Many women with chronic health conditions have successful pregnancies. If you have high blood pressure, diabetes, asthma, or any chronic health condition, it is important that you discuss pregnancy plans with your health care provider before becoming pregnant. If your doctor is not familiar with the impact of pregnancy on your condition, or your condition on pregnancy, you may be referred to a Maternal-Fetal Specialist or Perinatologist for preconception counseling. This counseling is designed to help you know what to expect and provide you with information and resources that help you have a successful conception, lower risk pregnancy and healthy baby.
Why is Preconception Counseling Important?
Many chronic health conditions are treated with medication. Some medications are safe for use in pregnancy, but others are not. One of the first questions to ask your doctor is "Can this medication be safely used in pregnancy?" And if not, what are your options.
Some chronic conditions negatively impact pregnancy if they are not well controlled. For this reason, it is very important to be "at your best" before attempting to carry a baby. This means working to meet disease management targets.
Some health conditions can be worsened by pregnancy. If you have a chronic disease, learning about risks pregnancy might entail can help you make the best decision about pregnancy options. The goal of pre-pregnancy counseling is to reduce the chance that either you or your baby will develop health problems during pregnancy.
High Blood Pressure and Pregnancy
Chronic Hypertension refers to high blood pressure that existed prior to pregnancy. Some women find out that they have high blood pressure at their first prenatal visit. Fortunately, many women that have uncomplicated mild hypertension, can have uneventful pregnancies. Hypertensive women should be aware that they are at increased risk for pre-eclampsia.
If you have hypertension and are planning to become pregnant, discuss your pregnancy plans with your health care provider. Before becoming pregnant, you should make sure any medication you are taking is safe for pregnancy. If you are overweight, weight loss before pregnancy may help control your blood pressure. Monitoring your blood pressure at home may be recommended as early detection of any blood pressure changes can help keep you and your baby healthy.
If you have high blood pressure that is secondary to other health conditions such as diabetes, heart problems, or kidney disease your pregnancy may carry greater risks. Early and ongoing prenatal medical care and individual guidelines are critical to a pregnancy success and your health.
For more information, visit our hypertensive disorders center.
Diabetes Mellitus and Pregnancy
Many women with diabetes mellitus (Type 1 and Type 2) are unaware that their diabetes increases the risks of problems during pregnancy. Because of the relationship between poor blood sugar control and increased risks of congenital anomalies (birth defects), a woman with diabetes should delay pregnancy until she can achieve and maintain good blood sugar control.
Guidelines For Pregnancy With Diabetes
Women with Type 1 or Type 2 diabetes should be evaluated prior to becoming pregnant. Prepregnancy evaluation should include assessment of diabetes complications and associated maternal and fetal pregnancy risks. Evidence of diabetes complications such as kidney, eye, or heart disease may increase pregnancy risks.
The preconception period should also be a time to evaluate a woman's knowledge of diabetes self-management skills, and provide education as needed. Pregnancy blood sugar targets, and the effect that pregnancy will have on her diabetes should be discussed.
Prior to pregnancy, a women with Type 2 diabetes may need to discontinue oral medication and start on insulin therapy. This is important to discuss with your physician before or very soon after conception since some oral medications are not safe during pregnancy. Frequency of blood sugar monitoring may need to be increased to help assess adequacy of blood sugar control and adjust insulin doses.
- Disease Management
Generally, capillary blood glucose targets for preconception and pregnancy are about 70-90mg/dl for pre-meal and fasting values and about 100-130 mg/dl for one hour after meal values. Achieving these blood sugar goals requires support and frequent contact with the health care team.
Pregnancy can make tight blood sugar control a challenge. Fetal uptake of glucose can increase the risk of low blood sugars between meals. Pregnancy hormones can make the body more resistant to insulin and make after meal blood glucose values higher.
- Nutrition Management
The goals of nutrition therapy for the pregnant woman with diabetes are twofold. The first is to ensure that nutrient needs for pregnancy are met and appropriate weight gain goals achieved. Second, a registered dietitian (often a Certified Diabetes Educator) should help design an eating plan that helps keep blood sugars in normal range and reduces episodes of hypoglycemia (low blood sugar). General carbohydrate management strategies will be recommended, and usually an individualized meal plan for carbohydrate control to match the medication and activity prescriptions.
For more information, see Diabetes and Pregnancy.
HIV Disease and Pregnancy
In the United States, it is estimated that about 7000 babies are born each year to women infected with HIV. Some of these women are unaware that they are infected. Ideally, women should know their HIV infection status before becoming pregnant, but this is not always possible. The U.S. Public Health Service (PHS) now recommends routine HIV screening for all pregnant women, so that measures to protect infants from existing virus can begin early.
Most childhood cases of HIV infection are the result of mother to baby transmission during pregnancy, delivery or breastfeeding. The risk of transmitting the virus can be significantly reduced, however, by several precautionary measures, including AZT drug therapy for the mother.
AZT therapy significantly reduces the likelihood that a mother's blood or body fluids will transmit HIV virus to her baby. This drug is typically given to pregnant women with HIV after the 14th week of pregnancy. It is also given to the mother during labor and delivery, and to the newborn immediately after birth, when the risk of blood and fluids exposure is highest. Another route of HIV transmission is breastmilk, and women who are HIV positive are urged not to breastfeed, but to bottle feed with infant formula as an alternative.
Pregnancy Issues For HIV Positive Women
- Should I tell my doctor that I am positive?
Yes. While screening pregnant women for HIV is recommended, your physician will want to know as soon as you establish medical care for this pregnancy that you have HIV. You cannot be offered proper care and helped with decision making if your health care providers are don't know. Some pregnancy tests, amniocentesis for example, can increase the risk that your baby could become infected.
- How does pregnancy affect HIV and how will my health be affected?
Pregnancy usually does not worsen HIV. A lot is known now about prenatal care for women with HIV and how to minimize the risk of passing the virus to the baby. Planning your pregnancy with your health care provider can help minimize the risks to you and your baby. Finding a provider who is familiar with the special needs of HIV during pregnancy, or a physician who consults with experts in the field, is important.
- Can I breastfeed my baby?
Studies have shown that babies can be infected with HIV from breast milk. It is important to feed your baby infant formula via a bottle, not your breastmilk, to reduce the risk of infection.
- Can I still take my medication?
If you take medication for any medical condition, it is best to discuss pregnancy and medication issues with your doctor before becoming pregnant. If you are already pregnant, talk with your doctor before stopping or changing any of your current medications.
Nutrition Issues For Women With HIV
HIV disease can challenge your nutritional health. Poor appetite and undesired weight loss can complicate a pregnancy further. If you are beginning the pregnancy underweight, your pregnancy weight gain goals will need to be a bit higher than the normal range. Eat often during the day and choose higher calorie, nutritionally sound snacks. If you are having trouble eating or suffer from nausea or vomiting you may benefit from meeting with a registered dietitian to help you customize an eating plan. Gaining an adequate amount of weight during the pregnancy is important for both you and your baby.
A daily general multivitamin with minerals before you become pregnant is a good idea if your diet is limited in any way, or if you are having problems with food absorption. Once pregnancy, discuss prenatal vitamins with your obstetrician. Additional iron may be indicated if you are anemic. If you are having trouble meeting your weight gain targets or nutrient intake goals, special nutrient supplements may be helpful. Talk to your doctor or dietitian if you think you could benefit from nutritional supplements.
Eating for Two
Use the pregnancy diet guide to help you make food choices for a healthy pregnancy. You may benefit from getting a little extra protein in your diet so choose more meat, fish, poultry, dairy foods, eggs, or vegetarian protein sources. If you can't eat dairy foods, consider alternative calcium-rich foods and protein sources.
Remember, HIV infection compromises your body's immune system leaving you more vulnerable to foodborne illness. Avoid eating any raw or undercooked animal products to minimize your risks.
For more information, see HIV/AIDS and Pregnancy Center.
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