Pre-existing disease in pregnancy
A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy (such as causing pregnancy complications). A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.
In such circumstances, women who wish to continue with a pregnancy require extra medical care, often from an interdisciplinary team. Such a team might include (besides an obstetrician) a specialist in the disorder and other practitioners (for example,
Chronic hypertension
Chronic hypertension in pregnancy can lead to increased complications for both the mother and fetus. Maternal complications include superimposed pre-eclampsia and caesarean delivery. Fetal complications include preterm delivery, low birth weight, and death. Increasing rates of obesity and metabolic syndrome play a key role in the increased prevalence of chronic hypertension and associated complications.[1] Women who have chronic hypertension before their pregnancy are at increased risk of complications such as premature birth, low birthweight or stillbirth.[2] Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing cardiovascular disease compared to women with normal blood pressure who had no complications in pregnancy. Monitoring pregnant women's blood pressure can help prevent both complications and future cardiovascular diseases.[3][4] While high blood pressure treatment has been shown to decrease the incidence of severe hypertension during pregnancy, there was no significant difference in pregnancy complications (for example, superimposed pre-eclampsia, stillbrith/neonatal death, small for gestational age).[5]
Endocrine disorders
Diabetes mellitus
Thyroid disease
Thyroid disease in pregnancy can, if uncorrected, cause adverse effects on fetal and maternal well-being. The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child. Demand for thyroid hormones is increased during pregnancy which may cause a previously unnoticed thyroid disorder to worsen. The most effective way of screening for thyroid dysfunction is not known.[6] A review found that more women were diagnosed with thyroid dysfunction when all pregnant women were tested instead of just testing those at 'high-risk' of thyroid problems (those with family history, signs or symptoms).[6] Finding more women with thyroid dysfunction meant that the women could have treatment and management through their pregnancies. However the outcomes of the pregnancies were surprisingly similar so more research is needed to look at the effects of screening all pregnant women for thyroid problems.[6]
Hypercoagulability
When combined with any additional underlying hypercoagulable state, the risk of thrombosis or embolism may become substantial.[7] Multiple pre-existing genetic disorders can worsen the hypercoaguable state observed in pregnancy. Examples include:
- Factor V Leiden
- Prothrombin G20210A
- Protein C deficiency
- Protein S deficiency
- Antithrombin III deficiency
Infections
Vertically transmitted infections
Many
- Toxoplasma
- Other: Parvovirus B19, Zika, Chickenpox
- Rubella
- Cytomegalovirus
- Neonatal herpes simplex
- HIV[8][9]
- Syphilis[10]
Infections in pregnancy also raise particular concerns about whether or not to use
Candidal vulvovaginitis
In pregnancy, changes in the levels of female sex hormones, such as
Bacterial vaginosis
Valvular heart disease
In case of
In individuals who require an artificial heart valve, consideration must be made for deterioration of the valve over time (for bioprosthetic valves) versus the risks of blood clotting in pregnancy with mechanical valves with the resultant need of drugs in pregnancy in the form of anticoagulants.
Other autoimmune disorders
Celiac disease
Untreated
Systemic lupus erythematosus
Behçet's disease
Pregnancy does not have an adverse effect on the course of
Multiple sclerosis
Being pregnant decreases the risk of relapse in
Mental health
Depression in pregnancy
The effects of depression during pregnancy are difficult to parse from depression before pregnancy as the symptoms of the two overlap. However, the biggest risk factor of depression during pregnancy is a prior history of depression.[25] Most of the research is focused on the consequences of untreated depression regardless if the depression developed during pregnancy or if it was there before conception. Untreated depression has been linked to premature birth, low birth weight, fetal growth restriction, and postnatal complications.[25] On the other hand, however, anti-depressant medications also come with a small risk of pre-term birth, low birth weight, and persistent pulmonary hypertension.[26][25]
Respiratory disease
Asthma
In the United States, the prevalence of asthma among pregnant women is between 8.4% and 8.8%.[27] Asthma in pregnant women is strongly associated with multiple adverse health outcomes, including pre-eclampsia, preterm birth, and low birth weight.[28][29] Other conditions such as gestational diabetes, placenta previa, and hemorrhage are inconsistently correlated to asthma.[30] Additionally, women with Asthma face a higher likelihood of complications during labor and delivery, such as breech presentation and caesarean delivery.[31] Poorly controlled and severe asthma may exacerbate conditions associated with maternal and neonate morbidity and mortality.[30][32] Asthma treatment recommendations during pregnancy are similar to those in non-pregnant women.[33]
As of 2018, Asthma was the most prevalent respiratory disorder to complicate pregnancy, remaining a high-risk condition despite therapeutic advancements.[34] Preventing asthma exacerbations during pregnancy is crucial to reduce the risk of complications and poor outcomes.[31]
The course of asthma during pregnancy
The course of asthma during pregnancy can vary, with some patients experiencing worsening symptoms while others see improvement.
As of 2006, it was believed the course of asthma during pregnancy varied with a similar proportion of women improving, remaining stable, or worsening.[35] However, as of 2013, it was found that deterioration may manifest in approximately 20% of women, improvement in around 30%, and no significant change observed in the remaining 50%.[36]
Structural (congenital) abnormalities of the uterus
Structural abnormalities of the uterus include conditions like septate uterus, bicornuate uterus, arcuate uterus, and didelphys uterus.[37] Most of these abnormalities occur when the Müllerian ducts are fused improperly or incompletely. Women with these congenital abnormalities are usually unaware as these conditions do not usually do not present any symptoms. During pregnancy, these conditions are associated with infertility, preterm birth, fetal malpresentation, and early miscarriages. Among these uterine abnormalities, those with canalization defects, i.e., not having a normal uterine canal such as septate defects have the worse pregnancy outcomes.[37] Surgical treatment is only recommended for individuals who have had recurrent miscarriages and have a septate uterus; however, the risks of surgery, especially scarring of the womb should be considered. Further evidence from randomized controlled trials are required to establish conclusively whether surgery is the better option when its risks and rewards are compared with the risks of the adverse pregnancy outcomes.[37]
Others
The following conditions may also become worse or be a potential risk to the pregnancy:
- Cancer[MMHE 2]
- Chronic hypertension[MMHE 3]
- Cirrhosis[MMHE 4]
- Congenital disordersthat may be passed on to offspring
- Eisenmenger's syndrome[MMHE 5]
- Kidney disorders[MMHE 6]
- Mental health.
- Depression has been linked to higher rates of preterm delivery.[38]
- Depression has been linked to higher rates of
- Respiratory disorders and diseases (associated, for example, with placental abruption)[39]
- Seizure disorders[MMHE 7]
- Structural abnormalities in the cervix
- Structural abnormalities in the uterus
- Viral hepatitis[MMHE 8]
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- ^ Merck. "Cancer during pregnancy". Merck Manual Home Health Handbook. Merck Sharp & Dohme. Archived from the original on 2015-03-28. Retrieved 2013-08-13.
- ^ Merck. "High blood pressure during pregnancy". Merck Manual Home Health Handbook. Merck Sharp & Dohme. Archived from the original on 2015-03-02. Retrieved 2013-08-13.
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