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Chronic
Diseases
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.
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.
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Guidelines
For Pregnancy With Diabetes
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Preconception
Counseling
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.
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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.
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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.
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Pregnancy
Issues For HIV Positive Women
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- 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.
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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.
Supplements
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.
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