Dr. Alicia Stone-Zipse, DO and Dr. Jennifer Duroy, DO
Most women go through their pregnancies with no health problems. However, it is possible to experience complications while you’re pregnant, so it is very important to have regular visits with your doctor. He or she will watch for any signs of trouble.
The following are two common complications that women could experience during pregnancy:
High Blood Pressure
There are various conditions related to high blood pressure (hypertension) that can arise or worsen during pregnancy.
Chronic hypertension is high blood pressure that was present before you became pregnant or that occurs in the first half (before 20 weeks) of your pregnancy.
Gestational hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.
Preeclampsia is a serious blood pressure disorder that can affect all of the organs in a woman’s body. A woman has preeclampsia when she has high blood pressure and other signs that her organ systems are not working normally. One of these signs is proteinuria (an abnormal amount of protein in the urine).
A woman with preeclampsia whose condition is worsening will develop other signs and symptoms known as “severe features.” These include a low number of platelets in the blood, abnormal kidney or liver function, pain over the upper abdomen, changes in vision, fluid in the lungs, or a severe headache. A very high blood pressure reading also is considered a severe feature.
Hypertension during pregnancy can decrease blood flow to your placenta and limit nutrients and oxygen to your baby. This can lead to complications, both for you and your developing baby. Some examples of these complications can include fetal growth restriction, preeclampsia, preterm delivery, placental abruption, increased need for cesarean delivery, and in the most severe cases death of mom or her baby. Because of this, pregnant patients with any of the above conditions will need to be monitored more closely for the duration of their pregnancy. It is not clear why some women develop preeclampsia, but the risk of developing preeclampsia is increased in women who are pregnant for the first time, have had preeclampsia in a previous pregnancy or have a family history of preeclampsia, have a history of chronic hypertension or kidney disease, are 40 years or older, are pregnant with twins or more, had in vitro fertilization, or have medical conditions including diabetes mellitus, thrombophilia, lupus, and obesity.
Baptist Health recommends keeping up with prenatal appointments, where your doctor will closely monitor your blood pressure, weight, and may require more frequent blood and urine tests. It is important to attend all of your prenatal appointments to ensure your physicians have as much information about you and your baby as possible before delivery.
Gestational diabetes occurs when a woman who didn’t have diabetes before pregnancy develops the condition during pregnancy. Diabetes occurs when too much glucose (sugar) stays in the blood instead of being used for energy. Health problems can occur when blood sugar is too high. Gestational diabetes occurs due to the hormonal changes in your body during pregnancy. Your body either will not produce enough insulin, or won’t be using it in the correct way. Instead, a high amount of glucose builds up and causes high blood sugar. Your physician will require more frequent check-ups and a more regular monitoring of your blood sugar. If you continue having problems controlling your blood sugar, it may be recommended that you take insulin. In specific situations, your doctor may need to conduct additional tests that determine how well your placenta is working, as it is the main way that your baby receives oxygen and nutrients.
All pregnant women should be screened for gestational diabetes. Your physicians will ask about your medical history to determine whether you have risk factors for developing gestational diabetes. If you have risk factors, your blood sugar will be tested early in pregnancy. These risk factors may include: if you are overweight or obese, are physically inactive, had gestational diabetes in a previous pregnancy, had a very large baby (9 pounds or more) in a previous pregnancy, have high blood pressure, have a history of heart disease, have polycystic ovary syndrome (PCOS), are of African American, Asian American, Hispanic, Native American, or Pacific Island background. If you do not have risk factors or your testing does not show you have gestational diabetes early in pregnancy, your blood sugar will be measured between 24 weeks and 28 weeks of pregnancy.
Women who develop gestational diabetes are at risk for other pregnancy-related complications. Your baby may grow very large because of excess sugar, which can lead to difficulties in labor, increased risk of shoulder dystocia (where your baby’s shoulders get stuck during delivery), increased risk of cesarean delivery, increased risk of large tears to the vagina at delivery, and heavy bleeding after delivery. Shoulder dystocia can cause injury to both baby and mom. Babies who are born to mothers with gestational diabetes may need to spend additional time in the NICU or nursery to help with breathing difficulties, treat low blood sugar, or treat jaundice. Women with gestational diabetes also have a higher chance of developing preeclampsia.
Women who have had gestational diabetes are at higher risk of developing diabetes later in life. All women who have had gestational diabetes need to be re-tested during the postpartum period to see if the diabetes has resolved. Some women who develop this condition may have had mild diabetes before pregnancy and not known it. For these women, diabetes does not go away after pregnancy and may be a lifelong condition.