If you have an existing medical condition you should consult with your specialist about planning for pregnancy.
Your medical condition may impact on your pregnancy, labour and birth and postnatal experience, your specialist team will collaborate with your maternity care team in order to provide you with the most appropriate care.
***Key Points***
Some women experience medical conditions that may have an impact on their pregnancy care choices.
These may include: asthma [or respiratory disease], diabetes, cardiac disease, epilepsy, problems due to previous injury including car accidents or birth, high blood pressure or previous surgery [this list is not inclusive of every medical condition that may impact on your pregnancy, birth and postnatal period].
Most importantly your specialist and maternity care providers collaborate in order to provide you with the most appropriate care to your needs.
In the majority of cases your pregnancy will be considered high risk as you will need more careful monitoring of your health and your baby’s.
Some symptoms may get worse due to the pregnancy and you may need changes to your medication or your treatment options may change.
***Key Points***
***Asthma***
If you have asthma before pregnancy it should not cause any problems if you manage it well. Most asthma medications are safe during pregnancy and it is usually better for you and your baby to take the medication rather than have your symptoms get worse if you don’t take medication. It is advisable to talk with your treating doctor about medications and pregnancy. For about one third of women their asthma will not change during pregnancy, for another one third their asthma will improve and for the other third they will notice their asthma getting worse during pregnancy. There is a chance that women with very bad asthma may develop high blood pressure or pre-eclampsia during pregnancy. If your asthma is not managed well there is a chance that your baby may be born early or have a low birth weight.
***Asthma***
***Diabetes***
Diabetes – it is important to manage your diabetes well if you are planning pregnancy or just found out you are pregnant. You will have a specialist team caring for you to help manage your diabetes and to carefully monitor your pregnancy. Keeping your blood sugars stable during pregnancy is important for the health of you and your baby.
There is a chance that you could develop eye or kidney problems during the pregnancy if your sugars are not well maintained. You also have a higher chance of developing pre-eclampsia which is a serious complication of pregnancy that may also affect your baby and cause a pre-term birth.
Your baby may have a higher chance of being born with some complications including – weighing more than average, being stillborn or having an abnormality, or developing diabetes later in life. Your doctor may recommend an induction of labour due to the effects of the diabetes on you and your baby. Both you and your baby will be monitored after the birth to check your sugar levels.
***Diabetes***
***Cardiac disease***
Cardiac disease – if you have pre-existing cardiac disease it is recommended that you speak with your treating doctor about your plans to get pregnant. Pregnancy increases your blood volume by about 30%-50% and during labour and birth increased pressure is placed on the heart and blood flow through the body.
Due to these added pressures, if you have cardiac disease it is recommended that you have an assessment by a cardiologist as part of your pregnancy care planning. You might develop high blood pressure during the pregnancy or if you have an epidural it might cause low blood pressure, throughout pregnancy, labour and birth there are constant changes to your blood pressure, heart rate and cardiac output.
This means that you may not have had problems before pregnancy but pregnancy may cause you to experience exacerbated symptoms.
***Cardiac disease***
***Epilepsy***
Epilepsy – as with other pre-existing conditions, careful management of your epilepsy you’re your specialist care team is important. Your medications may need to be changed or modified, aiming for the lowest dose to prevent seizures. About 95% of women with epilepsy have a successful pregnancy.
A detailed ultrasound is recommended at 18-20 weeks to specifically assess the heart, kidneys and presence neural tube defects. You will be more closely monitored during your pregnancy and labour and birth. The importance of rest and good quality sleep is particularly important during pregnancy.
Your baby will be more closely monitored after the birth, breastfeeding is encouraged but make sure you talk to your doctor or midwife about the type of medicine you are taking.
When you are home it is suggested that you feed your baby sitting on the floor, bath your baby when someone else is around, try not to carry your baby around too much and have an automatic brake on your pram.
***Epilepsy***
***High blood pressure***
High blood pressure – also known as chronic hypertension [also if high blood pressure was found before 20 weeks of pregnancy it will be called chronic hypertension] usually a blood pressure reading of more than or equal to 140/90 [140 over 90].
You may already be receiving treatment for your high blood pressure and will be taking medication to manage it. Your doctor or midwife will encourage a healthy life-style, including eating healthy, nutritious food, participating in regular exercise, maintaining a healthy weight and if you smoke to try to give up.
You will be more closely monitored during pregnancy and labour for signs that you may be developing pre-eclampsia. There is a higher chance of developing complications such as a placental abruption, pre-eclampsia, pre-term birth, low birth weight, perinatal death and gestational diabetes.
***High blood pressure***
***Pre-existing injury***
Pre-existing injury/surgery – you may have had an accident, injury or surgery that may impact on your choices during pregnancy or labour and birth. Things such as injury or surgery to the pelvis or spine may influence options for birth or pain relief during labour, or may affect your ability to be mobile during labour.
Breast surgery may influence your choices regarding feeding your baby. It is important to talk to your doctor about how this might affect your choices during pregnancy, labour and birth and the postnatal period.
***Pre-existing injury***
Resources
Department of Health WA – pre-existing conditions that can affect pregnancy
Family Education – managing pre-existing illness in pregnancy
Health Direct – Asthma and pregnancy
Diabetes Australia – pregnancy
Heart Foundation – heart disease and pregnancy
SA Health – guidelines epilepsy and pregnancy management
RACGP – epilepsy and pregnancy
Epilepsy Foundation – pregnancy planning
Department of Health – blood pressure
