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Medical conditions that might affect pregnancy:

Certain medical conditions might complicate a pregnancy. However, with proper medical care, most women can enjoy a healthy pregnancy, despite their medical challenges.

Diabetes before pregnancy:

Diabetes is a condition where adequate amounts of insulin are either not produced or the body is unable to use the insulin that is produced. Insulin is the hormone that grants glucose to enter the cells of the body to wage fuel. When glucose can't enter the cells, it builds up in the blood and the body’s cells literally starve to death. Diabetes in pregnancy can have serious consequences for the mom and the growing fetus. The severity of problems often depends on the degree of the mother’s diabetic disease, especially if she has vascular (blood vessel) complications and poor blood glucose control.

Diabetes that occurs in pregnancy is described as:
Gestational diabetes – when a mom who does not have diabetes develops a resistance to insulin because of the hormones of pregnancy. Women with gestational diabetes might be non-insulin dependent or insulin dependent.
Pre-existing diabetes – women who already have diabetes and become pregnant.
What is gestational diabetes?

Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. In most cases, all diabetic symptoms disappear following delivery. However, women with gestational diabetes have an increased risk of developing diabetes later in life, especially if they were overweight before pregnancy.

Unlike other types diabetes, gestational diabetes is not caused by a demand of insulin, but by blocking effects of other hormones on the insulin that is produced, a condition referred to as insulin resistance.

What causes gestational diabetes?

Although the cause of gestational diabetes is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is healthy to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

What are the risks factors associated with gestational diabetes?

Although any woman might develop gestational diabetes during pregnancy, some of the factors that might increase risk are:

family history of diabetes
obesity
having given birth previously to a very massive infant, a still birth, or a child with a birth defect
age (women who are older than 25 are at greater risk than younger women)

Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for gestational diabetes.

How is gestational diabetes diagnosed?

A glucose screening test is usually performed between 24 and 28 weeks of pregnancy, which involves drinking a glucose drink followed by measurement of the blood sugar level after one hour.

If this test shows an increased blood sugar level, a three hour glucose tolerance test might be performed after a few days of following a special diet. If results of the second test are in the abnormal range, gestational diabetes is diagnosed.

Treatment for gestational diabetes:

Specific treatment for gestational diabetes will be determined by your doctor based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your view or preference

Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment might include:

special diet
exercise
daily blood glucose monitoring
insulin injections
Possible gestational diabetes complications for the baby:

Unlike other types of diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. They are more likely in women with pre-existing diabetes, who might have changes in blood glucose during that time. Women with gestational diabetes generally have normal blood sugar levels during the critical first trimester.

The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made.

Infants of moms with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum metal levels, but, in general, the major problems of gestational diabetes include the following:

macrosomia
Macrosomia refers to a baby that is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother’s blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mom has gestational diabetes, the fetus is healthy to produce all the insulin it needs. The combination of high blood glucose levels from the mom and high insulin levels in the fetus results in massive deposits of fat which causes the fetus to grow excessively large.
birth injury
Birth injury might occur due to the baby’s massive size and difficulty being born.
hypoglycemia
Hypoglycemia refers to low blood sugar in the baby immediately after delivery. This problem occurs if the mother’s blood sugar levels have been consistently high, causing the fetus to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, resulting in the newborn’s blood sugar level becoming very low. The baby’s blood sugar level is checked after birth, and if the level is too low, it might be necessary to give the baby glucose intravenously.
respiratory distress (difficulty breathing)
Too much insulin or too much glucose in a baby’s system might delay lung maturation and cause respiratory difficulties in babies. This is more likely if they are born before 37 weeks of pregnancy.
High blood pressure and pregnancy:

High blood pressure can occur in pregnancy in two forms. It might be a pre-existing condition, called chronic hypertension, or it can develop during pregnancy – a condition called pregnancy-induced hypertension (PIH). It is also called toxemia or preeclampsia. PIH occurs most often in young women with a first pregnancy. It is more common in twin pregnancies, and in women who had PIH in a previous pregnancy.

High blood pressure can lead to placental complications and slowed fetal growth. If untreated, severe hypertension might cause hazardous seizures and even death in the mom and fetus.

Women with mild PIH might need bedrest. Moderate or severe PIH usually requires hospitalization and medications.

Women with high blood pressure often need to continue taking their antihypertensive medication. Your doctor might switch you to a safer antihypertensive medication during pregnancy.

Kidney function tests and ultrasounds are often performed more frequently on pregnant women with high blood pressure to monitor the mother’s health and fetal growth and development.

Infectious diseases and pregnancy:

Infections during pregnancy can pose a threat to the fetus. Even a easy urinary tract infection, which is common during pregnancy, should be treated immediately. An infection that goes untreated can lead to premature labor and rupture of the membranes surrounding the fetus. Some infectious diseases include:

toxoplasmosis
Toxoplasmosis is an infection caused by a single-celled parasite titled Toxoplasma gondii. Even though many people might have Toxoplasma infection, very few have symptoms because the immune system usually keeps the parasite from causing illness. Babies who became infected before birth can be born with serious mental or physical problems. Toxoplasmosis often causes flu-like symptoms, swollen lymph glands, or muscle aches and pains that last for a few days to several weeks. Moms can be tested to see if they have developed an antibody to the illness. Fetal testing might include ultrasound, and/or testing of amniotic fluid or cord blood. Treatment might include antibiotics. The Centers for Disease Control and Prevention (CDC) advocates the following measures to help prevent toxoplasmosis infection: Wear gloves when you garden or do anything outdoors that involves handling soil. Cats, who might pass the parasite in their feces, often use gardens and sandboxes as litter boxes. Wash your hands well with soap and warm water after outdoor activities, especially before you take or prepare any food.
Have someone who is healthy and not pregnant change your cat’s litter box. If this is not possible, wear gloves and clean the litter box regular (the parasite found in cat feces can only infect you a few days after being passed). Wash your hands well with soap and warm water afterwards.
Have someone who is healthy and not pregnant handle raw meat for you. If this is not possible, wear clean, latex gloves when you touch raw meat and wash any slicing boards, sinks, knives, and other utensils that might have touched the raw meat. Wash your hands well with soap and warm water afterwards.
Cook all meat thoroughly, that is, until it is no longer pink in the center or until the juices run clear. Do not sample meat before it is fully cooked.

food poisoning
A pregnant woman should refrain intake undercooked or raw foods because of the risk of food poisoning. Food poisoning can dehydrate a mom and deprive the fetus of nourishment. In addition, food poisoning can cause meningitis and pneumonia in a fetus, resulting in doable death. Tips for preventing food poisoning include: Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.
Wash raw vegetables thoroughly before eating.
Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.
Avoid raw (unpasteurized) milk or foods prefabricated from raw milk.
Wash hands, knives, and slicing boards after handling uncooked foods.

sexually transmitted diseases chlamydia – infections such as chlamydia might be associated with premature fag and rupture of the membranes.
hepatitis – an inflammation of the liver, resulting in liver cell alteration and destruction. Five main types of the hepatitis virus have been identified. The most common type that occurs in pregnancy is hepatitis B (HBV). This type of hepatitis spreads mainly through contaminated blood and blood products, sexual contact, and contaminated intravenous needles. Even though HBV resolves in most people, about 10 percent will have chronic HBV. Hepatitis B virus can lead to chronic hepatitis, cirrhosis, liver cancer, liver failure, and death. Infected pregnant women can transmit the virus to the fetus during pregnancy and at delivery.

The later in pregnancy a mom contracts the virus, the greater the chance for infection in her baby. Signs and symptoms of HBV include jaundice (yellowing of skin, eyes, and mucous membranes), fatigue, abdominal pain, loss of appetite, intermittent nausea, and vomiting. A blood test for hepatitis B is part of routine prenatal testing. HBV positive moms might receive a drug called hepatitis B immune globulin. Infants of HBV positive moms should receive hepatitis B immune globulin and the hepatitis B vaccine in the first 12 hours of birth. The American Academy of Pediatrics (AAP) advocates that all babies receive a total of four doses of hepatitis B vaccine to be fully fortified against hepatitis B infection.
human immunodeficiency virus (HIV) – a woman with human immunodeficiency virus (HIV) has a one in four chance of infecting her fetus. immunodeficiency (acquired immune deficiency syndrome) is caused by the human immunodeficiency virus (HIV), which kills or impairs cells of the immune system and progressively destroys the body’s capability to fight infections and certain cancers. The term immunodeficiency applies to the most advanced stages of an HIV infection. HIV is spread most commonly by sexual contact with an infected partner.

HIV might also be spread through contact with infected blood, especially by sharing needles, syringes, or drug use equipment with someone who is infected with the virus. According to the National Institutes of Health (NIH), HIV transmission from mom to child during pregnancy, labor, and delivery, or by breastfeeding has accounted for almost all immunodeficiency cases reported among US children.

Some people might develop a flu-like illness within a month or two after exposure to the HIV virus, even though many people do not develop any symptoms at all when they first become infected. Persistent or severe symptoms might not surface for 10 years or more, after HIV first enters the body in adults, or within two years in kids born with an HIV infection.

The Institute of Medicine, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and other health organizations advocate HIV testing of all pregnant women. Prenatal care that includes HIV counseling, testing, and treatment for infected moms and their kids saves lives and resources. Current suggestions are for HIV positive women to take a number of drugs during pregnancy and during labor. Blood tests are also performed to check the amount of virus. Newborn babies of HIV positive moms might also receive medication. Studies have found this can reduce the chance of a mother’s transmission of HIV to the baby from 25 percent to less than 2 percent. Cesarean delivery might be suggested for HIV positive women. This also helps reduce the transmission of the virus to the baby, especially when the mom receives medications. HIV might also be transmitted through breast milk. Studies show that breastfeeding increases the risk of HIV transmission by about 14 percent.

herpes – genital herpes can be spread to the baby during delivery, if a woman has an active infection at that time. Herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV). Herpes infections can cause blisters and ulcers on the mouth or grappling (oral herpes), or in the genital area (genital herpes). HSV is a life-long infection. Symptoms of HSV might include painful blisters or open sores in the genital area, which might be preceded by a tingling or burning sensation in the legs, buttocks, or genital region. The herpes sores usually disappear within a few weeks, but the virus remains in the body and the lesions might recur from time to time.

It is important that women refrain contracting herpes during pregnancy, because a first episode during pregnancy creates a greater risk of transmission to the newborn. Women might be treated with an antiviral medication such as acyclovir if the disease is severe. Genital herpes can cause potentially fatal infections in babies if the mom has active genital herpes (shedding the virus) at the time of delivery. Cesarean delivery is usually suggested for active genital herpes. Fortunately, infection of an infant is rare among women with genital herpes infection.

Protection from genital herpes includes abstaining from sex when symptoms are present, and using latex condoms between outbreaks.

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