Pregnancy-Related Diseases
From Encyclopedia of Sex and Sexuality
Over 95 percent of pregnant women will experience a totally normal pregnancy, ending with labor and delivery that have an excellent outcome for both mother and baby. All such women, however, will experience symptoms associated with pregnancy that sometimes bring feelings of illness. The myriad of symptoms accompanying pregnancy—everything from morning sickness in the early stages to backache in the later course of pregnancy—are not diseases; nor are they responses to the physical and hormonal changes associated with pregnancy. There are, however, several diseases that are specific and unique to pregnancy.
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[edit] Diabetes Mellitus
While 3 in 1,000 pregnant women have diabetes before pregnancy, 30 more will develop gestational diabetes (or diabetes limited to pregnancy). Pregnancy causes a decrease in fasting blood glucose (sugar) and a rise in postprandial (postmeal) glucose because of the body’s decreased ability to use insulin. In a gestational diabetic this results in prolonged periods of elevated glucose in maternal blood, which is transmitted to the fetus across the placenta. The higher glucose levels can cause the fetal pancreas to secrete very high levels of insulin which, in turn, can result in complications for the fetus and, later, the newborn infant.
Stillbirth rates and pregnancy losses are therefore higher in diabetic pregnancies. Infants of diabetic mothers are also more likely to have spinal and/or heart defects and/or skeletal abnormalities. There is a relationship between high maternal glucose levels and the frequency of these birth defects, emphasizing the importance of seeking prenatal care early in pregnancy.
Another problem encountered in babies of diabetic mothers is “macrosomia,” or excessively large infants. This condition can cause difficulty with labor and vaginal delivery. Macrosomia appears to be a result of high fetal insulin levels. Respiratory distress syndrome and low blood sugar in the newborn period can also be problems in infants of diabetic mothers, particularly when control of diabetes during pregnancy has been less than optimal.
Diabetes in pregnancy imposes additional risks to the mother as well. If a woman is overtly diabetic prior to pregnancy, prepregnancy counseling is essential. Poor control of diabetes during pregnancy can result in accelerated damage to the kidneys, nerves, retina, and other blood vessels in the mother. Special attention to these potential problems is an essential component of good prenatal care.
[edit] Hypertension
Pregnancy-induced hypertension (elevated blood pressure) is another disease specific to pregnancy. This illness, also know as toxemia or preeclampsia, occurs in about 7 percent of women, and usually occurs during the second half of a first pregnancy. Symptoms of high blood pressure, protein spillage in the urine, and edema (swelling) are classic. Other less specific symptoms include headaches, nausea, vomiting, visual disturbances, and hyperactive reflexes. Its cause is unknown.
Pregnancy-induced hypertension (PIH) is usually classified as mild or severe. Whereas for mild PIH the treatment prescribed is bed rest and ultimate delivery, in cases of severe PIH, treatment involves prevention of serious complications and prompt delivery. The goal in the management of preeclampsia is prevention of convulsions or coma, control of maternal blood pressure, and preparation for delivery.
Magnesium sulfate is commonly administered to decrease the possibility of epileptic seizures. While the mother’s blood pressure, urinary protein, and kidney function are carefully monitored, the fetus is also monitored for signs of distress. If pre-eclampsia worsens in spite of adequate medical therapy, if induction of labor is unsuccessful, or if the fetus shows signs of not tolerating the maternal disease, a cesarean section can be performed. Most women with pregnancy-induced hypertension, however, safely deliver vaginally, and most women who experience the disease with a first pregnancy have no recurrence in future pregnancies.
[edit] Blood Type Incompatibility
Rh disease (“isoimmune hemolytic disease of the newborn”) can occur when an Rh-negative mother is carrying an Rh-positive fetus. The combination of an Rh-negative mother and Rh-positive father gives a good chance of the fetus being Rh-positive. When this situation occurs, the potential exists for some of the fetus’s Rh-positive blood to get into the mother’s circulation; in turn, the Rh-negative mother forms antibodies to the Rh-positive red blood cells, and these antibodies go back across the placenta and destroy the fetus’s red blood cells, causing anemia.
This is rare, because nearly 90 percent of the population is Rh-positive, and Rh sensitization can be largely prevented by appropriate administration of Rh immune globulin, which prevents sensitization of the mother to Rh-positive cells. Good prenatal care involves recognition of Rh-negativity in the mother.
[edit] Anemia and Urinary Infection
Two other diseases worthy of mention, anemia and urinary tract infection, while not unique to pregnancy, are certainly more common during this time. The most common form of anemia during pregnancy is iron-deficiency anemia, resulting from the increased iron demands of pregnancy. A pregnant woman’s blood cell volume increases by nearly 50 percent during a normal pregnancy and these additional red blood cells require iron; the fetus has approximately two pints of blood near the end of pregnancy and these fetal red cells require iron too. Iron-deficiency anemia during pregnancy can be prevented by good nutritional practices prior to and during pregnancy and iron supplementation during the course of pregnancy (see pregnancy and diet).
Urinary tract infection occurs in about 8 percent of all pregnant women. This increased susceptibility is thought to be due to a variety of mechanical and hormonal factors—pressure on the bladder from the developing pregnancy and dilation of the uterers (the tubes leading from the kidney to the bladder), which occur as normal consequences of pregnancy. Urinary tract infection during pregnancy is nearly always successfully and easily treated, but prompt recognition during prenatal care is important.
