Pregnancy health Pregnancy Common pregnancy health conditions Some pregnancies require an extra bit of TLC. Our midwife explains the medical problems you need to keep an eye out for… 1 of Ad break For most mums to be, the biggest challenges during pregnancy will, thankfully, be morning sickness and aches and pains. But for some there could be other conditions that might need monitoring throughout the nine months. Don’t worry though, the main purpose of your antenatal appointments is to keep an eye on your pregnancy and make sure that problems don’t occur. Your midwife is constantly looking out for these conditions, and will be able to help if she spots one. Read on to find out what she’ll be watching for and how it could be treated. Gestational diabetes This is when high levels of glucose are present your blood. It’s diagnosed by a blood test and your doctor, or midwife, will send you for a test they think you’re at risk. Lots of women are checked for diabetes during pregnancy, including women with a family history of diabetes, raised BMI (Body Mass Index - a sign of being overweight), and certain ethnic groups (these are all factors that can increase the chance of getting it). Uncontrolled diabetes can cause babies to grow very large and may cause heart problems. Who gets it? Between 2 and 5 per cent of women in this country will have diabetes during pregnancy. Though the majority will no longer have the condition after the birth, there’s an increased risk of getting diabetes in later life. What’s the treatment? The majority of women who develop gestational diabetes successfully control it with exercise and a healthy diet, although a few will need injections of insulin in order to help the body break down the glucose. With close care from the diabetic and obstetric team, it shouldn’t be a problem. Pre-eclampsiaThis can occur anytime from around 20 weeks of pregnancy until a few days after the birth and is caused by a defect in the placenta. The placenta is the link between mum and baby, providing her baby with oxygen and nutrients. If undetected and allowed to develop, pre-eclampsia can potentially be life-threatening to the mum and baby, causing eclampsia which may result in seizures. Pre-eclampsia can cause a rise in blood pressure, and protein in the urine. In extreme cases it can mean premature delivery. Some women will get symptoms of headaches, visual disturbances and general swelling (oedema), suggesting high blood pressure, though others will have no symptoms at all. Who gets it? Pre-eclampsia affects one in 10 pregnancies in some form, but severely affects one in a 100 first pregnancies, and can affect both the mother and her unborn baby. What’s the treatment? There is no treatment for pre eclampsia, other than the birth of the baby, but if it is suspected you’ll be monitored closely with frequent checks on blood pressure, urine and blood. If the condition is mild, the doctors will aim for you to continue with your pregnancy for as long as possible though induction may be advised if the tests show that the pre eclampsia is becoming more significant. Severe pre eclampsia will need immediate admission to hospital. Placenta praeviaThis is when the placenta covers some, or all, of your cervix. It’s usually picked up at the anomaly scan at around 20 weeks of pregnancy. As the pregnancy progresses and the womb stretches, the placenta should rise up the wall of the uterus. When it doesn’t do that, you’re diagnosed with a placenta praevia. You’ll be closely monitored during the remainder of the pregnancy, and a c-section could be advised. Any fresh, painless bleeding should be reported immediately, as you might need to go to hospital. Who gets it? Placenta praevia occurs in a very small percentage, around 0.5 per cent of pregnancies. It’s more common in women who’ve had a previous caesarean section, subsequent pregnancies, twin pregnancy, and those who smoke. What’s the treatment? In more than 90 per cent of women who’ve been diagnosed with placenta praevia in the second trimester, the placenta will correct itself by the end of the pregnancy. The placenta itself doesn't actually move, but as the uterus stretches it’s not as close to the cervix as it was earlier in pregnancy. Clever, eh! If the condition is diagnosed after the 20th week, but you're not bleeding, you'll probably be advised to refrain from any vigorous exercise and to take life easy. If you're bleeding heavily, you’ll be admitted to hospital so that the bleeding can be monitored, but even when it stops, you might well be asked to stay in hospital until your baby is ready to be born. Continue slideshow > High blood pressureThis is also known as gestational hypertension. It can affect the blood flow through the placenta, potentially affecting the growth of your baby, or cause a placental abruption (see next slide) so it’s important to keep it under control. Many women will have no symptoms at all, but some will experience a headache or visual disturbances. Who gets it? About one in 10 pregnant women has problems with high blood pressure. What’s the treatment? If you develop high blood pressure during pregnancy, your midwife will first check for protein in your urine, to eliminate the risk of pre-eclampsia. High blood pressure can be controlled by medication but it will still need close monitoring to make sure that it stays within a normal range Placental abruptionThis is when the placenta completely or partially peels off the wall of the uterus. Symptoms include severe abdominal pain, uterine tenderness, and sometimes, vaginal bleeding. In serious cases an emergency caesarean would be necessary as the placenta is the baby’s lifeline. Who gets it? Nearly half the women who have this also have very high blood pressure. It can happen after some sort of trauma to the abdomen, such as a car accident, and is more common in women who smoke, drink a lot of alcohol or use drugs. Women over the age of 35 are more at risk, as are women who‘ve already had this in a previous pregnancy. What’s the treatment? With a mild abruption early on in the pregnancy, hospital bed rest may be recommended. And if the bleeding ceases you might be may be able to go home. Steroid shots are sometimes recommended to develop the baby's lungs just in case an early delivery is needed. Mum’s story “I had a scan at 34 weeks that confirmed there was a problem with my placenta. As I only lived five minutes from the hospital I was told that I could go home, but I should return immediately if I had any bleeding at all. At 37 weeks I started to lose small blood clots and rushed straight to the labour ward. An hour later, Jack was born by emergency c-section. He was absolutely fine but it was a such a shock that the whole thing had happened so quickly.” Jo Billingham, 30, from Bournemouth, mum to Tom, 3, and Jack, 4 months HELLP syndrome HELLP stands for: H – hemolysis, which is the breaking down of red blood cells EL – elevated liver enzymes LP – low platelet count In layman’s terms, this means it can affect your blood from clotting (sticking together to stop bleeding) and the liver’s ability to function. If you have HELLP syndrome, you may feel tired and have pain in the upper right part of your belly. There could be bad headaches and nausea or vomiting, and you may have swelling, especially in your face and hands. Who gets it? Most women who will get it have blood pressure problems beforehand. What’s the treatment? The only treatment for HELLP is to deliver your baby. This may have to be done before your due date, if you’re particularly ill. Most women with this illness start to get better a couple of days after their babies are born. If you aren’t too sick, your doctor may be able to wait for a little time before inducing labour. Obstetric Cholestasis (OC)This is a liver disorder that can cause unbearable itching, particularly at night. Itching in pregnancy is very common, but cholestasis often causes severe itching of the soles of the feet and palms of the hands. If left untreated it can be dangerous for the baby, so it’s always worth ruling the condition out if you’re showing symptoms of it. Who gets it? Obstetric cholestasis affects around one in 135 women. What’s the treatment? A series of blood tests will diagnose OC. If it’s confirmed you’ll be advised to begin medication to control the itching and help to correct your liver function, or induction may be advised. OC disappears soon after birth and causes no long-term effects. Mum’s story “I was 34 weeks pregnant and assumed that the itching was normal because of my skin stretching, even though it was driving me mad. My midwife took a blood test and later that day rang me to say that I must go to hospital as I had obstetric cholestasis. I was given medication and had blood tests twice a week until the end of my pregnancy. She warned me that I might have to be induced but I went into labour myself and the cholestasis disappeared immediately.” Paula Ashton, 25, from Southport, mum to Matthew, 2 months Continue slideshow > Polyhydramnios This is an excess of amniotic fluid. Women who have it often complain of getting breathless quickly and feeling bigger than they think they ought to be, the skin on the abdomen feeling tight and looking shiny. There can be various reasons for polyhydramnios, including diabetes, an infection acquired during the pregnancy or occasionally a problem with the baby such as inability to swallow the amniotic fluid and pass it as urine in the usual way. Sometimes there’s no apparent reason for an excess of fluid, but be reassured that in most cases, women go on to have a healthy baby. Who gets it? It’s a very rare condition, occurring in less than 1% of pregnancies. What’s the treatment? Polyhydramnios treatment includes careful monitoring and delivering the baby as soon as your pregnancy has run its term. If necessary amniotic fluid levels may be lowered with medication to decrease fetal urine output, or by an amnioreduction, which is the removal of amniotic fluid with a needle. OligohydramniosThis is the opposite of polyhydramnios – too little fluid in the amniotic sac around the baby. It’s often picked up by the midwife when she measures that your bump feels small for your dates. There are various reasons for it, such as a problem with the placenta, a health condition of the baby, or even a leaking of the amniotic fluid, but often no cause is found at all. Very low levels of fluid in the first trimester can cause an increased risk of miscarriage, but later on it’s a matter of keeping a close eye on you, and making sure that your baby is still growing. Some babies with low levels of fluid cannot cope as well with labour so your newborn will need close monitoring during the birth. Who gets it? It occurs in about 4% of pregnancies. What’s the treatment? Treatment depends on how far the pregnancy has progressed. If the pregnancy is at term, delivery is the best treatment. If the pregnancy is not far enough along to recommend delivery, amniotic infusion may be suggested, which is where amniotic fluid is injected through the amniotic membrane to raise fluid levels. Reduce your riskNo one can guarantee that one or more of these conditions won’t affect you during pregnancy but there are things you can do to help reduce the risk: Attend all your antenatal appointments and make sure you reschedule ASAP if you miss one. Stop smoking. Make sure you tell your doctor or midwife about any symptoms you’re experiencing. Eat a balanced diet containing lots of wholegrain carbs, lean proteins and heathy fats. Lose excess pounds if you’re planning a pregnancy. Take gentle exercise. Try Pilates, yoga, swimming, or even just plain old walking? Did you know… That it’s normal for iron levels to drop a little in pregnancy, as the blood becomes more diluted. 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