The pregnancy information and descriptions offered in this document
thus far have assumed that we have been talking about how the prenatal
pregnancy care process is likely to unfold for a relatively healthy
young woman. Not every woman who gets pregnant is necessarily healthy
or young, however. The following sections of this document describe
ways that doctors typically modify prenatal care recommendations when
various conditions are present that complicate pregnancy.
Hyperthyroidism. The prefix "hyper" means "over" or "above".
Hyperthyroidism occurs when a person's thyroid gland (located at the
front of the neck, and secreting hormones that regulate many metabolic
processes) becomes overactive. The most common form of hyperthyroidism
is known as Grave's disease. Hyperthyroidism can start during
pregnancy, triggering various symptoms to appear, including hard or
fast heartbeats, nervousness, trouble sleeping, nausea, and weight
loss. As most of these symptoms are likely to happen anyway during
pregnancy, it can be easy to miss that they are being caused by a
It is important that doctors bring hyperthyroid conditions under
control for pregnant women. Hyperthyroidism has a tendency to become
severe in the third trimester of pregnancy, and sometimes leads to
premature labor. A pregnant woman's poorly controlled hyperthyroidism
can cause her to be at increased risk for miscarriage, premature labor,
pre-eclampsia (late term high blood pressure), stillbirth, low birth
weight, and even heart failure.
A mother's hyperthyroidism can affect her baby's health as well as
affecting the quality of her pregnancy. Up to 5% of babies born to
women with Gravesâ€™ disease have hyperthyroidism. Symptoms of
hyperthyroidism in the fetus include high fetal heart rate, poor
growth, abnormal bone development, and an enlarged thyroid gland.
If you have hyperthyroidism, your doctor may measure your levels of
thyroid hormone every month, and may also perform additional tests,
such as prenatal sonography and fetal blood tests. Your doctor will
also likely take steps to control your hyperthyroid condition. Treating
maternal hyperthyroidism can be complicated as some of the medications
used to treat the condition can be harmful to the fetus. For example,
radioactive iodine, a common treatment for hyperthyroidism, cannot be
used during pregnancy because of the likelihood that this treatment
will damage the fetus' own thyroid gland. Fortunately, several
medications, including Propylthiouracil (also called PTU), Methimazole
(MMI), and Propanolol, may be safely used to treat hyperthyroidism
during pregnancy. Surgical removal of the thyroid gland may become
necessary when a pregnant woman fails to respond to medication
treatment of her hyperthyroidism.
Hypothyroidism. The prefix "hypo" means "under" or "below".
Hypothyroidism, then, is a disease characterized by an under-active
thyroid. Common among women of child-bearing age, hypothyroid can be
difficult to detect, as its symptoms, such as tiredness and weight
gain, are similar to normal pregnancy symptoms. Fortunately, a simple
blood test can detect hypothyroidism, and the condition can be treated
with thyroid hormone replacement medication such as Levothyroxine.
Women who had hypothyroidism prior to becoming pregnant will often need
to take a higher dose of the medication during their pregnancies so as
to keep their hormones at necessary levels. In general, women with
hypothyroidism can expect to have blood tests done every 4 to 6 weeks
in order to monitor their thyroid hormone level.
It is important to test for and treat hypothyroid conditions in
pregnant women as they are otherwise associated with negative outcomes.
Being hypothyroid can reduce a womanâ€™s chances of becoming pregnant.
Pregnant woman with hypothyroidism have a high chance of first
trimester miscarriage. Should pregnancy continue after the first
trimester, there remains a chance that the child will have congenital
abnormalities, be born with a low birth weight, and demonstrate
impaired psychomotor development.
Diabetes mellitus is a disease affecting blood sugar metabolism.
Diabetes complicates pregnancy in multiple ways. It negatively affects
the pregnancy itself, causing an increased risk of spontaneous abortion
(miscarriage), macrosomia (large sized fetus), preterm birth, and
respiratory problems. It also negatively affects the health of the
pregnant woman, who is at increased risk for hypoglycemia (low blood
sugar), ketoacidosis, increased microvascular complications (such as
poor circulation and retinal (eye) damage), kidney infections, and
hypertension. Because of these risks, it is very important that
diabetic women maintain close contact with medical personnel before and
throughout their pregnancies.
Pregnant diabetic women will undergo a battery of blood and urine tests
early in pregnancy. They may also be asked to have an electrocardiogram
(a measure of heart rhythm) and a comprehensive eye exam to measure
retinopathy (eye tissue damage). Throughout the course of their
pregnancies, they may be asked to consult with a diverse team of health
care professionals, including nutritionists, nurses, diabetic
educators, social workers, and their doctor, to help them remain
healthy and motivated throughout their pregnancy. They will need to
touch base with their health care team and doctor so that appropriate
monitoring of their health and the health of their pregnancies can take
place at least every two weeks until 32 weeks of gestation and then
every week until delivery to monitor the babyâ€™s development.
Research has demonstrated that good glycemic (sugar) control can lower
diabetic's pregnancy risks substantially, particularly during the first
seven weeks of fetal development when organs are being formed.
Maintaining good sugar control requires that pregnant women adhere to a
strict personalized meal plan and diabetic diet, monitor their glucose
levels on a regular basis, and carefully document their blood sugar
levels and insulin dosages throughout their pregnancies. They must also
strictly adhere to their medication regimen. Insulin is completely safe
to use during pregnancy (so long as it is used appropriately). However,
other medications that may have been prescribed prior to the pregnancy
may not be safe to take during pregnancy.
Though they require a great deal of discipline to act on, the dietary
and medical treatments described above are capable of reducing and even
eliminating many of the problems associated with diabetic pregnancy.
Paying attention to glycemic control, careful blood sugar monitoring,
insulin dosing, diet modifications, and regular doctor visits help to
increase the likelihood of an uncomplicated pregnancy.
Lupus is a chronic autoimmune disease in which a person's own
immune system attacks and inflames that person's own body tissues
resulting in symptoms including fatigue, swollen joints, rashes and
other serious symptoms. Pregnant women with Lupus are at risk for
pregnancy complications, including high blood pressure, diabetes,
hyperglycemia, blood clots in the placenta, toxemia, preterm delivery,
and sudden emergent need for cesearian birth. Of these various risks,
the largest is that of premature delivery, which can result in the baby
having difficulty breathing, being jaundiced and anemic. The majority
of babies born to women with Lupus do not develop the disease
themselves. However, about 3% of babies born to mothers who have Lupus
develop Neonatal Lupus. The symptoms of Neonatal Lupus are a transient
rash, transient blood count abnormalities, and rare but treatable heart
beat abnormalities. Babies who experience Neonatal Lupus without heart
beat abnormalities are generally symptom free by six months of age.
Women with Lupus who desire to get pregnant should put off conception
until they have been symptom free for at least six months if possible.
Once pregnant, women with Lupus have different symptom experiences.
While some women experience a flare of symptoms during pregnancy,
others actually improve. Often, it is difficult for doctors to
determine which symptoms during a Lupus pregnancy are caused by the
pregnancy itself and which are symptoms of the disease.
Lupus is a serious and chronic disease that continues to avoid cure.
Only several decades ago, doctors used to counsel women with Lupus to
avoid having children of their own. Today, approximately 75% of Lupus
pregnancies are successful, thanks to the application of carefully
developed research-based medical treatments (approximately 25% of
pregnancies still result in miscarriage). Ongoing prenatal care and
careful medical planning are vital parts of a Lupus pregnancy. Because
of the complications that can arise in pregnant women who have Lupus,
all Lupus pregnancies are considered high risk. All pregnant women with
Lupus should plan to deliver in a health care facility with a neonatal
intensive care unit in case of premature delivery.
If you have Lupus and plan to become pregnant, or are already pregnant,
it is important that you discuss your treatment options with your
doctor at your earliest convenience. Your doctor will likely need to
adjust your medications, for one thing, and will want to follow your
progress closely throughout your pregnancy so as to best insure your
health. As with other conditions, some medications will be safe to
continue during pregnancy, while others may harm your developing fetus.
More information about pregnancy and Lupus can be found at the Lupus Foundation of America website.
(continued on the next page)