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Disorders of Pregnancy

Posted: Jan. 1, 2007

All pregnancies involve a certain degree of risk to both mother and baby. But, factors present before pregnancy or that develop during pregnancy can place the mother and baby at higher risk for problems. Women with high-risk pregnancies may need care from specialists or a team of health care providers to help promote healthy pregnancy and birth.

During pregnancy, problems may develop even in a woman who was previously healthy. These may include (but are not limited to) gestational diabetes or preeclampsia/eclampsia.

Getting good prenatal care and seeing a health care provider regularly during pregnancy are important ways to promote a healthy pregnancy.

Gestational Diabetes Mellitus (GDM)

GDM is a specific type of diabetes that only pregnant women get. To support the fetus as it grows, the mother's body makes hormones. In some women, these hormones work against their bodies, making them less able to make the insulin needed to get energy from body cells. Without this insulin, the level of sugar in the mother's blood starts to build up, which, if left untreated, can cause health problems for both mother and fetus.

Researchers estimate that GDM occurs in nearly 7 percent of all pregnancies. Unlike some other disorders that occur during pregnancy, GDM is often treatable. GDM treatment plans should be designed by a health care provider to address a woman's specific health needs. In general, many GDM treatment plans include: following a healthy meal plan as outlined by a health care provider; getting regular, moderate physical activity; maintaining a healthy weight gain; and measuring and recording blood sugar levels. Some women also need to take insulin or other medications to maintain a healthy pregnancy.

Even though it usually goes away after the baby is born, GDM can affect the health of both mother and baby later in life. For instance, women who have GDM during pregnancy have a 40 percent greater chance of developing type 2 diabetes later in life. And, babies born to mothers with GDM are at greater risk than babies born to other mothers of developing type 2 diabetes or being obese (extremely overweight) later in life.

Because babies born to mothers with GDM tend to be larger than average, GDM can also affect the way a baby is delivered. In some cases, the safest way to deliver a baby from a mother with GDM is by surgery, called cesarean section; but, cesarean section delivery carries its own risks.

Preeclampsia and Eclampsia

Preeclampsia describes an abnormal increase in a woman's blood pressure after the 20th week of pregnancy. Preeclampsia is often associated with swelling in the face and hands. (A woman's feet might swell, too, but swollen feet are common during healthy pregnancies; swollen feet do not always mean there is a problem.) This dangerous condition occurs in 3 percent to 4 percent of all pregnancies and is the leading cause of maternal and fetal death in the United States.

Eclampsia is a more severe form of preeclampsia that can lead to seizures and coma. Estimates place the number of women affected by eclampsia at one in 200 women who have preeclampsia. Eclampsia can be fatal if it's not treated quickly.

High blood pressure is one possible sign of preeclampsia. Having abnormal levels of protein in the urine is also part of preeclampsia. If you are pregnant and your blood pressure normally runs high, or is suddenly high, your health care provider may ask for frequent urine samples throughout your pregnancy, to test your urine for protein as a sign of preeclampsia.

The only definite cure for preeclampsia is delivering the fetus. But, preeclampsia can occur early in pregnancy, which may mean delivery is not the best option. If so, your health care provider may develop a plan with you to try and safely prolong your pregnancy to allow the fetus to develop more, while closely monitoring you for signs that the fetus should be delivered, even prematurely, if necessary. In this case, the decision of whether or not to deliver can be very difficult; it requires that the mother be watched very closely, often in the hospital, as a precaution.

Currently, there is no definite way to predict which pregnant women will develop preeclampsia. Recent findings from a government-supported study found that abnormal levels of two molecules in the blood may predict the development of preeclampsia, but further research is needed.

Source: National Institute of Child Health and Development

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