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More on high risk pregnancies

Posted Jul 07 2008 7:17pm
This post is aimed at the mothers, mothers-to-be and dreaming of being a mother-to-be women out there.

I would like to expand my thoughts on high risk pregnancies. Bear with me, as this will be a slightly opinionated piece. I promise, I won't be judgemental! But I will give my opinions, and you may or may not agree with me.

As a labor and delivery nurse for over 7 years, I have seen quite a bit. I won't say that I've seen it all -- because there is a lot to see -- in the OB field. There are definitely things I hope to never see.

Let's start off with some common things in pregnancy that can make you high risk.

#1 - Diabetes --- whether it's an existing diabetes or gestational diabetes, this adds some risk into your pregnancy. It all truly depends on how long you've been diabetic, if you manage it with insulin, how well your blood sugars are under control (or not under control), and if you have any complications related to diabetes (neuropathy, retinopathy, kidney damage, kidney failure, kidney transplant, loss of limbs).

Obviously, if you have diabetes that is well controlled, either on insulin (or other oral meds), or just diet controlled, this is optimal to both your health and your baby's health.

If, on the other end of the spectrum, you've had diabetes for many years, and have complications like having had a kidney transplant, you might want to reconsider the additional stresses of pregnancy will have on both your body, and on your developing baby. I have seen women who have given birth after a kidney transplant, but it is NOT an easy pregnancy. I have also seen women who develop kidney failure during their pregnancy, and the baby/fetus dies before viability.

#2 - High blood pressure --- Once again, this depends on how controlled your blood pressure is with medication(s). You'll need to continue on some type of medication during pregnancy, and it might be something that is considered safer for pregnancy. Some BP meds are not safe for pregnancy. Check with your doctor about your medications and safety with pregnancy.

Existing high blood pressure can worsen during pregnancy, resulting in changes to medication, hospitalization, or even necessitating early delivery. High blood pressure reduces blood flow to the placenta and to the developing baby, and can result in small babies or IUGR (intrauterine growth restriction). The placenta may get calcified, leading to an even decreasing amount of blood flow to the baby. Expect to have extra monitoring and blood work during pregnancy to monitor your health and your baby's health. This may include Non-Stress tests, extended monitoring, and labs for preeclampsia.

#3 - Existing heart conditions --- all depends on what the heart condition is. Mitral valve prolapse usually will just mean antibiotics in labor, to prevent infection to the heart. Heart defects or prior heart surgeries could mean that you will need closer monitoring of your heart, and the resulting need for monitoring of the baby's growth and development. You might be told to not experience labor, or to get an epidural to reduce the stress on your heart. You might be advised to not push actively at the birth, to reduce stress on your heart. It all depends on WHAT exactly your heart condition is. See your doctor for more information on pregnancy, as it pertains to your condition.

#4 - High cholesterol --- most, if not all, cholesterol meds are contraindicated in pregnancy. See your doctor for more info on what to do if you become pregnant while on cholesterol meds.

#5 - Migraines -- you won't be able to take many migraine medications during pregnancy, but your doctor can prescribe some narcotic pain medications to help with your migraines. Once again, see your doctor for specific information on your medications and your headaches.

I'm sure there are other medical conditions that are a concern when it comes to deciding whether or not to get pregnant. The above conditions are usually manageable during pregnancy, depending on the severity of the condition.

My personal thoughts..........if you have kidney disease, or have had a transplant - truly consider what your body will go through to carry a pregnancy to term. You do want to be around for many years after you give birth, correct? That reminds me -- women with active cancer -- work on healing yourself, before you conceive. I have also cared for a woman with active breast cancer, and another with ovarian cancer. It was incredibly sad to have to see those women give birth, then have to move on to surgeries/chemo/radiation to try to cure their cancers, shortly after giving birth. How can a mother adequately care for her newborn when she is having to focus so much on her health too?? I understand if the pregnancy was unintentional. Then you have SO many choices to make. I don't advocate one way or another in those situations - it is the woman's choice - but consider ALL of the options.

Well controlled diabetics....not a problem. Well controlled hypertensives....not a problem. We (the docs and nurses) can usually keep things under good control with your continued good self-care. Yes, you are high risk, and yes, things can go sour, but if you work hard to maintain good health, you can have a successful pregnancy!

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