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High-Risk Pregnacy

Although every pregnancy has some risk, some have more risks than others, and each pregnancy is unique. A pregnancy is considered to be high risk when a problem is more likely to occur. Such a problem could be caused by a health condition that the mother had before she was pregnant, or it may arise during pregnancy or at delivery. In either case, a threat is posed to the health of the mother or fetus or both.

For this reason, a woman with a high-risk pregnancy, must be checked carefully by a doctor. This article describes some of the conditions that could make a pregnancy high risk and what can be done to keep problems under control. Whether you are already pregnant or just thinking about having a baby, you should be aware of these factors if they apply to you. See your doctor soon after you find out you are pregnant or if you are planning to get pregnant. You and your doctor will need to work closely together to ensure the best possible outcome for you and your baby.

Not all of the problems that can make a pregnancy high risk can be predicted. But there are some medical conditions, as well as factors of the mother's life style, that are known to contribute to a high-risk pregnancy. If you are pregnant, be sure to tell your doctor if you have any of these conditions or if there is anything about your life style that you think might make your pregnancy high risk.

Medical Factors Diabetes

Diabetes is a disease in which the levels of blood sugar (glucose), the body's main source of fuel, are too high. This can cause serious problems during pregnancy, including birth defects, stillbirth (birth of a dead infant), and premature birth (birth before 37 weeks).

Gestational diabetes. Some women first develop diabetes while they are pregnant. This is called gestational diabetes and usually subsides after the birth of the baby. This type of diabetes poses some of the same risks that are present for women who hadthe disease before they were pregnant.
If you have diabetes while you are pregnant-whether you had it before or whether it occurs during your pregnancy-it is important to keep your blood sugar at a normal level. Sometimes diabetes can be controlled by eating a carefully balanced diet. In other cases, shots of insulin, a hormone that regulates blood sugar_aevels, are needed. Your doctor will tell you about any tests you might need and will advise you about the best way to control diabetes during your pregnancy.

High Blood Pressure. A woman with high blood pressure is more likely to have a heart attack or stroke. In a pregnant woman, high blood pressure can cause the baby to be born too early or too small. Intrauterine growth retardation, a condition in which the baby does not grow at a normal rate in the mother's womb, is one possible result of high blood pressure during pregnancy. The chances of stillbirth are also greater in a mother with high blood pressure. If you have high blood pressure, you will need to be 'checked care, fully during pregnancy. You may ,need to take medicine or to stay in a hospital to keep this condition under control. If the problem becomes severe, your baby may need to be delivered early. Like diabetes, high blood pressure can first develop during pregnancy. If this occurs it may be called preeclampsia or toxemia. This condition poses some of the same risks to the baby andimother as high blood pressure that existed béfore pregnancy.

Heart or Kidney Disease. Depending on how severe it is, heart or kidney disease may make pregnancy dangerous for you. Pregnancy increases the work the heart has to do, and labor ánd delivery also place added stress on the heart. Kidney disease makes it more likely for a woman to have high blood pressure during pregnancy. Women with heart or kidney disease need special tests during pregnancy and special care during labor. There is also a greater risk of premature or small babies born to mothers with these conditions.

Herpes or Other Viral Diseases. A newborn baby is very vulnerable to viral infections passed on from the mother. If you have ever had herpes or have ever been exposed to herpes, tell your doctor. If the mother has an active herpes sore during delivery, the baby can be exposed to the virus as it passes through the mother's birth canal. Herpes can be life-threatening to a newborn. Other viral infections, such as rubella (German measles), viral hepatitis, and chicken pox, can also cause serious problems during pregnancy.

Birth Defects. Couples who have had a child with a birth defect-a physical or mental disability-are more likely to have another child with a birth defect. Some birth defects are due to genetic (inherited) factors. Just as we inherit our eye and hair color, birth defects can be part of the genetic makeup passed on from parents to children. Age and exposure to certain toxic elements are also factors that increase the risk of birth defects. Through testing and careful history-taking, some of these defects can be detected early in pregnancy.

Multiple Pregnancies. When the uterus contains more than one fetus, this is called a multiple pregnancy. Twins occur naturally about once in every 90 births. Triplets occur once in every 9000 births. Multiple pregnancies occur more often with the use of "fertility drugs." These drugs are taken under close medical supervision to help ovulation occur. Babies from multiple pregnancies are more likely to be born early and weigh less than single babies, and delivery can be more difficult.

Bleeding. Any vaginal bleeding in pregnancy, especially in the later stages, can be serious. This often involves a problem with the placenta (afterbirth). Normally the placenta is located on the upper portion of the wall of the uterus. Sometimes, though, the placenta lies very low in the uterus, so that the opening of the uterus is partially or completely covered. This is called placenta previa, and vaginal bleeding is the most common symptom. In other cases, the placenta is properly positioned but, for some reason, has begun to separate from the wall of the uterus before the baby is born. Often when this happens, vaginal bleeding occurs. This is called abruptio placentae, and it makes the abdomen become very hard and feel very painful. You may require hospitalization or special treatment for this serious problem. In some cases, the baby may need to be delivered early. Sometimes trauma, such as injuries from an auto accident, or high blood pressure can cause this problem.

Breech Position. The baby's position late in pregnancy is very important. Normally, the baby is positioned head first. In the breech position, however, the baby is positioned buttocks or feet first. After the doctor carefully evaluates thg cbndition of the mother and baby and the progress of the labor, some women may be able to deliver vaginally. If vaginal delivery poses significant risks, cesarean birth may be needed. In cesarean birth, the baby is born through a surgical incision (cut) in the mother's abdomen.

Postdate Pregnancy. Most pregnancies last from 38-42 weeks. A postdate pregnancy is one that extends beyond 42 weeks. When this happens, the fetus could be in danger, because the placenta, which supplies oxygen and nutrients, doesn't function as well. Labor may have to be induced (brought on) or a cesarean delivery may have to be performed in a postdate pregnancy.

Life Style and Environmental Factors

Alcohol Use. A pregnant woman's use of alcohol can be dangerous to the health of her unborn child. When the mother drinks, alcohol crosses the placenta and enters the baby's bloodstream. This can cause stillbirth, miscarriage (lóst pregnancy), birth defects, or a premature or low-birth-weight baby (baby weighing less than 5'/z pounds at birth).

Smoking. When a pregnant woman smokes, she risks not only her own health but-also that of her unborn baby. Smoking harms the baby before, during, and after birth. A pregnant woman who smokes is more likely to have a miscarriage, stillbirth, or low-birth-weight or premature baby.

Drug Use. Any type of drugwhether prescribed by a doctor, available over the counter, or illicit-can affect the fetus's well-being when taken during pregnancy. Some drugs not only can harm the health of a pregnant woman but also can cause severe birth defects or other serious problems for the baby. Even some "over-the-counter" drugs can cause problems and should not be taken during pregnancy.

Environmental Hazards. If you are pregnant, the health of you baby can be affected if you work around certain types of chemicals, gas, dust, fumes, or radiation. Exposure to some of these substances can cause miscarriage, birth defects, or other problems for the baby that appear later in life.

How Is a High-Risk Pregnancy Detected?

When you first find out that you are pregnant, your doctor will record your medical history, including any health problems that you or someone in your family has had. Knowing about past pregnancies and medical conditions can provide clues to possible risks in a current pregnancy. For instance, a woman who has had a premature birth is more likely than a woman without stjcli a history to have a premature birth in her present pregnancy. It is important for you to tell your doctor if you have had any of these conditions in a past pregnancy. Even with this information, though, not all abnormal outcomes can be predicted. Your doctor may also want to perform special tests fo find out whether you are high risk.

Alpha-Fetoprotein Test

A blood test called the maternal serum alphafetoprotein (AFP) test can help identify women who might be carrying a fetus with a neural tube defect (such as an "open spine," or improperly developed spinal cord).

Alpha-fetoprotein is a substance made by every fetus as it grows. Some of it is passed into the amniotic fluid (the fluid in the sac that surrounds the developing fetus). When the fetus has a neural tube defect, increased amounts of AFP may be present in the amniotic fluid and in the mother's blood. It is these increased amounts that the AFP test measures.

Since other conditions, such as twins, can also cause high AFP levels, the AFP test is just the first step in the screening procedure. Depending on the outcome of the first test, more tests may be needed to find out whether the high AFP levels could be caused by a neural tube defect.

Amniocentesis

With a procedure called amniocentesis, a small amount of amniotic fluid is taken from the sac in the mother's uterus surrounding the fetus for testing. This procedure is sometimes done to help detect certain birth defects, such as Down syndrome, in the fetus. It can also be used to assess the maturity of the fetus later in pregnancy.

Electronic Fetal Monitoring

Electronic fetal monitoring is used to determine the well-being of the fetus. In this test, electronic instruments are placed on the mother's abdomen, on the fetus's scalp, or on both to record the heartbeat and activity of the fetus in response to contractions of the mother's uterus late in pregnancy or during labor. By measuring how the fetus reacts to these contractions, your doctor may become aware of problems and take steps to correct them.

Glucose Screening

Your doctor may want to test you for diabetes, especially if someone in your family has diabetes. Glucose screening is done by taking blood samples after you drink a sugar solution. In this way the glucose levels in your blood can be measured.

Ultrasound

Ultrasound (also called sonography) is a test in which sound waves are used to create pictures of the fetus. Because ultrasound uses sound waves instead of X-rays, it is considered safe for the fetus as well as the mother. Ultrasound can provide valuable information about the fetus, placenta, and amniotic fluid.

What You Can Do

There are some things you can do to offset the risks of a high-risk pregnancy. One of the most important things you can do to make your pregnancy as healthy as possible-for both you and your unborn baby-is to take good care of yourself before you decide to get pregnant.

Before you try to get pregnant, make an appointment with your doctor for a check-up and counseling. Discuss your plans for pregnancy. Get answers tq any questions you may have, including questions about any present medical problems you have or any family medical history which may affect a future pregnancy.

Genetic Counseling

Your doctor may suggest that you see a genetic counselor to find out your chances of having a child with a birth defect. Genetic counseling can also help identify a pattern of inherited genetic disorders, if one exists.

Some people have a higher risk of having a child with a genetic disorder, especially women aged 35 or older, couples who have already had a child with a birth defect, and couples with a family history of genetic disorders. These women may need special tests or counseling.

Prenatal Care

Any pregnancy-whether normal or high riskputs new demands on a woman's body. See your doctor soon after you find out fhat you are pregnant. Alert him or her to any factor that may affect the outcome of your pregnancy. Let your doctor know of any medical problems you or your family have, any problems you had during earlier pregnancies, and any medications or drugs you have taken.

The first few weeks of pregnancy are very important. If you think you are pregnant, let your doctor know if you think that you may be high risk. Don't delay your first prenatal visit. Discuss a plan of care with your doctor. Work with your doctor to find out what you can do to lessen the risks for you and your baby. In this way, any problems that do arise will be easier to manage.

Be sure to schedule and keep regular visits with your doctor. Before your visit, write down any questions you want to ask. Bring them with you to your next visit so that you'll remember to discuss them with your doctor.

In most high-risk pregnancy situations, a woman is cared for during pregnancy, labor, and delivery by a health care team. Your doctor may consult with other specialists in the management of your pregnancy and may recommend that you be moved to another hospital. Sometimes another doctor specially trained in the care of high-risk newborns may be consulted. You may want to meet your baby's doctor before your baby is born to ask questions.

Changing Your Life Style

Even if you can't change the fact that you may have medical problems that could affect your pregnancy, there are some things about your life style that you can change to make your pregnancy safer. One thing you can do for yourself and your baby is to develop good eating habits and get adequate rest and exercise. Habits like these can help you look and feel better at any time in your life, but especially during pregnancy, when what you eat must do double duty to prepare you for childbirth and nursing and to fuel your baby's steady growth.

Because pregnancy affects a woman's entire body, high-risk mothers may need to follow a special diet while they are pregnant. An obese woman may need to lose weight before becoming pregnant. A diabetic may need a special diet to keep her blood sugar at a normal leve] throughout pregnancy. If you are overweight, your doctor can put you on a well-balanced diet. You should not try to lose weight once you are pregnant, however.

Stop smoking cigarettes and drinking alcohol before you become pregnant, or as soon as you think you are pregnant. If you find you cannot stop, you can help your baby by limiting your smoking or drinking as much as possible. Because smoking and drinking can deplete your body of needed nutrients, your doctor may give you supplements to provide missing vitamins. Tell your doctor about any drugs you are taking, even if they have been prescribed for you.

Discuss your work situation with your doctor. Not everything is known about the environmental factors that can affect a pregnant woman and her fetus, but you and your doctor should be aware of any hazards that do exist in your work place.

Some do's and don'ts

Adequate rest, good nutrition, and exercise are especially important during pregnancy..

You can help your baby by stopping or limiting your smoking and drinking as much as possible during pregnancy.

Finally…

Your doctor can suggest ways to get in good shape for pregnancy. How healthy you are before you get pregnant plays an important role in the health of your growing fetus.

To help any pregnancy go smoother, but especially in high-risk cases, planning ahead is a good idea. Although tests and good prenatal care énable you to have an understanding of the likelihood of problems, they cannot predict or prevent all problems. There are no guarantees of a perfect outcome for mother and baby, but knowirig about the factors described here can help you plan for your pregnancy and care for yourself properly.
Ramiro Antuña de Alaiz
Clínica Diabetológica
education > taking control over your diabetes > pregnancy & diabetes