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 Are
You
High-Risk?
The top five conditions that mean your pregnancy
needs special attention
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Pregnancy usually is a time of joy, anticipation and only
minor discomforts. But some women begin their nine months
with medical conditions or other issues that classify them
as high-risk. Here's a look at five of the most common and
what you should know to keep yourself and your baby healthy
from conception to delivery.
Diabetes
About 1 in 100 women of childbearing age has diabetes, and many
of those affected don't even realize it. "A lot of women
don't see a doctor until they're already pregnant, so they may
not know they have a blood-sugar issue," says Siobhan M.
Dolan, M.D., assistant professor of obstetrics and gynecology
at the Albert Einstein College of Medicine & Montefiore
Medical Center in Bronx, N.Y., and assistant medical director
for the March of Dimes. "But the good news is that once
you know how to manage it, you can make a big difference."
It's essential to get your blood-sugar level under control in
the first trimester, when the baby's organs are being formed.
Otherwise, your baby has a greater chance of developing a heart
problem or neural-tube defect. That's why it's important to
schedule a preconception visit with an OB-GYN if you are diabetic
and considering becoming pregnant. (In fact, experts recommend
a preconception visit even if you don't have a preexisting medical
condition.)
In
some cases, diabetes can be managed successfully with diet
and exercise alone; in others, insulin injections are required.
Women who take oral medications for diabetes must stop taking
them before and during pregnancy and switch to insulin, which
is safer for babies.
Regardless
of how your diabetes is managed, your doctor will monitor your
blood-sugar level throughout pregnancy and perform regular ultrasounds
to check the baby's growth. You also will receive a level II
ultrasound (one that is very detailed) midway through pregnancy
to rule out fetal abnormalities, as well as a fetal echocardiogram
to check the baby's heart. Later in pregnancy, your doctor will
check the baby's heart rate via an external monitor. Also, if
the baby is very large (as is common with diabetic mothers),
a Cesarean section may be recommended.
Chronic
hypertension
Chronic hypertension is defined as blood pressure that is
consistently greater than 140/90. Left untreated, it can restrict
a baby's growth and increase the risk of preeclampsia, placental
abruption and preterm delivery. (See "When Things Go
Wrong" on pg. 53 for information on these and other conditions
that can occur during pregnancy.)
Fortunately,
there are steps you can take to ensure your baby's well-being:
Simple lifestyle changes such as exercising and reducing your
salt intake can reduce blood pressure. (Losing weight can
help, too, though this should only be done before you become
pregnant.) And if needed, your doctor can prescribe medication
that is safe to use during pregnancy.
Expect frequent prenatal visits as well as additional tests,
such as ultrasounds, to check the baby's heart rate. Your
doctor also may ask you to take blood-pressure readings at
home to supplement those at the office.
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Being
35 or older
Most women who are 35 or older and in good health have problem-free
pregnancies. So why do doctors automatically classify these
women as high-risk due to "advanced maternal age"?
Because as women age, so do their eggs. That means there's a
greater likelihood of having a child with a chromosomal disorder,
such as Down syndrome.
Age brings other potential concerns as well. "As women
age, they are more likely to develop chronic diseases such as
hypertension and diabetes," says Carlos W. Benito, M.D.,
associate director of maternal-fetal medicine at Saint Peter's
University Hospital in New Brunswick, N.J. Women 35 and older
are also at higher risk for preeclampsia, gestational diabetes,
preterm labor and pregnancy loss.
Doctors
typically advise women over the age of 35 to meet with a genetic
counselor while pregnant to better understand the risks they
may face.
In
addition, these women have the option of undergoing genetic
testing, including chorionic villus sampling or amniocentesis,
to rule out certain birth defects. Despite the risks, it's
encouraging to remember that the majority of women over 35--and
their babies--do just fine.
Carrying
twins or more
Women who are pregnant with multiples have a greater risk
of health problems, as do their babies, says Barbara Luke,
Sc.D., M.P.H., R.D., a professor of obstetrics and gynecology
at the University of Miami School of Medicine and co-author
of When You're Expecting Twins, Triplets, or Quads (HarperCollins,
1999). Mothers of multiples have a higher chance of developing
preeclampsia and gestational diabetes and experiencing preterm
labor. As a result, their babies are more likely to be premature:
The average gestational age is 36 weeks for twins and 32 to
34 weeks for triplets. That's why mothers of multiples should
deliver at a hospital equipped with a high-level neonatal
intensive-care unit, if possible.
If
you're pregnant with twins or more, expect close monitoring,
including a monthly ultrasound to check on the babies' growth.
To rule out preterm labor, your doctor might regularly check
the length of your cervix to make sure it has not started
to shorten. And after 24 weeks, he might screen you for the
presence of fetal fibronectin, a protein that can be found
in fetal membranes and amniotic fluid, as this, too, can be
a sign of preterm labor.
You
should also familiarize yourself with the signs of preterm
labor so you can alert your doctor immediately if you suspect
that something is not right.
Previous
problems
Women who have had two or more early miscarriages or one second-trimester
loss face a greater risk of a subsequent loss. A history of
preterm delivery also makes a woman high-risk.
If
you have had such complications with previous pregnancies,
you can expect frequent monitoring, possibly including a trans-vaginal
ultrasound at 15 to 16 weeks to rule out an incompetent cervix.
(An incompetent cervix gradually opens during pregnancy, which
can put you at risk for preterm labor or miscarriage.) This
procedure might be repeated periodically, depending on your
symptoms. Your doctor also may perform a fetal fibronectin
test at about 24 weeks to assess your risk of preterm labor.
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