Complications of Pregnancy

Jessica Evert, MD, edited by Benjamin McDonald, MD

sad womanThough the majority of pregnancies occur without difficulty, there are conditions that can develop during pregnancy that will require medical treatment. The most important of these conditions are described below:

  • Pre-Eclampsia. Pre-eclampsia, also known as Toxemia, is one of several hypertension (high blood pressure) disorders of pregnancy. Pre-eclampsia occurs in about 2%-8% of pregnancies worldwide. It most commonly develops in the third trimester of pregnancy, but can develop at any time during the second half of pregnancy.

    In pre-eclampsia, your blood vessels become constricted, resulting in decreased blood flow to your major organs, and to your developing baby. This condition can result in poor growth, decreased amniotic fluid, and placental abruption (sudden breakage and bleeding).

    The signs of pre-eclampsia include high blood pressure; protein in the urine; and swelling of the hands, feet, or head. Additional symptoms of pre-eclampsia include persistent headaches, change in vision, pain or tenderness in your upper abdomen, and nausea or vomiting. Swelling can be a normal symptom of pregnancy and does not always indicate pre-eclampsia. Regular monitoring of your blood pressure and urine during your pregnancy will help your doctor to know whether or not your swelling is normal or a sign of pre-eclampsia.

    You may be at risk for pre-eclampsia if you have a past history of the complication, had high blood pressure before this pregnancy, have a large body size, come from a family with a history of pre-eclampsia, or have a personal history of multiple pregnancies, Diabetes Mellitus, or advanced maternal age (e.g., you're over 35 years old).

    Women with pre-eclampsia are generally monitored in the hospital for several days after the birth of the baby. In severe cases, women with pre-eclampsia may be given magnesium sulfate through an IV, or may be put on blood pressure medication. Depending on how far along you are in your pregnancy and how severe your pre-eclampsia is, your doctor may choose to continue to monitor you at home or in the hospital, or he or she may decide to deliver your baby right away.

  • Pre-Term Labor. Pre-term labor is defined as the onset of labor before 37 weeks gestation (or 3 weeks before the due date). There is no accurate way to predict whether pre-term labor will occur. However, there are known risk factors for this complication:
    • Previous preterm birth
    • Use of illicit drugs or smoke cigarettes
    • Multiple gestation (twins, triplets, etc)
    • History of cervical procedures
    • Infections during pregnancy
    • Women with uterine malformations

    Signs of pre-term labor include: watery/bloody discharge, pelvic pressure or pain (occurring at regular intervals and sustained for more than 60 seconds), backache, abdominal cramps, and ruptured membranes (also known as ‘water breaking’). Doctors can often stop pre-term labor if they can administer proper treatment quickly enough. For this reason, it is important for you to keep the signs and symptoms of pre-term labor in mind so that you will know when to contact your doctor or go to the hospital emergency room.

  • Gestational Diabetes. Diabetes is a disease involving a breakdown of the normal mechanisms through which your body's cells feed themselves with blood sugar. Gestational diabetes is a type of diabetes that some women develop during pregnancy.

    Under normal conditions, your digestive system breaks down most of the food you eat into blood sugar (glucose). Your body's responds to glucose in the blood by secreting a hormone called insulin from your pancreas.  Insulin helps use glucose to fuel themselves. Women who have gestational diabetes have improper insulin response to glucose in the blood causing their blood glucose to be poorly regulated. Approximately 3-10% of pregnant women develop gestational diabetes and require special medical monitoring throughout their pregnancies. Luckily, most women can control gestational diabetes through diet and exercise. A very few women who develop the condition require medication.

    Gestational diabetes often has no obvious symptoms. When symptoms are present, they can include increased hunger, thirst or fatigue. It is important that women undergo a glucose screening between 24 and 28 weeks gestation so that they can be checked for this condition.

    Gestational diabetes can cause several problems in a developing fetus.  These problems may include growth disturbances (either babies who are too large or too small), low blood sugar at birth, increased red blood cells in the baby's circulation, heart problems, and abnormal calcium and magnesium levels.  If you have gestational diabetes and your doctor suspects that your baby may be too large, he or she may suggest that you deliver via cesarean section.

    Gestational diabetes is more common in certain racial and ethnic groups such as Latino, African, Native American, and Asian populations.  Additional risk factors for developing gestational diabetes include a family history of diabetes, advanced maternal age, history of giving birth to a large baby over 9 lbs., polycystic ovarian syndrome, history of abnormal glucose tolerance, a mother who was large (over 9lbs.) or small (less than 6 lbs) at birth, obesity and usage of glucocorticoid (steroid) medications.



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