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Sexual & Reproductive Health

4 Common Pregnancy Complications

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When you find out you’re pregnant, your thoughts and emotions may go into overdrive. You might be as excited about this new person you will bring into the world as you are terrified that something may go wrong. 

Most pregnancies progress without incident. But approximately 8 percent of all pregnancies involve complications that, if left untreated, may harm the mother or the baby. While some complications relate to health problems that existed before pregnancy, others occur unexpectedly and are unavoidable. 

It can be scary to hear that doctors have diagnosed a complication. You may be worried about your baby’s health and your own health. You may even feel panic that perhaps something you did (or didn’t do) caused this to happen. These feelings are completely normal. It may reassure you to know that nothing you did caused these complications. And beyond that —these complications are treatable. The best thing you can do for you and your baby is to get prenatal care from a provider you trust. With early detection and proper care, you increase the chances of keeping you and your baby healthy.

Linda Szymanski, M.D., Ph.D., medical director of labor and delivery and inpatient obstetric services at The Johns Hopkins Hospital, discusses some common pregnancy complications and how they can be managed. 

Hyperemesis Gravidarum 

What is it? While many pregnant women experience morning sickness (nausea, possibly with vomiting, generally in the morning hours) and other discomforts during pregnancy, women with hyperemesis gravidarum (HG) have morning sickness times 1,000. HG is severe nausea that results in significant weight loss and may require hospitalization. (Though it may not make you feel any better, know that if you have HG, you are in royal company — Her Royal Highness The Duchess of Cambridge, Kate Middleton, suffered from it.) 

What are the symptoms? Women with HG have severe nausea and vomiting. The vomiting and reduced appetite leads to weight loss and dehydration. The major difference between HG and normal morning sickness is that HG results in a weight loss of 5 percent or more of your pre-pregnancy weight.

Who is at risk? Doctors do not yet fully understand HG, what causes it or who is more likely to experience it.

Can you prevent it? You cannot prevent HG, but you can take steps to control and manage it during your pregnancy. The most important thing you can do for you and your baby is to get regular prenatal care. HG can lead to not getting enough nutrients, which can be harmful to both you and your baby. However, with proper treatment, there are typically no long-term effects to either mom or child after the pregnancy. 

How is it treated? If you have been diagnosed with HG, the priority is ensuring you have enough nutrients to keep you and your baby healthy. For some women, a diet of bland foods and fluids may be enough, while others may need to take medication to help relieve the nausea. In severe cases, you may need to be hospitalized to receive nutrients and fluids via intravenous (IV) line. You may feel down about having to be in the hospital during your pregnancy. But remember that you are just doing what you need to do to protect your and your baby’s health!

Many women start to feel better by the 20th week of pregnancy, while some continue to experience symptoms throughout the entire pregnancy. 

What should I ask my doctor? If you’ve had HG in the past, talk to your doctor when you are thinking about getting pregnant again. It’s important to make sure you are physically, emotionally and psychologically ready to begin another pregnancy. If you had severe weight loss or other nutritional deficiencies, you’ll need to talk to your doctor about making sure you are healthy before getting pregnant.

Gestational Diabetes 

What is it? Diabetes is a condition that prevents your body from breaking down sugar. Gestational diabetes mellitus (GDM) is a type of diabetes that occurs during pregnancy. One of the biggest risks of gestational diabetes is that your baby may grow much larger than normal, a condition called macrosomia. “During delivery, a baby’s shoulders can get stuck,” says Szymanski. “If the baby is thought to be too big for a safe vaginal delivery, we recommend a cesarean section.”

What are the symptoms? Gestational diabetes has no outward signs or symptoms. Doctors screen for it between 24 and 28 weeks of pregnancy, or earlier in high-risk women such as those who are overweight or have a history of gestational diabetes.

Who is at risk? Risk factors for gestational diabetes include being overweight or having a history of GDM in previous pregnancies. If you are at high risk, your doctor will screen for GDM earlier than 24 weeks, typically in the first trimester. 

Can you prevent it? Losing weight before pregnancy, sticking to a healthy diet and getting regular exercise can lower your risk of developing GDM.

How is it treated? You and your doctor should discuss how you can best control the GDM. Good old diet and exercise seem to be a good place to start. “A very high percentage of gestational diabetes can be controlled by diet,” Szymanski says, though some women with GDM will need to take medications (pills or even insulin) to control blood sugar levels.

Szymanski adds that exercise during pregnancy, even just walking 30 minutes a day, is great for controlling blood sugar. It’s best to do something you enjoy so you’ll stick with it, but you should let your doctor know what type of exercise you are doing. 

What should I ask my doctor? If you’ve had GDM, you and your baby are both at risk of developing type 2 diabetes later in life. So talk to your doctor about steps you can take to reduce that risk. 

Placenta Previa

What is it? While you are pregnant, the placenta provides your baby with oxygen and nutrients for proper development. The placenta normally attaches to the upper part of the uterus, but in placenta previa it either totally or partially covers the cervix (which is the opening between the uterus and vagina). 

Who is at risk? You may be at higher risk if you have scarring on your uterus from previous pregnancies or from a uterine surgery, or if you have fibroids.

What are the symptoms? The main symptom is vaginal bleeding that is not accompanied by cramping or other pain. Some women, however, do not experience any symptoms. Your doctor will confirm a diagnosis using an ultrasound or physical exam. 

Can you prevent it? There’s nothing you can do to prevent placenta previa. However, you can increase your and your baby’s health by getting regular prenatal care. If you are at high risk — because of a previous surgery, C-section or fibroids — make sure to tell your doctor. He or she may want to monitor you more closely during your pregnancy. 

How is it treated? Placenta previa may result in bleeding during pregnancy. Some women have no bleeding, some have spotting and others may experience heavy bleeding. If the bleeding is heavy, you may need to stay in the hospital for a period of time. Women with placenta previa will require a C-section to deliver the baby, usually scheduled two to four weeks before their due date. 

What should I ask my doctor? Always talk to your doctor if you notice any vaginal bleeding at any point during your pregnancy. 

Preeclampsia 

What is it? Preeclampsia is a condition that causes dangerously high blood pressure. It can be life-threatening if left untreated. Preeclampsia typically happens after 20 weeks of pregnancy, often in women who have no history of high blood pressure.

What are the symptoms? Symptoms of preeclampsia may include severe headache, vision changes and pain under the ribs. However, many women don’t feel symptoms right away. “The first alert is usually when a woman comes in for a routine prenatal visit and has high blood pressure,” says Szymanski. “From there, we test for things like kidney and liver function to determine whether it’s preeclampsia or just high blood pressure.”

Who is at risk? Risk factors for preeclampsia include having a history of high blood pressure, being obese (having a body mass index, or BMI, greater than 30), age (teenage mothers and those over 40 are at higher risk) and being pregnant with multiples. 

Can you prevent it? While you can’t prevent preeclampsia, staying healthy during pregnancy may help. If you have risk factors, experts recommend that you see your obstetrician either before you become pregnant or very early in your pregnancy, so you and your doctor can discuss ways that you can reduce your risk. For example, many women at risk for preeclampsia are prescribed a baby aspirin after the first trimester. 

Regular prenatal visits are the best way to control preeclampsia. During those routine visits, your doctor will check your blood pressure. If it’s high, further tests can diagnose the condition so you can start getting the treatment you need. 

How is it treated? The condition only goes away once the baby is born, so delivery is the best way to treat preeclampsia. However, delivering the baby too early can put the baby at risk for health problems. The decision about how to treat you will largely depend on how far along the pregnancy is. You may need to be hospitalized so your team can monitor you and your baby closely. 

What should I ask my doctor? Your doctor will discuss the risks and benefits of delivering the baby early versus continuing the pregnancy and trying to manage the preeclampsia as long as possible through other methods. After delivery, the condition will go away, but you will be at greater risk for heart disease later in life. Talk to your doctor about what you can do help reduce and manage those risks. 

Pregnancy Complications: The Bottom Line

While these conditions may differ from one another, you may have noticed one common thread: Regular prenatal (even preconception) care is crucial. “We always like women to come in for a preconception consult to talk about what they can do to reduce their risks,” Szymanski says. “Being healthy before pregnancy is the best thing you can do for your baby.”

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