Maternal Medical Conditions - An Overview

Introduction

Maintaining good health before and during pregnancy is crucial to reducing potential complications. Some women have health issues before pregnancy, while others encounter medical conditions during pregnancy.

What Are the Most Common Medical Conditions During Pregnancy?

Pregnancy-related medical issues include nausea, vomiting, fatigue, headaches, backaches, leg cramps, constipation, diarrhea, and depression.

• Iron Deficiency Anemia: This condition arises due to low hemoglobin or hematocrit levels in the blood. Pregnant women must have adequate levels of hemoglobin or hematocrit level than non-pregnant women as they need more than the normal amount of iron and blood in their body for the developing child. An iron deficiency anemia patient shows symptoms like fatigue, feeling faint, looking pale, or experiencing shortness of breath.

• Urinary Tract Infection: This is a common cause of serious infection in pregnant women. Risk factors for urinary tract infections in pregnancy include low socioeconomic status, young age, lack of hygiene, etc. The signs and symptoms of urinary tract infection in a pregnant woman include a burning sensation while urination, an urge to urinate often, a feeling of bladder fullness even after urinating, and urine that looks cloudy, bloody, and smelly.

• Mental Health Conditions: Some women experience depression, anxiety, and other mental health issues during or after pregnancy. The most common causes of depression in pregnancy are changes in the hormones, any stress, and patients related to a family history of depression.

• Gestational Diabetes: Gestational diabetes occurs when blood sugars are elevated during pregnancy. Gestational diabetes is diagnosed in a particular period of 24 to 28 weeks with a glucose screening test and further by an oral glucose tolerance test. Gestational diabetes, if not monitored and managed, increases the risk of macrosomia (baby being too large in size) and will result in potentially dangerous medical conditions like stillbirth and preeclampsia.

• Hypertension (High Blood Pressure): This is the most common medical problem in pregnancy. When there is a rise in blood pressure during pregnancy, it can result in preeclampsia.

• Placental Abruption: Sometimes, in pregnant women, the placenta gets separated from the uterine walls, although the separation can be categorized as mild, moderate, or severe. In severe conditions, the fetus will be deprived of oxygen and nutrients needed to survive.

• Miscarriage: Fetal loss from natural causes before 20 weeks gestation is considered a miscarriage. The incidence of miscarriage is highest in the first trimester. Symptoms of miscarriage include cramping or bleeding.

• Preterm Labor: Childbirth before 37 weeks gestation is a complication as the liver, lungs, and brain of the fetus is in a very crucial period of growth in 37 to 39 weeks of pregnancy; thus, preterm childbirth is a major risk factor. However, planned deliveries are essential in certain medical conditions.

• Preeclampsia: This condition was previously called toxemia. It causes a sudden rise in blood pressure after 20 weeks of gestation that is associated with headaches, dizziness, swelling in the hands and face, pains in the abdomen, blurred vision, and seizures (rare cases) preeclampsia. Planned delivery helps save the fetus and mother from fatal complications.

• Hyperemesis Gravidarum: The pregnant woman experiences persistent nausea and vomiting in this condition. This is not typical morning sickness. The condition gradually subsides after the 20th week of pregnancy. The treatment options include medications, and in severe cases, hospitalization is essential to supply nutrients and fluids through the parenteral route.

• Placenta Previa: Sometimes, the placenta, on developing, covers the opening of the cervix partly or completely from the inner side along with the uterus; it is called placenta previa. It results in painless bleeding during the second and third trimesters. The treatment includes bed rest and hospitalization if the bleeding is heavy.

• Hypothyroidism: Abnormal variations in thyroid hormone levels can have a negative impact on the fetus.

• Toxoplasmosis: Toxoplasmosis is an infection that is caused by Toxoplasma gondii, which is a parasite. Babies infected with toxoplasmosis before birth can have serious mental or physical problems. The symptoms are flu-like illness with swollen lymph nodes and muscle aches. Fetal testing may include ultrasound, amniotic fluid, or cord blood testing to determine the infection.

How to Prevent Maternal Medical Conditions During Pregnancy?

Regular prenatal visits with gynecologists or health care providers help identify potential health problems early, and managing them accordingly can prevent maternal medical conditions from occurring during pregnancy and the fetus’s development.

What Are the Danger Signs in Pregnancy?

The most dangerous signs of pregnancy include:

• Vaginal bleeding.

• Elevated blood pressure.

• Elevated glucose level.

• Convulsion or fits.

• Severe abdominal cramping.

• Severe abdominal pain.

• Shortness of breath.

• Rapid breathing.

• Fever.

• Swelling in the face, ankles, feet, and fingers.

• Severe headaches.

• Blurred vision.

• Severe fatigue.

• Frequent contractions before 36 weeks gestation.

• Pelvic or abdominal pain.

• Persistent back pain.

• A gush of fluid from the vagina.

• No fetal movement.

What Is Gestational Diabetes, and What Are Its Risk Factors?

Gestational diabetes results in increased blood glucose levels during pregnancy. It is caused by insulin resistance in the body. In most cases, the glucose levels return to the normal reference range after delivery. However, gestational diabetes is a warning sign that a person will likely develop diabetes in the future. Risk factors for gestational diabetes include:

• Family history of diabetes.

• Prior history of gestational diabetes with earlier pregnancy.

• Overweight or obese.

• A pregnant woman of age above 25.

• Polycystic ovarian syndrome.

How Is the Diagnosis Done?

Gestational diabetes is diagnosed in a particular period of 24 to 28 weeks with a glucose screening test and further by an oral glucose tolerance test.

What Are the Treatment Options for Gestational Diabetes?

Routine prenatal visits with the health care provider help identify the risk factors of gestational diabetes and evaluate and manage it. The treatment options include:

• Routine Check-Ups: Regular monitoring of blood glucose levels.

• Diet: Consuming foods with a low glycemic index, limiting the intake of high carbohydrate foods, avoiding sugars, processed foods, and starchy foods.

• Regular Exercise Regimen: Moderate aerobic exercise helps improve glycemic control.

• Medications: Oral glucose-lowering medications or insulin injections as prescribed by the health care provider.

What Are the Complications of Gestational Diabetes?

Gestational diabetes does not cause fatal medical conditions like birth defects. Gestational diabetes complications are usually treatable and preventable. The complications associated with gestational diabetes are:

• Fetal Macrosomia: When the size of a baby is larger than normal, it is called fetal macrosomia. The increased glucose levels in the mother's blood are passed to the fetus, which is sensed by the fetal pancreas, which produces more insulin to utilize this glucose. The excess glucose is converted into fat, resulting in a large baby. Macrosomia may result in birth injury as it may be difficult to deliver a large baby, and thus, the baby is susceptible to injuries in the process.

• Hypoglycemia: Low blood sugar levels in the baby after delivery as a result of the baby having high insulin levels but being unable to get sugar from the mother.

• Respiratory Distress: Too much insulin or glucose in a baby's system may delay lung maturation and cause respiratory problems such as difficulty breathing. This can be cited in cases of preterm labor or delivery before 37 weeks of gestation.

What Is Gestational Hypertension?

When there is a rise in blood pressure during pregnancy, it can lead to disturbances in fetal development and growth along with placental complications. If treatment is not provided, it can result in dangerous seizures, preeclampsia, stroke, and even fatal complications of death in the mother and fetus. In addition, high blood pressure during pregnancy results in a medical condition termed preeclampsia. Gestational hypertension is often accompanied by protein in the urine and may cause swelling in the face, ankles, feet, and fingers due to fluid retention.

How Is Pregnancy-Induced Hypertension Treated?

The treatment options for pregnancy-induced hypertension (PIH) include bedrest, hospitalization for monitoring, and prescription of magnesium sulfate or other antihypertensive medications such as IV Hydralazine, Labetalol, and oral Nifedipine are commonly used and are safe in pregnancy.

Conclusion

Maternal medical conditions can be identified and treated by regular pregnancy monitoring with a healthcare provider. Seeking medical supervision immediately upon encountering any warning signs of pregnancy is essential for safe pregnancy and childbirth.