preeclampsia, or gestational diabetes with poor glucose control.

What advice would you give to women who are obese and either want to get pregnant or are already pregnant?

A good diet and exercise plan are always key elements to a healthy pregnancy. Before pregnancy, obese women can optimize their pregnancy outcomes by losing weight to reach an ideal body weight. Obese pregnant women can also optimize outcomes by following a healthy diet and exercise plan. Although we typically associate healthy pregnancy with weight gain, depending on a patient’s BMI, it may be best for her to gain little weight.

Why is it important to manage your autoimmune disease during pregnancy?

Most of the time, women with autoimmune disorders can expect a normal pregnancy. However, some serious problems like fetal growth restriction or even stillbirth can occur, depending upon a patient’s exact diagnosis and disease control. Also, sometimes medications have to be adjusted before pregnancy if they aren’t safe for the fetus. Patients with well-controlled disease before pregnancy do best during pregnancy. So, it’s important to have a plan, ideally before pregnancy.

Are there some chronic conditions, where women actually feel better when they’re pregnant than when they’re not?

About one third of patients with autoimmune diseases report feeling better while pregnant, and one third report no change and another third feel worse or have a first episode during pregnancy. This is probably because of the natural steroid production that occurs during pregnancy.

Are there any chronic conditions where getting pregnant is not recommended?

Rarely, a high-risk obstetrician might advise against pregnancy, for instance, in women with antiphospholipid syndrome and history of recurrent blood clots, or severe pulmonary hypertension, or certain kinds of heart problems. That doesn’t happen often, but anticipating serious problems is one reason to contact your high-risk obstetrician before becoming pregnant.

Keep in mind most pregnancies and births are normal

If you have a chronic medical condition, it’s important to meet with your doctor early, ideally before you are pregnant, to develop a management plan. This helps you and your healthcare team to optimize your situation for the best possible outcome for you and your baby.

For more information

Go to https://intermountainhealthcare.org/

And search for high risk pregnancy or maternal fetal medicine.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.


Leave a Reply

*