Published January 30, 2007
The vast majority of all medical complications during pregnancy fall into one of the following three categories: hypertension, diabetes, and premature labor. Let’s take a closer look at each one of these.
1. Gestational Hypertension: When Normal Is Too High
Even as you progress well into your pregnancy, every obstetrical visit will still include a measure of your blood pressure. Blood pressure is the force of the blood pushing against the walls of your arteries, which are the blood vessels that carry oxygen-rich blood away from the heart to all parts of your body. When the pressure on the arteries becomes too high, it’s called hypertension.
About 5 percent of women have hypertension before they become pregnant. This is called chronic hypertension. Another 5 percent or so develop hypertension during pregnancy. This is called gestational hypertension. Oddly enough, a normal blood pressure reading may actually signal hypertension during pregnancy. Why? Because all the natural hormones your body pumps out during pregnancy end up dilating your blood vessels, which should produce a blood pressure at the low end of the normal range.
So, if yours is at the upper end of the normal range, your blood pressure is, relatively speaking, too high.
Excessively high blood pressure during pregnancy can cause many problems. One is a condition called placental abruption. This is a premature separation of the placenta from the uterine wall, a condition that would typically cause vaginal bleeding and uterine contractions. If the abruption jeopardizes your health or your baby’s health, you’ll need to have an immediate delivery.
Another high blood pressure problem is a rare but life-threatening condition called preclampsia. This occurs when high blood pressure is accompanied by protein in the urine. The mechanisms leading to precalmpsia are not clear, but this condition can quickly worsen and jeopardize the life of both mother and baby. If the fetus is less than 34 weeks old, a drug called a corticosteroid may be administered to help speed up the maturity of the fetal lungs. On the other hand, if it occurs after the 37th week, the physician may recommend inducing delivery.
The only real cure for preclampsia is delivery. Receiving regular prenatal care allows your doctor to deal with the problems that might arise from hypertension early on.
Most reasons for hypertension during pregnancy are unknown. Certainly, if you have a history of hypertension, pregnancy could just exacerbate the condition. But obesity and stress can also have a compound effect on your blood pressure during pregnancy.
Hypertension is a particularly worrisome issue during pregnancy because it can constrict the blood vessels in the uterus, which supply the fetus with the necessary oxygen and nutrients. This can slow the fetal growth and result in a low birth weight. Hypertension also increases the risk of a preterm delivery, that is, a delivery that occurs before your 37th week. Both low birth weight and prematurity not only increase the risk of health problems for newborns but may result in learning problems and the delayed development of motor skills later on.
The treatment for hypertension during pregnancy is limited. A doctor will generally recommend that a pregnant woman with early or mild hypertension cut back on her activities and avoid strenuous exercise, while more serious cases require hospitalization.
2. Gestational Diabetes: Not So Sweet
When you’re pregnant, it’s breakfast, lunch, and dinner for two every day for nine months. Your body provides your baby with its only source of nourishment. And that source of nourishment is also your own body’s source of nourishment—the glucose that results from the breakdown of carbohydrates in your body. This glucose is delivered from your bloodstream to the muscles and other cells that need this fuel through a hormone called insulin. When your body fails to produce enough insulin, the glucose builds up in your body, which can possibly result in diabetes. There is never a good time to have diabetes, but there is no worse time than during pregnancy, as it puts two of you at risk.
During pregnancy, your body delivers glucose to the baby through the placenta, a temporary organ that also provides the baby with oxygen and serves to pass out the baby’s waste. (After birth the placenta is called the afterbirth.) For its limited existence, this organ has a tremendous workload, including producing hormones that assist in the baby’s development.
Trouble is, the natural hormones of pregnancy, which are designed to break down your fat cells into glucose, may create more glucose in your system than your body can adequately metabolize. The result is gestational diabetes. If, on top of that, your diet is high in sugar by-products—in other words, if you are taking in large amounts of carbohydrates and sugar through candies and cakes—this second source of glucose coming in from the outside may put you over the threshold.
Pregnancy affects the blood glucose levels in all women, so at 28 weeks you’re going to be screened for diabetes. Diabetes is a very common problem in pregnancy and some women who are nearly diabetic when they get pregnant will go right over the edge and experience this glucose intolerance, and the inability to process all the glucose in their system.
The problem with diabetes in pregnancy is that it often leads to the birth of large babies, because the excess glucose goes to the baby directly. In other words, if mommy has high sugar, the baby has high sugar. And it affects you as an individual—by frequent urination, weight gain, and restricted movements—the same way it affects the baby in utero. The baby gets excessively large and urinates frequently, changing the composition of the fetal fluid, which may even put the baby at risk of death.
The other problem with large babies is that they tend to suffer more trauma during vaginal delivery—broken collarbones, for instance, or injury to the nerves in the neck called the brachial plexus. Large babies also have a very difficult time as newborns because they’re so overweight that they may suffer from a variety of metabolic disorders.
To test for diabetes, the physician will administer a challenge test. You’ll be asked to drink a glucose solution in a soda-style liquid. After an hour, your glucose level will be measured. If the reading is too high, which occurs about 20 percent of the time, your doctor will have you come back for a glucose tolerance test.
The good news is that most women whose challenge test comes back high don’t turn out to have gestational diabetes after this follow-up test. But if your blood sugar level is still high, the doctor will put you on a diabetic diet based on complex carbohydrates, proteins, and vegetables. You will then need to monitor your sugar on a daily basis. If it continues to be elevated after a week or two, then you might need to start taking medication, such as insulin or oral hypoglycemic agents. The aim, whether by diet or medication, is to bring down your blood sugar to a level that will hopefully not interfere with your pregnancy.
3. Premature Birth: Ready or Not
Every day one in eight babies born in the United States arrives sooner than expected. Premature birth is another common problem of pregnancy, and it can happen to anyone. By definition, a premature birth is one that occurs before the thirty-seventh week of pregnancy. The average size of a baby at 37 weeks is about five pounds.
However, since the field of neonatology has improved dramatically in the last couple of decades, a baby born healthy at 35 weeks has an overwhelmingly good prognosis for long-term survival. So more and more these days the definition of preterm labor has to do with how early in the pregnancy it occurs relative to the health of the baby. Prematurity can grossly compromise a child’s quality of life and put the child at risk for deafness, cerebral palsy, and blindness.
Just what causes premature birth, no one knows for certain. Some research suggests that one of the main contributing factors to preterm labor is infection. Though such infections must be occurring quietly, without showing any symptoms, the bacteria in the cervix must be causing an inflammation, and the by-products of that inflammation are chemicals that can induce preterm labor.
In other cases, women who have no infection may have a relatively weak uterus, or their cervix just doesn’t have the integrity to hold the pregnancy as the baby gets bigger, thus allowing the cervix to open up early on. Still other women may have anatomical deformities of the uterus that again may put them at risk for preterm labor. Another probable cause of premature birth is stress. And as everyone knows who has been through it, stress is certainly a big factor in pregnancy.
The typical signs of premature labor are lower back pain, vaginal bleeding, excessive vaginal discharge, and premature contractions. Preterm labor is treated by such medications as magnesium sulfate, terbutaline sulfate, and antibiotics—all of which aim, though with limited results, to stop those contractions.
Women in premature labor are often given steroids. Steroids? Yes, not all steroids are bad for you. When used appropriately in the right circumstances and under a doctor’s supervision, steroids are a wonder. They are given to women experiencing premature labor in order to literally pump the baby up. Like turning up the heat on the stove to boil the potatoes a little quicker, the steroids help mature the baby’s physiology more quickly so that he or she—however small—has a better chance of survival at birth.
Five Illnesses to Avoid During Pregnancy
If the mother-to-be is exposed to any of the following, see your doctor immediately.
--Fifth disease is caused by the parovirus and can cause anemia in your baby. If you get fifth disease early in your pregnancy, you could have a miscarriage.
--Chickenpox is caused by the varicella virus and can cause birth defects.
--Rubella, or German measles, is now rare, but it used to be a common cause of birth defects. Pregnant women should be tested to see if they’re immune to rubella.
--Cytomegalovirus (CMV) is a common infection that can be passed from the mother to the baby, and it can cause birth defects. It doesn’t produce symptoms, and there is no way to treat it. Those most at risk are those who work in day-care or health-care settings. Wash your hands after handling diapers and avoid nuzzling the babies.
--Toxoplasmosis is an infection caused by parasites from raw or uncooked infected meat or from contact with the feces of a cat. It can result in stillbirth, or death shortly after birth, and can cause mental or motor-developmental delays, cerebral palsy, epilepsy and visual impairments, including sometimes blindness.
Cook meats well, wash or peel fruits and vegetables, wear gloves while gardening, and have others change the kitty litter.
Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007), from which this article was excerpted.
Dr. Manny Alvarez is the managing editor of health news at FOXNews.com, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.