Medical Conditions and Pregnancy
What You Need to Know
- Certain medical conditions may complicate a pregnancy. However, with proper medical care, most women can enjoy a healthy pregnancy in spite of medical challenges.
- Women who have diabetes before pregnancy or develop diabetes during pregnancy (gestational diabetes) will require additional medical monitoring.
- High blood pressure can impact pregnancy in two forms: chronic hypertension (pre-existing high blood pressure) or gestational hypertension (high blood pressure that develops during pregnancy).
- Infections during pregnancy can pose a threat to the fetus and should be treated right away. Potential infections include toxoplasmosis, food poisoning or sexually transmitted diseases.
Diabetes and Pregnancy
Diabetes is a condition in which the body does not make enough insulin or the body is unable to use the insulin that is made. Insulin is the hormone that allows glucose to enter the cells of the body to make fuel. When glucose cannot enter the cells, it builds up in the blood and the body’s cells starve to death. If not managed properly, diabetes can have serious consequences for you and your growing baby.
If you already have diabetes and become pregnant, your condition is known as pre-gestational diabetes. The severity of your symptoms and complications often depends on the progression of your diabetes, especially if you have vascular (blood vessel) complications and poor blood glucose control.
Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy. Unlike other types of diabetes, gestational diabetes is not caused by a lack of insulin but by other hormones that block the insulin that is made. This condition is known as insulin resistance. If you have gestational diabetes, you may or may not be dependent on insulin.
In most cases, all diabetic symptoms disappear following delivery. However, if you experience gestational diabetes, you will have an increased risk of developing diabetes later in life. This is especially true if you were overweight before pregnancy.
Causes of Gestational Diabetes
Although the specific cause of gestational diabetes is unknown, there are several theories about the origin of this condition. For example, the placenta supplies the growing fetus with nutrients and water. It also makes a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol and human placental lactogen) can have a blocking effect on the mother’s insulin, which usually begins about 20 to 24 weeks into pregnancy.
As the placenta grows, it produces more of these hormones, increasing the level of insulin resistance in the mother. Normally, the mother’s pancreas is able to make additional insulin to overcome insulin resistance. However, if the mother’s production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.
Risk Factors of Gestational Diabetes
The following factors increase your risk of developing gestational diabetes:
Age (over 25 years old)
A family history of diabetes
Previous delivery of a very large infant, a stillborn or a child with certain birth defects
Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for gestational diabetes.
Diagnosing Gestational Diabetes
A glucose screening test is usually done between 24 and 28 weeks of pregnancy. To complete this test, you will be asked to drink a special glucose beverage. Then, your doctor will measure your blood sugar level one hour later.
If the test shows an increased blood sugar level, a three-hour glucose tolerance test may be done. If the results of the second test are in the abnormal range, you will be diagnosed with gestational diabetes.
Treatment Options for Gestational Diabetes
Your health care provider or midwife will determine your specific treatment plan for gestational diabetes based on:
Age, overall health and medical history
Condition and the severity of the disease
Long-term expectations for the course of the disease
Tolerance for specific medicines, procedures or therapies
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Your specific treatment plan may include:
A special diet
Daily blood glucose monitoring
Insulin injections or oral medications
Possible Fetal Complications from Gestational Diabetes
Unlike other types of diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. They are more likely if you have pre-gestational diabetes, as you may have changes in blood glucose during that time. If you have gestational diabetes, you most likely had normal blood sugar levels during your critical first trimester.
The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels as soon as the diagnosis of gestational diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several imbalances, such as low-serum calcium and low-serum magnesium levels. In addition, gestational diabetes may cause the following:
Fetal macrosomia. This condition describes a baby that is considerably larger than normal. All of the nutrients your baby receives come directly from your blood. If your blood has too much glucose, your baby’s pancreas senses the high glucose levels and makes more insulin in an attempt to use this glucose. The extra glucose is then converted to fat. Even when you have gestational diabetes, your fetus is able to make all the insulin it needs. The combination of your high blood glucose levels and your baby’s high insulin levels may result in large deposits of fat that cause your baby to grow excessively large.
Birth injury. If your baby is large in size, it may be difficult to deliver and become injured in the process.
Hypoglycemia. This refers to low blood sugar in your baby right after delivery. This problem happens if your blood sugar levels have been consistently high, causing the fetus to have a high level of insulin in its circulation. After delivery, your baby continues to have a high insulin level, but it no longer has the high level of sugar from you. This results in the newborn’s blood sugar level becoming very low. Following delivery, your baby’s blood sugar level will be tested. If the level is too low, it may be necessary to administer glucose intravenously until your baby’s blood sugar stabilizes.
Respiratory distress (difficulty breathing). Too much insulin or too much glucose in a baby’s system may delay lung maturation and cause respiratory problems. This is more likely if it is born before 37 weeks of pregnancy.
High Blood Pressure and Pregnancy
High blood pressure during pregnancy can lead to placental complications and slowed fetal growth. If left untreated, severe hypertension may cause dangerous seizures, stroke and even death in the mother and fetus.
If you have high blood pressure, your doctor will perform kidney function tests, ultrasounds for growth and testing of your baby more frequently to monitor your health and fetal development.
If you have high blood pressure before pregnancy, you will likely need to continue taking your antihypertensive medicine. Your health care provider may switch you to a safer antihypertensive medicine during pregnancy to help manage your condition.
Gestational hypertension occurs most often during a young woman’s first pregnancy. You are more likely to develop gestational hypertension during a twin pregnancy or if you had blood pressure problems during a previous pregnancy.
Pre-eclampsia (formerly called toxemia) is characterized by pregnancy-induced high blood pressure. This condition is usually accompanied by protein in the urine and may cause swelling due to fluid retention. If you have pre-eclampsia, you may need bed rest. Eclampsia, the most severe form of this condition, is diagnosed when you have a seizure caused by pre-eclampsia. Your doctor may recommend hospitalization, medications and often delivery to treat pre-eclampsia or eclampsia.
Infectious Diseases and Pregnancy
Infections during pregnancy can pose a threat to your baby. Even a simple urinary tract infection, which is common during pregnancy, should be treated right away. An infection that goes untreated can lead to preterm labor and a rupturing of the membranes surrounding the fetus.
Toxoplasmosis is an infection caused by a single-celled parasite called Toxoplasma gondii (T. gondii). Although many people may have toxoplasma infection, very few exhibit symptoms because the immune system usually keeps the parasite from causing illness. Babies who became infected with toxoplasmosis before birth can be born with serious mental or physical problems.
Toxoplasmosis often causes flulike symptoms, including swollen lymph glands or muscle aches and pains, which last for a few days to several weeks. You can be tested to see if you have developed an antibody to the illness. Fetal testing may include ultrasound and/or testing of the amniotic fluid or cord blood. Treatment may include antibiotics.
The following measures can help prevent toxoplasmosis infection:
Have someone who is healthy and not pregnant change your cat’s litter box, since cat feces can carry T. gondii. If this is not possible, wear gloves and clean the litter box daily. (The parasite found in cat feces can only infect you a few days after being passed.) Wash your hands well with soap and warm water afterward.
Wear gloves when you garden or do anything outdoors that involves handling soil. Since cats may use gardens and sandboxes as litter boxes, be cautious when handling soil/sand that could contain the parasite. Thoroughly wash your hands with soap and warm water after outdoor activities, especially before you eat or prepare any food.
Have someone who is healthy and not pregnant handle raw meat for you. If this is not possible, wear clean latex gloves when you touch raw meat. Wash any surfaces and utensils that may have touched the raw meat. After handling the meat, wash your hands with soap and warm water.
Cook all meat thoroughly. It should be cooked until it is no longer pink in the center or until the juices run clear. Do not sample meat before it is fully cooked.
If you are pregnant, you should avoid eating undercooked or raw foods because of the risk of food poisoning. Food poisoning can dehydrate a mother and deprive the fetus of nourishment. In addition, food poisoning can cause meningitis and pneumonia in a fetus, resulting in possible death.
Follow these tips to prevent food poisoning:
Thoroughly cook raw food from animal sources, such as beef, pork or poultry.
Wash raw vegetables before eating them.
Store uncooked meats in an area of the refrigerator that’s separate from vegetables, cooked foods and ready-to-eat foods.
Avoid raw (unpasteurized) milk or foods made from raw milk.
Wash hands, knives and cutting boards after handling uncooked foods.
Sexually Transmitted Disease
Chlamydia may be associated with premature labor and rupture of the membranes.
Patients with hepatitis experience inflammation of the liver, resulting in liver cell damage and destruction. Hepatitis B virus (HBV) is the most common type that occurs during pregnancy in the United States.
HBV spreads mainly through contaminated blood and blood products, sexual contact, and contaminated intravenous needles. The later in pregnancy you get the virus, the greater the risk of infecting your baby.
HBV Symptoms and Related Conditions
Signs and symptoms of HBV include jaundice (yellowing of skin, eyes and mucous membranes), fatigue, stomach pain, loss of appetite, intermittent nausea and vomiting.
Although HBV resolves in most people, about 10 percent will develop chronic HBV. HBV can lead to chronic hepatitis, cirrhosis, liver cancer, liver failure and death. Infected pregnant women can pass the virus to their fetus during pregnancy and at delivery.
HBV Screening and Vaccination
A blood test for HBV is part of routine prenatal testing. If a risk of HBV is present, the following should occur:
Infants of HBV-positive mothers should receive hepatitis B immune globulin and the hepatitis B vaccine during the first 12 hours of birth.
Babies of mothers with unknown HBV status should receive the hepatitis B vaccine in the first 12 hours of birth.
Babies of mothers with negative HBV status should be vaccinated before leaving the hospital.
Premature infants weighing less than 4.5 pounds who are born to mothers with negative HBV status should have their first vaccine dose delayed until one month after birth or leaving the hospital.
All babies should complete the hepatitis B vaccine series to be fully protected from HBV infection.
If you have HIV, you have a one in four chance of infecting your fetus with the virus if you are not on medication. AIDS is caused by HIV. This virus kills or impairs cells of the immune system and progressively destroys the body’s ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of an HIV infection.
HIV is most commonly transmitted by sexual contact with an infected partner. HIV may also be spread through contact with infected blood. This happens mostly by sharing needles, syringes or drug use equipment with someone who is infected with the virus.
According to the National Institutes of Health, HIV transmission from mother to child during pregnancy, labor/delivery or breast-feeding has accounted for nearly all AIDS cases reported among children in the United States.
Some people may develop a flulike illness within a month or two of exposure to the HIV virus, although many people do not develop any symptoms at all when they first become infected. In adults, it may take 10 years or more for persistent or severe symptoms to surface. Symptoms may appear within two years in children born with an HIV infection.
HIV Testing and Treatment
Prenatal care that includes HIV counseling, testing and treatment for infected mothers and their children saves lives and resources. Since the Centers for Disease Control and Prevention began recommending routine HIV screening for all pregnant women in 1995, the estimated incidence of mother-to-child transmission has dropped by approximately 85 percent.
If you have tested positive for HIV while pregnant, your doctor may recommend:
Having blood tests to check the amount of virus present.
Taking a number of drugs during pregnancy, labor and delivery.
Delivering via Cesarean section if you have a high viral load.
Administering medicine to your newborn baby. Studies have found that giving a mother antiretroviral medicines during pregnancy, labor and delivery, and then to the baby for six weeks after delivery can reduce the chance of a mother’s transmission of HIV to her baby. This reduction is from 25 percent to less than 2 percent.
Refraining from breast-feeding. Studies show that breast-feeding increases the risk of HIV transmission.
Herpes is a chronic, sexually transmitted disease caused by the herpes simplex virus (HSV). Herpes infections can cause blisters and ulcers on the mouth or face (oral herpes), or in the genital area (genital herpes).
A first episode of genital herpes during pregnancy creates a greater risk of transmission of the virus to the newborn. Because of this risk, it is important that you avoid contracting herpes during pregnancy. Protection from genital herpes includes abstaining from sex when symptoms are present and using latex condoms between outbreaks.
During the third trimester, your doctor will prescribe an oral antiviral medicine to be taken daily to prevent a recurrent genital herpes outbreak around the time you are due. If you have active genital herpes (shedding the virus) at the time of delivery, your doctor will likely recommend a Cesarean delivery to prevent a potentially fatal infection in your baby. Fortunately, infection of an infant is rare among women with genital herpes infection.
More Information About HIV from Johns Hopkins Medicine
The Johns Hopkins HIV Women’s Health Program
Established in 1988, The Johns Hopkins HIV Women’s Health Program has provided reproductive health care for over 3,000 HIV-infected women. The goal of this program is to offer community-based, culturally-sensitive, coordinated and flexible care to women with HIV infection.