Medical Problems of Pregnancy

The majority of women enter pregnancy healthy and remain so until delivery of the baby. Aside from a variety of minor problems -- for example, backache, morning sickness, and constipation -- the woman generally tolerates the many changes in her body that result from pregnancy. In some cases, however, either the mother enters pregnancy with a medical problem or a problem develops during pregnancy. Some of these conditions affect only the mother, while others may affect both mother and baby.

Toxemia of Pregnancy

Toxemia of pregnancy is a severe condition that sometimes occurs in the latter weeks of pregnancy. It is characterized by high blood pressure; swelling of the hands, feet, and face; and an excessive amount of protein in the urine. If the condition is allowed to worsen, the mother may experience convulsions and coma, and the baby may be stillborn.

The term toxemia is actually a misnomer from the days when it was thought that the condition was caused by toxic (poisonous) substances in the blood. The illness is more accurately called preeclampsia before the convulsive stage and eclampsia afterward.

Causes

The causes of preeclampsia and eclampsia are not clearly understood. They tend to develop more often in women who are having their first baby, especially teenage mothers and women from lower socioeconomic groups. One theory proposes that certain dietary deficiencies may be the cause of some cases. Also, there is the possibility that some forms of preeclampsia and eclampsia are the result of deficiency of blood flow in the uterus.

Symptoms

The symptoms of toxemia of pregnancy (which may lead to death if not treated) are divided into three stages, each progressively more serious:

Mild preeclampsia symptoms include edema (puffiness under the skin due to fluid accumulation in the body tissues, often noted around the ankles), mild elevation of blood pressure, and the presence of small amounts of protein in the urine.


Severe preeclampsia symptoms include extreme edema, extreme elevation of blood pressure, the presence of large amounts of protein in the urine, headache, dizziness, double vision, nausea, vomiting, and severe pain in the right upper portion of the abdomen.


Eclampsia symptoms include convulsions and coma.
Treatment

Preeclampsia and eclampsia cannot be completely cured until the pregnancy is over. Until that time, treatment includes the control of high blood pressure and the intravenous administration of drugs to prevent convulsions. Drugs may also be given to stimulate the production of urine. In some severe cases, early delivery of the baby is needed to ensure the survival of the mother.

Prevention

There is no known preventive for toxemia of pregnancy. Though the restriction of salt in the diet may help reduce swelling, it does not prevent the onset of high blood pressure or the appearance of protein in the urine. During prenatal visits, the doctor routinely checks the woman's weight, blood pressure, and urine. If toxemia is detected early, complications may be reduced.

Heart Disease

Although the incidence of heart disease among women in their childbearing years has declined dramatically in recent years, it still remains one of the major causes of death in pregnant women. Most women with known heart disease withstand pregnancy without any problems. However, in some cases in which the heart muscle or valves are seriously diseased, the added strain normally placed on the heart during pregnancy may lead to heart failure and even death. For this reason, any woman who knows that she has a heart problem should check with her doctor before attempting to become pregnant.

Kidney Disease

The most common disease of the kidneys during pregnancy is pyelonephritis, a bacterial infection of the kidney. This can occur when an infection of the bladder allows bacteria to travel up to the kidneys. Symptoms include fever, severe low back pain, and chills. It is important to treat pyelonephritis quickly because it may cause a pregnant woman to go into premature labor. All instances of severe low back pain and fever should be reported to the doctor immediately.

Women who have severe kidney disease before pregnancy can have many serious problems during pregnancy. Extremely high blood pressure and kidney failure (inability to produce urine) are life-threatening complications for both the mother and the fetus. Some women with severe kidney disease may be advised not to become pregnant. Consult your doctor if you have any questions.

Diabetes

Before the discovery of insulin for the treatment of diabetes, women with diabetes who became pregnant either miscarried or the pregnancy resulted in the death of the mother and baby. Today, a diabetic woman can expect to deliver a healthy, normal baby.

Even though medical care of the diabetic woman has improved greatly in the last decade, a variety of serious problems may be associated with pregnancy, including an increased chance of preeclampsia, stillbirth, and abnormally small babies.

For these reasons, it is important for a diabetic woman to achieve excellent glucose control prior to conception to decrease her risks for complications associated with pregnancy. Once pregnant, the diabetic woman should expect more frequent prenatal office visits and more laboratory testing. It is important for her to maintain a strict diet, exercise appropriately, and take her insulin at all the prescribed times.

Another form of diabetes -- called gestational, or pregnancy-induced, diabetes -- affects women only during pregnancy. In this disorder, women who were not diabetic before pregnancy display signs of diabetes only when they are pregnant.

During routine prenatal office visits, the pregnant woman's urine is always tested for the presence of sugar, or glucose (urine should normally contain no glucose). If sugar appears in the urine, the doctor performs a blood test to see if the woman's blood sugar level is abnormally high. In addition, most physicians now routinely perform a blood test called a glucose challenge test at 24 to 28 weeks of pregnancy, even if urine tests have been normal. If the results show elevated levels, a more complex test is done to confirm the diagnosis.

Women with pregnancy-induced diabetes are generally treated with a special diet that restricts their intake of sugar and carbohydrates. Insulin is sometimes necessary to bring the blood sugar level down to normal.

Since women with pregnancy-induced diabetes also are at a greater risk for preeclampsia and stillbirth, they can expect to have more frequent prenatal visits. These women are also at risk of having macrosomic, or very large, babies. About 30 to 40 percent of women who develop gestational diabetes go on to develop nongestational diabetes several years after pregnancy. Postpartum weight control can help reduce this risk.

Digestive System Problems

The most common digestive system problem affecting pregnant women is hyperemesis gravidarum. In this condition, the woman suffers excessive or abnormal vomiting. This vomiting is more severe than that caused by normal "morning sickness," which usually clears up on its own within a few months. In hyperemesis gravidarum, the vomiting leads to starvation, loss of water in the body, and an imbalance in bodily fluids.

Symptoms include weight loss and dehydration. The condition is most often treated in the hospital through the use of antivomiting drugs and intravenous feeding. A pregnant woman should not attempt to treat herself with drugs for vomiting without first consulting her doctor.

Lung Disease

Lung disease is uncommon in pregnant women with the exception of occasional bouts of cough and congestion associated with the flu or a cold. The most serious lung disease to affect a pregnant woman is asthma. In women who have only mild asthma attacks before pregnancy, their asthma may stay the same, improve, or worsen. In women with severe asthma before pregnancy, symptoms usually worsen during pregnancy. Women with severe asthma are also more likely to have premature labor and small babies. Before a woman with severe asthma attempts to become pregnant, she should consult her doctor.

Liver Disease

Fatty liver disease and HELLP syndrome, both of which affect the liver, are rare. Fatty liver disease is generally associated with preeclampsia and occurs in the third trimester of pregnancy. The cause is unknown, but symptoms include nausea, vomiting, abdominal pain, and jaundice. Liver failure may result. HELLP syndrome (which is named after its characteristics: Hemolysis, a breakdown of red blood cells; Elevated Liver enzymes; and a Low Platelet count) is a severe form of preeclampsia and is, in part, characterized by liver inflammation. If a woman knows she has liver disease, she should check with her doctor before attempting to become pregnant.

Nervous System Disease

The most common nervous system problem in a pregnant woman is headache, generally caused by tension, migraine, or an infection of the sinuses or throat. Simple measures, such as lying down in a quiet room and applying ice packs over the forehead, relieve most simple headaches. However, since a headache may be a symptom of high blood pressure associated with preeclampsia, all severe or persistent headaches should be reported to the doctor immediately.

Numbness and tingling of the fingers, thighs, and toes are quite common in pregnancy and usually result from retention of water and swelling.

Epilepsy is the most serious nervous system problem that can affect a pregnant woman. About half of women with epilepsy experience worsening of symptoms during pregnancy. Furthermore, certain drugs commonly used to treat epilepsy may cause birth defects in the baby. Before a woman with epilepsy attempts to become pregnant, she should check with her doctor.

Skin Disease

Several types of skin changes are common in pregnant women and result from the normal hormonal changes of pregnancy. Darkening of the skin is common, especially on the face, abdomen, vulva, thighs, and around the nipples. As pregnancy progresses, the palms of the hands often become red, and small spider veins may develop on the arms and face. Stretch marks on the skin of the lower part of the abdomen usually develop late in pregnancy.

Several types of skin diseases occur only in pregnancy. These appear as numerous small, raised bumps that are usually extremely itchy. Though these conditions are rarely serious, report any unusual skin changes or itching to your doctor.

Infectious Diseases

Though most common infectious diseases, such as colds and the flu, have no effect on pregnancy, some diseases transmitted by other people may have very serious effects on the baby.

The herpes virus is responsible for frequent, painful ulcers that may occur in the genital areas of both men and women. A sexually transmitted disease, this virus is spread by direct genital contact.

Though this infection rarely causes serious problems in the woman, the newborn baby may become seriously infected and die if she comes into contact with an open herpes ulcer during delivery. For this reason, cesarean section is performed if a woman has a herpes ulcer in the genital region when she is in labor. If a woman knows she has had herpes, it is important that she tell her doctor, so he or she carefully examines the genital area during prenatal visits.

Syphilis is another sexually transmitted disease that may seriously affect the baby. If a mother has an active syphilis infection during pregnancy, the bacteria may enter the baby's bloodstream and cause a variety of abnormalities, including malformations of the heart, eyes, bones, and mouth.

As a part of the routine blood testing of the mother during the first prenatal visit, a blood test to detect the presence of syphilis is usually performed. If a pregnant woman thinks she may have acquired syphilis during pregnancy, she should tell her doctor immediately.

Rubella (German measles) is a common infectious disease that usually affects children. The rash and fever of rubella usually pass within a few days, and complete recovery from the infection is the rule. Rubella infection during pregnancy, however, may have many serious effects on the baby, especially if the infection develops early in pregnancy when the organs of the fetus are just beginning to form.

Complications in the baby may include microcephaly (abnormally small head), mental retardation, seizures, defects in the eyes, heart malformations, and deafness. If a pregnant woman suspects she may have come into contact with someone with rubella, she should report it to her doctor immediately, even if a rash or fever has not yet appeared. The doctor may then perform blood tests to determine if the woman has actually contracted rubella.

Since rubella infection in pregnancy is serious, a woman who is considering becoming pregnant should undergo testing to see if she is immune to rubella. Usually, if a person has had rubella at one time in her life, she never gets the infection again. If a woman is not immune, most doctors advise that she obtain a rubella vaccination before becoming pregnant.

Toxoplasmosis is another infection that may have serious effects on the baby. The mother may become infected with the Toxoplasma organism if she eats infected raw meat or if she is in close contact with cats infected with Toxoplasma. Babies born to infected mothers may have many serious birth defects, including microcephaly, seizures, and other disorders of the brain, and conditions involving the liver, blood, lungs, and kidneys. To avoid toxoplasmosis, a pregnant woman should always cook meat thoroughly and avoid contact with cat litter boxes.