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Ectopic Pregnancy

Ectopic pregnancy is a condition where a fertilized egg is implanted outside uterus in a female body. Ectopic means “misplaced”. In ectopic pregnancy, a fertilized egg can be settled in cervix, fallopian tubs, abdomen, or ovaries. Ectopic pregnancy is most commonly called ‘tubal pregnancy’ because most of the times egg settles in the fallopian tubes. This is an abnormal condition and this kind of pregnancy does not result in a child birth. This is because none of the areas where a fertilized egg settles has enough space to sustain the growing size of fetus except uterus.

Symptoms of Ectopic Pregnancy

The ectopic pregnancy occurs when a fertilized egg is unable to make its way to the uterus through fallopian tubes due to some reasons. These reasons include partial or complete blockage of fallopian tubes due to inflammation and infections in fallopian tubes. Pelvic Inflammatory disease (PID) is also one of the causes for this condition.

The early symptoms of ectopic pregnancy are similar to normal pregnancy symptoms and therefore it is difficult to detect it in earlier stages. For example, in ectopic pregnancy also a pregnant woman will have missed periods, morning sickness, breast tenderness, nausea, vomiting, and frequent urination. As the ectopic pregnancy grows the pain in pelvis and abdomen is felt by the pregnant women. Pain is the first alarming symptom of ectopic. The other symptoms that appear gradually in ectopic pregnancy are: vaginal spotting or bleeding, lower back pain, faintness and dizziness, and low blood pressure.

If ectopic pregnancy is not detected in earlier stages there is a danger of bursting of tissues and intensive bleeding. This may also endanger the life of the patient. Sometimes to terminate the ectopic pregnancy, the organ where the fertilized egg has settled, needs to be removed. For example, if the egg has been settled in one of the fallopian tubes then the fallopian tube, where egg had been settled, may need to be removed. The chances of conceiving again and sustaining the pregnancy, reduces in a woman who already had an ectopic pregnancy.

Treatment

Besides surgery, there are other treatments also to remove ectopic pregnancy. The treatment varies with the size and location of fetus and also your willingness to conceive again. The early ectopic pregnancy can be aborted by giving methotrexate injection to the patient, which can dissolve the fertilized egg into the body itself. The other treatments at further later stage include laparoscopy, which is a less invasive surgical procedure. In this procedure small incisions are made and laparoscope is inserted to view internal organs and remove ectopic pregnancy. With this procedure the internal organs are repaired or removed to treat ectopic pregnancy. The last option is the surgery, which is done when the size of fetus has grown big and no other treatment is possible. This may include the removal of organs where ectopic pregnancy has taken place. This may also reduce your chances to conceive again.

To avoid the risk of ectopic pregnancy, it is important that you contact your doctor immediately as soon as you become pregnant. This ensures your pregnancy is developing normally.

Multiple Pregnancies

Multiple-pregnancy is a medical condition where a woman is pregnant with two or more babies in her womb. The chances of twin-pregnancy are 1% to 1.2% and a pregnancy with triplets is 0.015%, and with quads is about 0.0002% and with quintuplets in about 0.000002% under normal conception. Most of the times, multiple pregnancies occur when a woman is taking infertility treatments, before becoming pregnant. Multiple pregnancies can also occur naturally when a woman’s body releases more than one egg in a month during ovulation. Either the eggs can be fertilized or one egg may split into two. When one egg is split into two sharing the same sperm and genes then identical twins are born and when two separate eggs are fertilized with two different sperms then fraternal twins with genetically unique features are born.

Multiple-pregnancy brings mixed emotions in a pregnant woman. Where on one hand a mother to be is excited about having two babies together on the other hand she is apprehensive about their care, the delivery, the labor pains, and their upbringing. Multiple-pregnancy is considered a high risk pregnancy and a pregnant woman with multiple-pregnancy needs to see her doctor more frequently then a pregnant woman with single fetus. More visits to the doctor are required to ensure the proper development of all the fetuses present in the womb. If you are pregnant with multiple babies then instead of panicking you should be more careful and cautious with your pregnancy. Most twin pregnancy result in the birth of healthy babies without any serious complications.

The early pregnancy symptoms of multiple-pregnancy are quite similar with single pregnancy with little difference in intensity of symptoms. You may be feeling excessive morning sickness and fatigue. You may also find an over-size belly which may not be in sync with the normal gestational age. If you are pregnant with multiple babies than you must be more careful about the diet you take. The diet must be more nutritional and balanced so that nutrition reaches body but excessive weight gain should be avoided. Generally 250 to 300 additional calories each day with more proteins are suggested by the doctors. The quantity of vitamins is also doubled in multiple pregnancies but you must consult your doctor for proper nutritional supplements and should not just double them on your own.

The complications that may occur in multiple pregnancies can be little more as compared to the single pregnancy. A woman with multiple-pregnancy often suffers from Pre-eclampsia, high blood pressure, and anaemia. Bleeding before birth of babies and preterm labour are more likely to occur. Due to large or double placenta gestational diabetes may also occur in the pregnant woman. One most important thing that a pregnant woman with multiple pregnancies must remember is to avoid stress. You should take things and find solutions for them when they come instead of keep on worrying about them. A proper rest both at the beginning of pregnancy and in the later stages is advised by the doctors. A proper care can result in the birth of healthy babies.

Preterm labor and birth

If the labor pains start and you start having regular contractions before completing 37 weeks of pregnancy then you are going through a preterm labor. In such a case your baby after your delivery will be considered a premature baby. Premature babies usually do not have their internal organs developed completely especially lungs. Babies born between 34 to 37 weeks of pregnancy are considered born premature. The premature babies often face health problems and sometimes if the gestation period is even less than 34 weeks the health problems can even be fatal and cost life. More mature the baby is at birth more are the chances for the baby to have good health.

Although most pregnancies complete the full gestation period of 40 weeks, sometimes due to some problems either the preterm labor is induced by the doctors or it happens naturally. Usually in case of multiple pregnancies or if you are pregnant with twins, you are at risk to get preterm labor. There are many other reasons also for a preterm labor. Some of the reasons for preterm labor are:

  • Genital track infections: If you are suffering from bacterial infections of genital track such as bacterial vaginosis, chlamydia, and trichomoniasis, you are at a risk to get preterm labor. This is because bacterial infections cause the weakening of tissues around amniotic sac, which results in the premature rupture of amniotic sac.
  • Placental displacement: In some cases if the pregnant woman has placenta displacement problems such as placenta previa and placenta abruption, then there are chances of preterm labor. In placenta previa, the placenta is placed low in the uterus instead of being at the top of the uterus. This condition causes the closing of cervix completely or partially and results in preterm labor. Placental abruption is a condition when the placenta is separated from the uterus completely or partially and thus stopping all the nutrients and oxygen supply to fetus. This results in the preterm labor of death of fetus.
  • Multiple-pregnancies: If you are pregnant with multiple fetuses than you may be having excessively large uterus and excessive amniotic fluid which may result in umbilical cord prolapse and preterm labor. Amniotic fluid surrounds your baby and protects it in the womb from any accident.
  • Illness: If you are suffering from some chronic diseases such as diabetes, asthma, and lupus, you may have the risk of preterm labor. The other diseases that can cause preterm labor include sickle cell, inflammatory bowel disease, anemia, hepatitis, kidney infections, appendix and severe gingivitis.

You may also be at a risk of preterm labor if you had a previous preterm delivery, you are less than 17 years old or above 35 years old, overweight, underweight, short, or you smoke, take drugs, or had vaginal bleeding in more than one trimester.

To avoid preterm labor, you must take good care of your health. You should take plenty of rest, eat well and take balanced diet, start your prenatal care early, and see doctor regularly. Besides all this you should manage your stress level, take care of hygiene, and spend some quiet time so that you can focus your attention on your baby’s movements and feel any unusual aces and pressures in your womb.

Chronic hypertension during pregnancy

Chronic hypertension is a medical condition when your blood pressure rises to 140/90 or higher before pregnancy or before 20 weeks of pregnancy. Hypertension is caused due to high blood pressure. Some women already have high blood pressure when they become pregnant while some develop during pregnancy. The hypertension developed during pregnancy is called gestational hypertension and occurs after 20 weeks of pregnancy and goes away with delivery. But chronic hypertension is a condition which does not go away with pregnancy.

The reasons for chronic hypertension are not clearly understood but some factors that contribute to its occurrence are heredity, diet, and lifestyle of a person. If you are suffering from a chronic hypertension then you should consult your doctor even before conceiving and take advice. Your doctor may change your medicines that you take to control your blood pressure. This is because some medicines such as angiotensin-converting-enzyme (ACE) inhibitors pass to the fetus and harm the fetus and can bring birth defects to your child. Sometimes doctors stop all the medicines that you take to control hypertension during the first half of the pregnancy because the blood pressure decreases naturally during this course of pregnancy. But a close watch to blood pressure during pregnancy is very important and to ensure a healthy pregnancy you must visit your doctor regularly.

Most women with chronic hypertension enjoy healthy pregnancy but in some cases gestational hypertension called preeclampsia is developed in a pregnant woman’s body. Preeclampsia is a serious disorder and can be detected by the detection of protein in the urine with high blood pressure. This disorder occurs after 30 weeks of pregnancy and must be treated immediately. The symptoms of preeclampsia are severe head ache, swelling on hands and face, and unbearable pain in stomach. Untreated preeclampsia can cause serious problems. In some rare cases, Preeclampsia can bring major complication called eclampsia, which may cause seizures and coma to patients.

Delivery is the only cure of preeclampsia. Sometimes the pains are induced to initiate early delivery. If preeclampsia occurs between 37 to 40 weeks of pregnancy then pains can be induced and preeclampsia can be treated without any major complications for both mother and child. If preeclampsia occurs before 37th week of pregnancy and the cervix of pregnant woman is not ready to take labor then doctors recommend some medications, complete rest, and closely monitor her for her health and for fetal development. Sometimes the patient is hospitalized and doctors wait for the labor pains to start naturally. In severe cases of preeclampsia, when it occurs between 33 to 34 weeks of pregnancy, the patient is hospitalized and is given a drug to speed up the maturity of fetus to avoid the premature delivery problems in the baby. After that labor pains are induced and baby is delivered.

All kinds of hypertensions can cause serious complications in pregnant woman. For example hypertension can block blood vessels in the uterus and reduce the supply of nutrition and oxygen to the uterus. It can cause preterm labor and placental abruption. It can also cause the baby to born with low birth weight. A premature baby can have serious health problems and everlasting disabilities. Thus it is very important to treat hypertension with utmost care during pregnancy and a woman should take the advice of her gynecologist even before conceiving and while planning a baby.

Iron-Deficiency or Anemia in Pregnancy

Your body’s iron requirements double during pregnancy because the amount of blood doubles during pregnancy to support growing fetus. Iron is required to make hemoglobin in blood. Hemoglobin is a protein in red blood cells, which carries oxygen to all the parts of the body. With the increase in amount of blood, the requirement of hemoglobin exceeds and thus the requirement of iron increases in the body during pregnancy. Your body requires 27 mg of iron during pregnancy, each day as compared to 17 mg of iron, which is your normal iron requirement. The additional iron requirement in body cannot be fulfilled by just taking iron rich diet each day therefore doctors recommend iron tablets as a preventive measure to avoid any severe repercussions of iron deficiency in a pregnant woman.

Iron deficiency can cause anemia in a pregnant woman and if a pregnant woman remains anemic in first two trimesters, then the chances of preterm delivery and a low weight baby increases. Sever deficiency can cause anemia in your baby too just after the birth of your baby. Usually fetus growing in a pregnant woman’s body takes care of its iron requirement before the pregnant woman will do. The available iron in your body is taken by the fetus thus you are more at risk than the fetus growing in your body unless server deficiency condition arises. Iron deficiency can make you feel sick, less energetic, and unable to fight with any infections in your body. You may feel dizzy, your heart rate increases, and you may need to get hospitalized for blood transfusion in some sever deficiency conditions.

Usually fatigue, less energy, weakness, and dizziness are common symptoms that a pregnant woman faces and therefore sometimes it becomes difficult to detect the occurrence of anemia. But if you are suffering from anemia you will have short breath, you will be unable to concentrate, and you will have heart palpitations. Your body requires more iron in second and third trimester of pregnancy and if you have morning sickness and vomiting or you have close pregnancies or multiple pregnancies, you are more likely at the risk of becoming anemic. To avoid any such condition, start your prenatal care early in pregnancy so that your doctors can test your blood for anemia and give you proper care.

Iron deficiency alone cannot be held responsible for anemia because anemia can also be caused due to the shortage of Vitamin B12 or folic acid, loss of blood, hereditary disorder of blood or any other disease. Under such circumstances taking iron supplements to cure anemia will not cure anemia rather proper treatment of anemia depends on its actual cause. If you are anemic due to iron deficiency, your doctor may prescribe 60mg to 120 mg iron in a day or more. You should take iron tablets in the morning empty stomach with orange juice or water. Orange juice can give you Vitamin C, which can help your body to absorb iron. Avoid taking iron tablets with milk because calcium in milk can hinder the absorption of iron in the body.  Consult your doctor before taking iron supplements because overdose of iron can upset your gastrointestinal tract and cause constipation. Finally don’t worry if your stool looks darker because that is a common side effect of taking iron.

Pregnancy and Heart Disease

Any woman suffering from some form of heart ailment should first discuss her condition with her health care provider before she decides to conceive and become pregnant. There is an average global figure of 1% pregnant women, who suffer from some form of heart disease during their pregnancy. The chances that women with congenital heart disease giving birth to a child with the same type of heart defect are very strong. A woman with heart problem needs special care during pregnancy and delivery to avoid any sort of complications. Even normal women may face some sort of heart problems during pregnancy because pregnancy places an increased demand on the heart. Some gestational heart problems include peripatum cardiomyopathy, hypertension, preeclampsia , blood clots, and others.

Heart diseases are very scary and are the third highest cause of death in women during or soon after pregnancy. They can also affect the fetus. The child in the womb does not develop properly and may not even survive the pregnancy and delivery process. Congenital heart defects that may develop in the fetus include abnormalities in the structure of the heart chambers and valves and also the vessels that carry blood to and from the heart. Heart diseases create complications for about 1-4% normal women without any pre existing cardiac abnormalities during pregnancy.

The heart is the hardest working muscle in the body and there is an increase in the volume of blood as the pregnancy progresses. During the first trimester, the blood increase to approximately 50 pecent more than normal and there is extra load on the heart. The pain, pressure and the force exerted during labor and subsequent delivery causes changes in the heart and vascular system. The contractions in the uterus moves a lot of blood from there and can cause the heart beat rate, the blood pressure, and the cardiac results to change and become high. Post delivery, again there are a number of changes in the heart beat and blood pressure because of extreme blood loss due to which the heart slows down .

Pregnant woman with heart problems show the following symptoms –

  • Palpitations
  • Difficulty in breathing
  • Dizziness and exhaustion
  • Heart murmur
  • The coloring of a person is blue because of low levels of oxygen in the blood called cyanosis
  • Enlarged heart

A heart disese symptom should not be ignored and a physician should be consulted for diagnosis. After a thorough examination of physical and medical history, the physician may recommend an ECG (Electrocardiogram) test and an Echocardiography test.

Some common cardiac problems during pregnancy are –

  • Mitral stenosis (MS) –  In this condition, a throat virus called streptococcus causes the heart valve between the left atrium and left ventricleis to narrow. This causes a pregnant woman suffer from problems such as irregular heartbeat, lung congestion, and  difficult breathing. Woman under such conditions need medication to regularise their heart and may also need some surgery involving the valve during pregnancy. Also during labor and delivery the heart and the pressure within the heart needs to be monitored invasively.
  • Ventrlcular septal defect (VSD) – In this condition, a malfromed and deformed opening between the right and the left ventricle leads to an out of control blood flow from the heart. The heart enlarges because it overworked. This VSD can pass on from the mother to the child.
  • Aortic stenois (AS) – In this condition, it becomes very difficult for the heart to supply blood to the whole body because the arotic valve between the left ventricle and the arota becomes very narrow and thin. A normal valve has three cusps where as a stenotic valve has only one or two. Women with serious Arotic stenosis are generally not advised to get pregnant because it may deteriorate the condition of the heart. In such cases invasive monitoring of the heart and the blood pressure is required. The patient under this condition is put on antibiotics to avoid any kind of infection.
  • Atrial septal defect (ASD) – In this condition, a deformed or out of shape opening between the two upper chambers of the heart causes a distorted blood flow through the heart. Pregnant women with this problem suffer from fatigue and no other serious complication arises but babies of such mothers may have the risk of getting this condition.
  • Mitral valve prolapse (MVP) –  In this condition, the mitral valves flaps (one or more) bulge during the heart contractions. The flaps do not close properly causing the blood to flow backward which results in a mitral regurgitation murmur. 12 percent of childbearing age women suffer from MVP but do not face any complications during pregnancy. Under this condition antibiotics need to be given during labor and delivery to prevent any kind of infection.

Women with heart diseases who get pregnant go through a lot of stress and tiredness due to all the physical changes in the body and their effect on the heart. They require an excellent prenatal care and a close watch to enable them to go through this period of challenges with good spirits and deliver a healthy baby froma healthy mother.

Sex During Pregnancy

Sex life and sexual relationships always tends to take a back seat during pregnancy. You are always thinking about the safety of the fetus during lovemaking. It should be noted that it is perfectly safe to have sex during pregnancy unless you have been advised otherwise by your doctor. The baby in the mother’s womb is absolutely safe and is protected by the amniotic fluid, the abdomen and the mucus plug which closes the cervix.

Expecting mothers find a decline in their sexual desires during certain stages in the pregnancy because they are more preoccupied with their present condition and with the thought of becoming a parent. There are times when they may find sex uncomfortable also. This fact needs to be communicated to their partner. They need to discuss other forms of intimacy such as kissing, holding hands and caressing. They can even discuss some more comfortable position for sex. Women at times tend to get uncomfortable with the way their body changes but men enjoy the changing shape of their partners with fuller breasts and rounder hips. Sex at times during pregnancy can be more enjoyable because there is an increase in the vaginal lubrication, no precautions for birth control have to be taken, and swelling in the genital areas helps certain people attain orgasms or multi orgasms.

Listen to the changes that your body is going through during pregnancy and accordingly make changes in your sexual lifestyle, so that you derive the maximum pleasure out of it. The sex positions which are comfortable before pregnancy and in early pregnancy can be very uncomfortable and unsafe during late pregnancy.

During the first trimester, it is very safe for a woman to indulge in normal sexual activity without causing any harm to the fetus.  Sex doesn’t cause miscarriage. The male sexual organ, penis, does not come in contact with the fetus at any time during pregnancy so it can’t do any harm

During the second trimester, the woman is sexually more sensitive and get aroused easily. This happens because more blood is circulating into your genitals and breasts and you have renewed energy. If the pregnancy has started showing and there is a large abdomen then the woman and her partner should experiment with alternate positions during this time.

In the last trimester of the pregnancy, there might be a few problems like back ache, swollen ankles, fatigue. Either of the two partners may be scared at this stage to indulge in sex. So the healthy option is to talk about one’s feelings and discuss your physical and emotional changes. One can even talk about the need for physical sex and the most comfortable position for love making at this stage. There should be openness about the comfortable positions. The non-missionary (woman on top) position during intercourse and orgasm is linked with reduced risk of premature delivery.

Couples should take pregnancy to be a time when they can learn to please and arouse each other with other means of love-making than penetration. This helps them to experiment and develop other means of pleasing each other sexually.

In a few situations your doctor may tell you to abstain from sex during pregnancy –

  • There is family history of miscarriage
  • Bleeding or vaginal discharge occur.
  • Symptoms of placenta previa occur or the placenta is low lying.
  • There is a broken water bag
  • If the cervix is dilated
  • Chances of STD (sexually transmitted diseases) in either you or your partner.
  • There is a family history or preterm labor

After the fourth month pf pregnancy, during sexual intercourse the woman should avoid lying flat on her back. You should look for alternative positions which are convenient and relaxing because you keep on growing in size. Some of these positions are –

  • Woman on top
  • Spooning (man behind woman)
  • Side lying with knees pulled up.

A mild cramping is very normal in low risk pregnancies after sex. This happens due to an increase in blood flow to the pelvic area during pregnancy, contractions of the uterus after orgasm. Oral sex is a very good and safe substitute when intercourse is not permitted during pregnancy. Mutual comfort and pleasure should guide your sex life. If there are certain issues where one of you is not comfortable, it is best to avoid it than be sorry later.

Infertility – Unable to get Pregnant

When a couple is unable to acquire pregnancy even after 12 months of unprotected sex and intercourse, then they are called Infertile. This type of infertility is termed as Primary infertility. There are other cases of Secondary infertility when a couple is able to get pregnant at least once but have not been able to conceive again.

The various male causes of infertility can be –

  • male impotence
  • hormone deficiency
  • scarring from sexually transmitted diseases
  • decreased sperm count
  • environmental pollutants
  • retrograde ejaculation
  • mumps

The various female causes of infertility can be –

  • ovulation dysfunction
  • hormone imbalance
  • ovarian cysts
  • pelvic infection
  • tumor
  • movement abnormality from the cervix through the fallopian tubes
  • scarring from sexually transmitted diseases
  • poor nutrition

About 30% to 40% of infertility is due to male factor and 40% to 50% is due to the female factors. For the remaining cases there is no specific cause which has been determined. We can even contribute it to inputs by both the partners. A woman’s peak fertility time is her early 20s. 35 years and beyond, a woman’s chances of conception are less than 10% per month. Chances that a healthy couple under the ages of 30, having regular sex will conceive are 25% to 30% per month.  About 10% to 20% couples face the problems of infertility. The causes of infertility, apart from age related, can also be multiple sex partners, past history of pelvic inflammatory disease in women, past history of orchitis or epididymitis in men, mumps in men, and eating disorder in women, anouilatory menstrual cycles, and a chronic disease like diabetes. Some birth control devices like IUD (intrauterine device) carries a great risk of future infertility and is not recommended to women who have not previously had a child. A woman using it before her first conception does it on her own risk and chances of infertility

The treatment to be carried out for infertility basically depends on the reasons for infertility. There are times when it may be treated with simple counseling and education. At times some simple medicines to promote ovulation or to treat infection may be the answer. Sometimes vitro fertilization, a very sophisticated medical procedure may be way out. The emotional consequence that a couple is facing because of infertility should most importantly be discussed and sorted out by them and help should be taken from their health care provider. The psychological impact of infertility may lead to depression, anxiety and at times even marital problems. Out of most of the infertility case, 85% to 90% cases can find a probable cause and using the treatments and helps available about 50% to 60% of them can conceive. About 15% to 20% couples also eventually get pregnant without going in for any treatment. .

Infertile couples may have to go through the following physicals examinations and tests –

  • The couple has to go in for a complete physical checkup along with their medical history.
  • An examination of the semen is done to determine the mass, thickness and also the count of the semen along with its motility, shape and speed.
  • A biopsy of the woman’s uterine lining and also of the man’s testicles.
  • Measuring basal body temperature – since higher temperature is related to ovulation.
  • The cervical mucus is checked to keep tract of its wetness and stretchiness during the ovulatory period.
  • Pelvic examination to check for cysts.
  • Laparoscopy to have a direct visualization of the pelvis.
  • Serum hormonal level test for both or either partner
  • Hysterosalpingography (HSG) an X-ray to know the route taken by the sperm from the cervix through the uterus and fallopian tubes is done.

There are alternative medicine treatments which treat the patient as a whole rather than only the infertility.  The alternative medical treatments like ayurveda, reiki, yoga, aromatherapy, homeopathy, naturopathy, acupuncture, and acupressure work in conjunction with each other rather than individually. Although treatments such as aromatherapy, reiki, and yoga do not directly treat infertility but they definitely reduce the additional strain that infertility place on couples. Some essential oils used in aromatherapy affect nervous system, reduces blood pressure, relaxes muscles, and eliminate emotional stress. Acupressure is said to re-balance the bio-energy of the body and cures hormonal imbalance, which may cause infertility. The relationship between the mind and body cannot be ignored and this is where alternate medicines find their place.

Alternative medicine treatments should be used in combination with the scientific treatments and under the guidance of your infertility specialists. Before using the alternate medicine treatments, you must understand the strengths and limitations of this system and use them only as much is required. These treatments do give results and patients conceive but till today they have not found a universal acceptance due to lack of scientific base.

Pregnancy and Diabetes

Pregnancy brings with it the happiness and fears of having a baby. A pregnant woman who is suffering from diabetes has to be extra careful about the effects diabetes can have on her baby right from conception to its birth. The biggest challenge for you in a diabetic pregnancy is to keep a check on your blood sugar levels. As the pregnancy progresses, all possible precautions must be taken to avoid any kind of complications.

To keep your blood sugar levels under check and control, you can refer to the following health specialists or doctors who will help you to manage your sugar levels during pregnancy.

  • An obstetrician – they have experience in dealing with high risk pregnancies and diabetic pregnant women.
  • An endocrinologist – they specialize in the treatment of diabetes.
  • A dietician – they will help you to plan a healthy meal to be consumed during and after pregnancy to keep your blood sugar levels under control.
  • A neonatologist – they specialize in taking care of sick babies specially ones who are born to diabetic women.

As your pregnancy progress, you have to keep a watch on the progress and growth of the baby and your health. During the first trimester, first 10 to 12 weeks, your endocrinologist or obstetrician will help to keep your blood sugar levels close to normal because the baby’s organs are developing at this time. This is done by a regular blood sugar monitoring. Any carelessness at this time may lead to birth defects in the baby.

In the second trimester, the congenital anomalies in the fetus are checked by an ultrasound. This is because the congenital anomalies can affect your pregnancy. For diabetic patients too much of weight gain during pregnancy is not advisable and if you gain too much of weight then you may need to consult a dietician to keep it in check. Also the insulin requirements of your body will increase gradually from 16th week to 20th week and then suddenly shoot up since the hormones made in the placenta, which are needed for the baby’s growth block the effect of insulin

In the third trimester which is the last stage of the pregnancy, your doctor will keep a check on any complications related to diabetes  like high blood pressure, swollen ankles, and kidney buildup. Because the diabetic women usually give birth to overweight babies therefore another ultrasound is done to check the size and weight of the baby. This also checks out if the placenta is working properly and everything is under control.

A number of women develop diabetes during pregnancy which is referred to as “gestational diabetes” which may or may not go after delivery. Gestational diabetes during pregnancy can be controlled by taking proper diet and exercise as suggested by your doctor but in certain cases the patient needs to take insulin also to control it.

If gestational diabetes is not controlled during pregnancy, your baby can also develop low blood sugar level. The baby under such circumstances must be watched very closely till the body of the baby adjusts with the amount of insulin it makes. During pregnancy a number of changes happen in your blood sugar and if a control is not kept on the sugar level, you may end up getting various problems related to diabetes and if you already have these problems, they might get worse. Blood sugar levels if not controlled may lead to a miscarriage or may cause high blood pressure. The high blood pressure may lead to an early delivery and at times can even lead to seizures or strokes during the labor and delivery. At times out of control blood sugar levels, may cause a women to make extra large amount of amniotic fluid and this leads to an early delivery. Another problem of uncontrolled sugar levels is that the baby grows too large and causes a discomfort to the carrying mother along with a number of complications during the delivery.

Risk factors present before pregnancy

There are certain physical and social risk factors, problems of previous pregnancies, and certain pre-existing disorders in women before they become pregnant, which may pose problems during pregnancy and subsequent deliveries. Physical characteristics such as age, weight, and height of women also have an effect in the risks involved in pregnancy. Young mothers in age group of 13 to 15 years have increased chances of giving birth to underweight or undernourished babies. Women above 35 years have more chances of getting gestational diabetes, high blood pressure, and complicated labor. Underweight women have small and underweight babies and obese women have large babies with difficult deliveries. Any structural defects in the reproductive organs may lead to miscarriages because weak cervix tends to open as the fetus grows. Women from lower socio economic backgrounds have more problems and risks during pregnancy because they aren’t eating a proper and healthy diet and also have bad living habits such as smoking and drinking.

If you had any problems in the previous pregnancy, then these problems may recur in the subsequent pregnancies also. Problems such as premature baby, underweight baby, and baby with birth defects, a late delivery, and Rh incompatibility, which requires blood transfusion may all recur during the next pregnancy and need to be handled with care and precautions.

When a woman, who already has a pre-existing disorder, becomes pregnant, the risk factor during pregnancy increases. They should consult their doctor and try to be in the best physical condition before pregnancy. After conception they should follow the advice of their consultant team, which may include an obstetrician, a disorder specialist, and other health care practitioner. The various disorders may include –

  • High Blood Pressure – During pregnancy the blood pressure problem increases and worsens causing an untimely detachment of placenta from the uterus, stillbirth, undernourished growth of fetus and preeclampsia. For women with blood pressure higher than 150/100 mm Hg, treatment with anti-hypertensive drugs is done. This reduces the risk of stroke and related complications. High blood pressure at times also causes damage to the kidneys. Pregnant women need to be monitored to check the blood pressure, proper functioning of kidneys and fetal growth. Stillbirth can be avoided by going in for premature deliveries.
  • Kidney problems – During pregnancy kidney functions become worse. There may not be proper growth of the fetus and the problem of high blood pressure also becomes worse. A proper monitoring of the fetal growth and early delivery are the appropriate solutions to this problem
  • Seizure Disorders – The frequency of seizures does not change during pregnancy and you may have to increase the dosage of the anticonvulsant to treat them. Taking an anticonvulsant increases the chances of birth defects and should therefore be taken in consultation with the doctors.
  • Sexually transmitted diseases – Women infected with this disease can have a preterm labor or early rupture of membrane of the fetus. Some of the diseases like Syphilis cause severe birth defects and can be transmitted to the baby from the placenta.  The HIV virus can also be passed on to the baby. Hence necessary precautions under the care of a health care provider and a specialist are advised.
  • Heart Diseases – The heart needs to work harder during pregnancy and its condition may worsen during pregnancy due to more pressure on it. If the heart is not in a fit condition, it may lead to death of the woman or the fetus. Women with heart disease have a tough time and need to limit their activities as they tend to become tired quickly. Even post delivery the condition of the heart may not be totally fit, depending upon the heart disease and its intensity. But most of the women with heart problems can give birth to healthy babies without any ill effects to their heart.
  • Diabetes – Diabetic women have a higher risk in pregnancy and may suffer from problems like high blood pressure and kidney damage. The level of sugar in the blood needs to be controlled and kept as normal as possible so that the risk factor can be reduced. A well planned diet, exercises, and insulin should be started before pregnancy. Badly controlled diabetes increases the chances of miscarriage, birth defects, still birth, large fetus causing delivery problems. Also such a fetus has large lungs which develop very slowly causing complications.
  • Liver and Gall bladder disorders – The chances of miscarriage or premature deliveries for women with cirrhosis of liver or viral hepatitis are very high. These women suffer from varicose veins and have more chances of bleeding from these veins especially during the third trimester. Gall bladder stones may necessitate surgery which is quite safe for the woman and the fetus.