Chronic Health Conditions and Pregnancy

So you’ve decided to start or expand your family. Congratulations! Every family wants to ensure that their pregnancy is as healthy as possible. If you have chronic health conditions, you may wonder if you can have a healthy pregnancy.

Chronic health conditions such as advanced age, high blood pressure, and diabetes can lead to an increased risk of complications during pregnancy, but many women with chronic health conditions have healthy pregnancies and healthy babies. Planning ahead and working with your obstetrical healthcare team will help you have the safest, healthiest pregnancy possible.

Advanced maternal age

While age really isn’t a chronic health condition per se, it does factor into pregnancy. For pregnancy, advanced age is considered pregnancy with a due date after the pregnant person turns 35. Pregnancy complications associated with advanced age include:

• Pre-eclampsia (high blood pressure associated with pregnancy, also called toxemia)
• Gestational diabetes
• Premature birth or low birth weight
• Multiple births (twins)
• Miscarriage
• Down syndrome and other genetic disorders
• C-section
• Stillbirth

Women are born with all the eggs they’ll ever have at birth. Over time the quality of those eggs goes down. In addition, the risk of other chronic health conditions increases with age, even in nonpregnant people.

Let’s face it, there’s nothing you can do to change your age. Certain tests, however, may help determine if your baby is at high risk for certain genetic conditions. Noninvasive perinatal screening (NIPS) is one option for testing. You can have this screening as early as 10 weeks into pregnancy, and it can tell you if your baby is likely to have certain genetic conditions. If the screening tests are positive, your care team may offer additional testing such as chorionic villus sampling (CVS) or Amniocentesis.

You can lower your risks of complications associated with advanced age. Planning ahead to be as healthy as possible is very critical. Ensure you are current on your preventative healthcare and get all your chronic medical conditions well controlled. Start taking a prenatal vitamin before you’re pregnant. You should also stop smoking and drinking. Additionally, eat healthily and exercise regularly. Being proactive even before you’re pregnant is one of the most important things you can do when planning your pregnancy.

High blood pressure

High blood pressure is an extremely common condition. The incidence of high blood pressure in women of childbearing age is over 9%. Several high blood pressure conditions are associated with pregnancy.

Chronic hypertension is hypertension present before 20 weeks gestation, including before pregnancy or persisting for more than 12 weeks after delivery. Gestational hypertension develops after 20 weeks and is not associated with elevated urinary protein levels and other features of pre-eclampsia. Pre-eclampsia is a hypertensive condition of pregnancy-associated that develops after 20 weeks of pregnancy. It is usually associated with blood pressure greater than 140/90 and elevated urine protein levels.

Severe pre-eclampsia has BP higher than 160/110 and other associated lab findings such as elevated liver function tests, low platelets, and poor kidney function. It is an obstetrical emergency and requires urgent delivery. Hypertensive conditions of pregnancy are associated with low birth weight, preterm birth, and in the case of severe pre-eclampsia, damage to maternal organs including kidney failure and seizures.

You should take steps to reduce the risk of pregnancy complications associated with high blood pressure. Your healthcare provider can help you ensure your chronic hypertension is under control before getting pregnant and throughout the. In patients who have risk factors for pre-eclampsia, studies show that aspirin therapy, after the first trimester, may decrease the risk of developing pre-eclampsia.

Patients with high blood pressure conditions in pregnancy may require extra monitoring, more frequent lab tests, imaging, and appointments. Your healthcare team can help you figure out the best path to a healthy pregnancy.

Diabetes

Diabetes in pregnancy comes in 3 primary forms: type 1 diabetes, type 2 diabetes, and gestational diabetes:

• Type 1 diabetes usually starts in childhood. It is an autoimmune disease where the body makes very little to no insulin. Type 1 diabetics need to be on insulin daily.
• Type 2 diabetes usually starts in adulthood. It occurs when the body becomes resistant to the insulin you naturally produce, and eventually, the pancreas burns out and can’t produce enough insulin to overcome the resistance. Type 2 diabetics can sometimes be controlled with diet and exercise. Frequently, they need to take medications such as pills or insulin.
• Gestational diabetes occurs during pregnancy. Your obstetrical care provider will do a test for gestational diabetes during your pregnancy (usually between 24-28 weeks). The placenta, which provides nutrients to your baby during pregnancy, can become insulin resistant and cause gestational diabetes. Gestational diabetes occurs in up to 10% of pregnancies in the United States. It often goes away after pregnancy, but sometimes it doesn’t. When it doesn’t go away, it is considered type 2 diabetes. Women who develop gestational diabetes are also at an increased risk for type 2 diabetes later in life, even if gestational diabetes goes away after the baby is born. Gestational diabetes can frequently be treated with diet but sometimes requires medication.

Diabetes in pregnancy can cause a big baby, increased risk for C-section, high blood pressure, and low blood sugar. Women who have diabetes during pregnancy need to have more monitoring during their pregnancy. Frequently, a multidisciplinary team, including a nutritionist and sometimes a high-risk pregnancy specialist, will follow the woman through her pregnancy. Women who have diabetes before pregnancy should meet with their obstetrical care provider to discuss the best options for managing their condition before they get pregnant.

All women who have diabetes (either before pregnancy or who develop it during pregnancy) should eat healthy foods (ideally working with a dietician experienced with diabetes in pregnancy), exercise regularly, monitor their blood sugars often, keep their routine obstetrical care appointment, and take any medications recommended by their healthcare teams.

No matter whether you have chronic health conditions or not, the key to a healthy pregnancy is planning ahead, following up with your healthcare team, eating a healthy diet, and exercising if recommended by your doctor.

Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.

References:

https://my.clevelandclinic.org/health/diseases/22438-advanced-maternal-age#:~:text=Advanced%20maternal%20age%20describes%20a,disorders%20and%20high%20blood%20pressure.

https://medlineplus.gov/genetics/understanding/testing/nipt/

https://www.cdc.gov/pcd/issues/2019/19_0105.htm#:~:text=The%20overall%20prevalence%20of%20hypertension,uncontrolled%20hypertension%20(Table%201).

https://www.aafp.org/pubs/afp/issues/2016/0115/p121.html#:~:text=Elevated%20blood%20pressure%20in%20pregnancy,preeclampsia%20superimposed%20on%20chronic%20hypertension.

https://www.cdc.gov/bloodpressure/pregnancy.htm#:~:text=Complications%20from%20high%20blood%20pressure,the%20wall%20of%20the%20uterus

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication#:~:text=The%20USPSTF%20recommends%20the%20use,at%20high%20risk%20for%20preeclampsia

https://www.cdc.gov/pregnancy/diabetes.html

https://www.cdc.gov/pregnancy/diabetes-gestational.html