Risky business

While pregnancy itself isn’t a risky state to be in, there are certain circumstances in which you and your baby might need additional care. These are some of the most common ones, writes Tracey Hawthorne

“PREGNANCY IS A natural event for which a woman’s body is perfectly designed,” says Dr Dalene Barnard, an obstetrician and gynaecologist from Kloof Mediclinic in Pretoria. “However, high-risk pregnancies are when a woman or her baby has a characteristic condition that has been recognised by medical research to increase the chance of an adverse outcome for the mother and/or the baby.”

Some of the most common of these are for women at the extremes of their reproductive life (in their teens or over 35), those who are substantially overweight, women with pre-existing medical conditions, and women expecting multiple babies.

AGE EXTREMES

Pregnant teens, especially those who don’t have support from their parents, are at risk of not getting adequate critical prenatal care. Prenatal care screens for medical problems in mother and baby, and monitors the baby’s growth; and prenatal vitamins with folic acid are essential in helping to prevent certain birth issues such as neural-tube defects. Pregnant teens also have a higher risk of getting high blood pressure (pregnancy-induced hypertension) and pre-eclampsia, a dangerous medical condition characterised by high blood pressure and signs of damage to other organ systems, most often the liver and kidneys, and which can lead to serious – even fatal – complications for both the mother and the baby.

For teens who have sex during pregnancy, sexually transmitted diseases such as chlamydia and

HIV are a major concern; and teens are more likely to take drugs, drink alcohol and smoke cigarettes during their pregnancy, all of which have adverse affects on the mother’s and the growing baby’s health.

Teens are at higher risk of having low-birth-weight and/or premature babies, and may be at higher risk of postpartum depression. At the other end of the spectrum, pregnant women aged 35 and older are more prone to gestational diabetes and hypertension, may have a more difficult delivery, and have more of a risk of having a miscarriage or a still birth; and their babies are more likely to have Down syndrome or other chromosomal or structural abnormalities.

EXISTING HEALTH CONDITIONS

High blood pressure prior to and carried into pregnancy poses various risks, including a decreased blood flow to the placenta, which means the baby might receive less oxygen and fewer nutrients; and placental abruptio, in which the placenta separates from the inner wall of the uterus, and which can be lifethreatening for both mother and baby. If you’re HIV positive, you can pass HIV to your baby during pregnancy, while in labour, while giving birth or by breastfeeding, although there are many ways to lower the risk of passing HIV to your baby to almost zero.

If you have diabetes – high blood glucose – and you’re trying for a baby, try and get your blood-sugar levels close to target range before, as high blood glucose levels can harm the baby during the first weeks of pregnancy, even before you know you’re pregnant. Staying in the target range during pregnancy is also important. “Only 2 to 5 percent of pregnant women develop diabetes during pregnancy,” says Johannesburg-based clinical dietitian Kate Tattersall. “It’s more common in women who had raised blood-sugar levels before they fell pregnant, and who were overweight before they fell pregnant.”

BEING OBESE OR SUBSTANTIALLY OVERWEIGHT

Obesity increases the risk for high blood pressure, pre-eclampsia, gestational diabetes (developed during pregnancy), stillbirth, neural-tube defects, and the need for a caesarean delivery, and research has shown that obesity can raise infants’ risk of heart problems at birth by 15 percent.

Having gestational diabetes is a warning sign that you’re at risk for getting diabetes again in your next pregnancy, so you need to take good care of yourself – keep your weight in the normal range by eating well, and exercise regularly.

You can use the body mass index (BMI) to work out your ideal nonpregnant weight. To do this, divide your weight in kilograms by your height in metres, then divide the answer by your height again, for example 62kg divided by 1.6m = 38.75 divided by 1.6m = 24.2.

BMI categories

Underweight = lower than 18.5 Normal weight = 18.5 to 24.9 Overweight = 25 to 29.9 Obese = higher than 30

MULTIPLE BIRTHS

The risk of complications is higher in women carrying more than one foetus. Common complications include preeclampsia, premature labour and preterm birth. More than half of all twins and as many as 93 percent of triplets are born at fewer than 37 weeks’ gestation. “Studies seem to indicate that women over 35 have a higher incidence of dizygotic pregnancies, where two separate eggs are fertilised by two separate sperm, although the incidence of monozygotic, or identical, twins isn’t increased in women over 35,” observes Johannesburg gynaecologist Kiran Kalian. “By far the greatest contributor to the incidence of dizygotic twinning in women over 35 over the last few decades has been because of assisted reproduction such as IVF.”

Also, women in their 30s experience greater fluctuations in hormone levels, especially follicle-stimulating hormones, which stimulate egg production for ovulation; and a study shows that women who are overweight before conceiving are more likely to conceive twins than those who aren’t.

BIRTH DEFECTS OR GENETIC CONDITIONS

Depending on the nature of the problem, the pregnancy may be considered high risk because treatments are needed while the foetus is still in the womb or immediately after birth. For example, certain forms of spina bifida and some heart defects can be repaired before birth.

MANAGING HIGH-RISK PREGNANCIES

“If a pregnancy is high risk due to a problem with the baby, we will often refer the patient to a foetal specialist,” says Dr Barnard. “If the mom has a medical condition prior to pregnancy – for instance, diabetes or a heart problem – the caregiver will aim to optimise the mom’s health prior to pregnancy, prevent the disease from negatively influencing the pregnancy, prevent the pregnancy from negatively influencing the mother’s health, and prevent and manage changes in the body after the pregnancy that can have an influence on the disease.”

This will often require an above-average effort from the mother to understand the factors that make her pregnancy high risk and how to manage them, and more frequent visits to the midwife or doctor caring for her.