Medical Conditions and Pregnancy
Certain health conditions may complicate a pregnancy. But with proper care, most women
can enjoy a healthy pregnancy, even with their health challenges.
Diabetes before pregnancy
Diabetes is a health problem where the body does not make enough insulin. Or the body
is not able to use the insulin that is made. Insulin is the hormone that lets glucose
enter the cells of the body to make fuel. When glucose can't enter the cells, it builds
up in the blood, and the body's cells starve to death. Diabetes in pregnancy can have
serious results for you and the growing fetus. How serious the problems are depends
on how serious your diabetes is. This is especially true if you have blood vessel
(vascular) problems and your blood sugar (glucose) is not in good control.
Diabetes that happens in pregnancy
When diabetes happens during pregnancy, it is described as:
Gestational diabetes. This is when you develop a resistance to insulin because of the hormones of pregnancy.
If you develop gestational diabetes, you may be noninsulin dependent or insulin dependent.
Pregestational diabetes. This is when you already have diabetes and become pregnant.
What is gestational diabetes?
Gestational diabetes is a condition in which the glucose level is elevated and other
diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed
with diabetes. In most cases, all diabetic symptoms disappear following delivery.
However, women with gestational diabetes have an increased risk of developing diabetes
later in life. This is especially true if they were overweight before 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, a condition referred to
as insulin resistance.
What causes gestational diabetes?
The cause of gestational diabetes is not known. But there are some theories as to
why it happens.
The placenta supplies a growing fetus with nutrients and water. It also makes a variety
of hormones to maintain the pregnancy. Some of these hormones are estrogen, cortisol,
and human placental lactogen. These hormones can block insulin. This often starts
about 20 to 24 weeks into the pregnancy.
As the placenta grows, more of these hormones are made. Insulin resistance becomes
greater. Normally, the pancreas is able to make more insulin to overcome insulin resistance.
But when not enough insulin is made to overcome the effect of the placental hormones,
gestational diabetes results.
Who is at risk for gestational diabetes?
Any woman may have gestational diabetes during pregnancy. But these factors may raise
Family history of diabetes
Having given birth before to a very large infant, a stillbirth, or a child with a
Age. Women who are older than 25 are at greater risk than younger women.
A higher level of glucose in the urine is often included in the list of risk factors.
But it is not believed to be a reliable sign for gestational diabetes.
How is gestational diabetes diagnosed?
A glucose screening test is usually done between 24 and 28 weeks of pregnancy. For
this test, you drink a special glucose beverage. Your blood sugar level is then measured
1 hour later.
If this test shows an increased blood sugar level, you may need a 3-hour glucose tolerance
test after a few days of eating a special diet. If results of the second test are
in the abnormal range, gestational diabetes is diagnosed.
Treatment for gestational diabetes
Treatment will depend on your symptoms, age, and general health. It will also depend
on how severe the condition is.
Treatment for gestational diabetes focuses on keeping blood glucose levels in the
normal range. Treatment may include:
Possible gestational diabetes complications for the baby
Unlike other types of diabetes, gestational diabetes generally does not cause birth
defects. Birth defects often show up during the first trimester of pregnancy. They
are more likely in women with pregestational diabetes who may have changes in blood
sugar during that time. Women with gestational diabetes generally have normal blood
sugar levels during the critical first trimester.
The complications of gestational diabetes are can often be managed and prevented.
The key to prevention is to carefully control your blood sugar as soon as your healthcare
provider diagnoses gestational diabetes.
Infants of mothers with gestational diabetes are at risk for several chemical imbalances.
Examples are low levels of calcium and magnesium in the blood. But the main problems
of gestational diabetes are the following.
This is when a baby is much larger than normal. All of the nutrients the fetus gets
come directly from the mother's blood. If the mother's blood has too much glucose,
the pancreas of the fetus senses the high glucose levels and makes more insulin to
try to use this glucose. The fetus converts the extra glucose to fat. Even when the
mother has gestational diabetes, the fetus is able to make all the insulin it needs.
The combination of high blood glucose levels from the mother and high insulin levels
in the fetus results in large deposits of fat. This causes the fetus to grow very
Birth injury may occur because of the baby's large size and problems being born.
Hypoglycemia is when the baby has low blood sugar right after birth. This problem
happens if the mother's blood sugar levels have been high. This causes the fetus to
have a high level of insulin in its circulation. After birth, the baby still has a
high insulin level. But it no longer has the high level of sugar from its mother.
This results in the newborn's blood sugar level becoming very low. The baby's blood
sugar level is checked after birth. If the level is too low, the baby may need glucose
given by IV.
Trouble breathing (respiratory distress)
Too much insulin or too much glucose in a baby's system may delay lungs becoming fully
mature. This can cause breathing problems. This is more likely if a baby is born before
37 weeks of pregnancy.
High blood pressure and pregnancy
High blood pressure can happen in pregnancy in 2 forms. It may be a preexisting health
problem called chronic hypertension. Or it can develop during pregnancy. It is then
known as gestational hypertension. It is also called toxemia or preeclampsia. It happens
most often in young women with a first pregnancy. It is more common in twin pregnancies,
and in women who had blood pressure problems in an earlier pregnancy.
High blood pressure can lead to placental problems and slowed fetal growth. If untreated,
severe high blood pressure may cause unsafe seizures and even death in the mother
Women with preeclampsia may need bedrest. If you have moderate or severe preeclampsia
or eclampsia (preeclampsia complicated by seizures), you will often need to stay in
the hospital and be treated with medicines.
Women who have high blood pressure before pregnancy often need to keep on taking their
blood pressure medicine. Your healthcare provider may switch you to a safer medicine
Kidney function tests and ultrasounds are often done more often on pregnant women
with high blood pressure. They help keep an eye on the mother's health and the fetus'
growth and development.
Infectious diseases and pregnancy
Infections during pregnancy can pose a threat to the fetus. 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 rupture of the membranes
surrounding the fetus. Some infectious diseases are listed below.
Toxoplasmosis is an infection caused by a single-celled parasite named Toxoplasma
gondii. Many people may have toxoplasma infection. But very few have symptoms because
the immune system often keeps the parasite from causing illness. Babies who became
infected before birth can be born with serious mental or physical problems. Toxoplasmosis
often causes flu-like symptoms, swollen lymph glands, or muscle aches and pains that
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 or testing of amniotic
fluid or cord blood. Treatment may include antibiotics. The following measures can
help prevent toxoplasmosis infection:
Wear gloves when you garden or do anything outdoors that involves handling soil. Cats
may pass the parasite in their feces. They often use gardens and sandboxes as litter
boxes. Wash your hands well with soap and warm water after outdoor activities. Do
this especially before you eat or prepare any food.
Have someone who is healthy and not pregnant change your cat's litter box. 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.
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 cutting boards,
sinks, knives, and other utensils that might have touched the raw meat. Wash your
hands well with soap and warm water afterward.
Cook all meat thoroughly. This means until it is no longer pink in the center or until
the juices run clear. Don't taste meat before it is fully cooked.
A pregnant woman should not eat undercooked or raw foods because of the risk of food
poisoning. Food poisoning can dehydrate you and keep the fetus from getting nourishment.
It can also cause meningitis and pneumonia in a fetus, ending in possible death. Here
are tips for preventing food poisoning:
Thoroughly cook raw food from animal sources such as beef, pork, or poultry.
Wash raw vegetables before eating.
Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat
Don't drink raw (unpasteurized) milk or eat foods made from raw milk.
Wash your hands, knives, and cutting boards after handling uncooked foods.
Sexually transmitted diseases (STDs)
Infections like chlamydia may be linked to premature labor and rupture of the membranes.
This is a virus that causes inflammation of the liver. It may result in liver cell
damage and destruction. There are 5 main types of the hepatitis virus. The most common
type that happens in pregnancy is hepatitis B (HBV). This type spreads mainly through
contaminated blood and blood products, sexual contact, and contaminated IV needles.
HBV goes away in most people. but about 1 in 10 people will have chronic HBV. Hepatitis
B virus can lead to chronic hepatitis, cirrhosis, liver cancer, liver failure, and
death. Infected pregnant women can send the virus to the fetus during pregnancy and
The later in pregnancy a mother gets the virus, the greater the chance for infection
in her baby. Signs and symptoms of HBV are:
Yellowing of the skin, eyes, and mucous membranes (jaundice)
Loss of appetite
Nausea that comes and goes
A blood test for hepatitis B is part of routine prenatal testing. HBV positive mothers
may get a medicine called hepatitis B immune globulin. Infants of HBV positive mothers
should get hepatitis B immune globulin and the hepatitis B vaccine in the first 12
hours of birth. Babies of mothers with unknown HBV status should get the hepatitis
B vaccine in the first 12 hours of birth. Babies of mothers who are negative for HBV
should be vaccinated before leaving the hospital. Premature infants weighing less
than 4.5 pounds (2,000 grams) born to mothers with negative HBV should have their
first vaccine dose delayed until 1 month after birth or leaving the hospital. All
babies should complete the hepatitis B vaccine series to be fully protected against
hepatitis B infection.
A woman with HIV has a 1 in 4 chance of infecting her fetus. AIDS is caused by HIV.
This virus kills or harms cells of the immune system. Over time it destroys the body's
ability to fight infections and certain cancers. The term AIDS is used for the most
advanced stages of an HIV infection. HIV is spread most often 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 has the virus. According
to the National Institutes of Health, HIV is passed from mother to child during pregnancy,
labor, and birth, or by breastfeeding. This makes up nearly all AIDS cases in U.S.
Some people may develop a flu-like illness within a month or two after exposure to
the HIV virus. But many people don't have any symptoms at all when they first become
infected. Lasting or severe symptoms may not show up for 10 years or more after HIV
first enters the body in adults. Or they may show up within 2 years in children born
with an HIV infection.
The American College of Obstetricians and Gynecologists recommends HIV testing of
all pregnant women. Prenatal care that involves HIV counseling, testing, and treatment
for infected mothers and their children saves lives and resources. Current recommendations
are for HIV positive women to take medicines during pregnancy and during labor. Blood
tests are also done to check the amount of virus. Newborn babies of HIV positive mothers
may also get medicine. Studies have found that giving a mother antiretroviral medicines
during pregnancy, labor, and birth can lower the chance of passing the virus to the
baby. This reduction is from 25% to less than 2%. Since the CDC began recommending
routine HIV screening for all pregnant women in 1995, the estimated numbers of mothers
passing HIV to their children has dropped by about 85%. Cesarean delivery is often recommended
for HIV positive women with a high level of the virus. Because breastmilk contains
the virus, HIV positive women should not breastfeed their babies. Studies show that
breastfeeding increases the risk for spreading the virus.
Genital herpes can be spread to the baby during birth if a woman has an active infection
at that time. Herpes is 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). HSV is a life-long infection. Symptoms of HSV may include painful
blisters or open sores in the genital area. A tingling or burning feeling in the legs,
buttocks, or genital region may happen first. The herpes sores usually go away within
a few weeks. But the virus stays in the body, and the lesions may return from time
It's important that women not get herpes during pregnancy. A first episode during
pregnancy creates a greater risk of passing it on to the newborn. Women may be treated
with an antiviral medicine if the disease is severe. Genital herpes can cause potentially
deadly infections in babies if the mother has active genital herpes (shedding the
virus) at the time of birth. Cesarean delivery is often recommended for active genital
herpes. Fortunately, infection of a baby is rare among women with genital herpes infection.
Protection from genital herpes includes not having sex when you have symptoms and
always using latex condoms between outbreaks.
The Zika virus is spread mainly by infected mosquitos. You can also get the Zika virus
by having unprotected sex with someone who has the Zika virus. Babies who are infected
before birth can have birth defects, such as microcephaly. This is when the baby’s
head and brain is smaller than expected when compared to babies of the same sex and
age. It may also cause other birth defects that affect the brain.
Don't travel to places with the risk of the Zika virus while you are pregnant. Use
condoms with a partner who has the Zika virus or who has traveled to places with it.
If you have to travel, speak with your healthcare provider about ways to prevent the
spread of the virus.