Having chronic health conditions doesn't mean you can't have a smooth pregnancy. Here's what you need to know.
FACT: 30 percent of women who have asthma find that their condition improves in pregnancy.
Any pregnancy -- and especially your first -- is bound to bring worry. But when you have a condition such as asthma, epilepsy, or an autoimmune disease, it's natural to be even more concerned. Chronic diabetes and high blood pressure are perhaps the best-known conditions women need to manage while pregnant, but the four chronic disorders profiled here can also be worrisome to women and their doctors. Here's what you need to know to ensure a healthy pregnancy and baby if you have one of these conditions.
If you have asthma, which affects roughly eight percent of pregnant women, be prepared for a possible change in your condition, says Martha V. White, MD, research director at the Institute for Asthma and Allergy, in Wheaton, Maryland. "About 30 percent of pregnant women with asthma will have asthma that gets worse, for about 30 percent it will get better, and for the other third it stays the same," she explains, and she adds that it's nearly impossible to predict which camp you'll fall into.
This means that during pregnancy you should see your allergist or pulmonologist every month for a lung function test to check if your medications need to be adjusted. It's likely you'll also self-monitor your breathing with a device called a "peak flow meter," which determines how open your airways are.
Will Asthma Medication Affect My Baby?
Not surprisingly, the biggest question facing an asthmatic mother-to-be is whether the drugs she is taking will affect her baby. While albuterol and inhaled steroids are considered safe in pregnancy, other newer asthma medications, like Advair, do not have a proven track record. You'll need to work with your doctor to find the drug combination that's right for you.
Whenever possible, Dr. White chooses inhaled drugs for her pregnant patients. "That way the lungs see the drugs, but the rest of the woman's body doesn't," she explains. This reduces the fetus's exposure to the drugs. Severe asthma might need to be treated with oral corticosteroids like prednisone, which has not been established as safe for pregnant women. However, severe, uncontrolled asthma poses a worse risk -- after all, the fetus will be deprived of oxygen that it needs, too, so the use of these medications might be warranted.
Because you're breathing for two, it's vital to stay on top of symptoms. Ideally, you'll stop them before they start. Keep a lid on asthma triggers such as animal dander, respiratory infections, smoke, dust mites, pollen, cockroaches, and indoor mold. Unless the asthma is very mild, most asthmatic women take both an anti-inflammatory medication and a fast-acting drug to treat wheezing and shortness of breath. The condition tends to worsen during the second trimester and most of the third, so make a particular effort to keep symptoms under control during this period.
On the upside, symptoms might improve during the last month of pregnancy, thanks to hormonal changes, says Dr. White. Interestingly, a 2006 study in the American Journal of Epidemiology found that pregnant women carrying a girl were likely to have worse asthma symptoms than those expecting a boy; researchers think that the androgens (male sex hormones) boys produce might have a protective effect for asthmatic moms-to-be, especially from the second trimester on.
FACT: 90 percent of moms-to-be who have epilepsy will have a healthy pregnancy.
The good news for pregnant women with epilepsy is very good: While seizure disorders affect about 1 million women and girls, more than 90 percent of moms-to-be with this disease have healthy babies, according to the Epilepsy Foundation. As with other chronic conditions, working closely with your doctor to manage your condition is key, says Marianna V. Spanaki, MD, PhD, senior staff neurologist at Henry Ford Hospital and an associate professor at Wayne State University, in Detroit.
During pregnancy, your body goes through so many changes -- including your weight and the way your kidneys metabolize drugs. Your kidneys may remove antiepileptic drugs (AED) from your system more quickly than usual -- the levels could drop to 50 percent of what they were prepregnancy, say Dr. Spanaki. That means making monthly visits to your neurologist for blood tests to ensure you're on adequate dosages. Your doctor will aim to put you on the lowest effective dose and to use just one drug if possible. He'll also check to see that you're getting adequate levels of folic acid -- Dr. Spanaki recommends at least 800 micrograms daily -- very early in pregnancy, because epileptic women are at an increased risk of having a baby with neural tube defects.
Women with epilepsy are also at greater risk for morning sickness, vaginal bleeding, placental abruption (in which the placenta detaches from the uterine wall), preterm labor, and bleeding problems in the baby following delivery. The best way to ensure an uneventful pregnancy is to take your antiseizure medication exactly as your doctor has instructed. "Some people think that if they don't take their medication, they will eliminate problems with the baby, but this isn't true," Dr. Spanaki stresses. "They shouldn't stop their medication or drop their dose."
As with asthma, about one-third of women will have more seizures, one-third will have the same number, and the other one-third will have fewer. Dr. Spanaki says women who had infrequent or no recent seizures prior to conception and who take their medicine as prescribed are most likely to get through pregnancy without a seizure. However, the unhappy truth is that following the rules does not always protect your child from birth defects. The general risk for having a baby with birth defects is two to three percent; for women on AED, it's six percent.
Seizures pose their own potential risks to both you and your child. "If a woman falls during a seizure, she may injure herself and the baby," says Dr. Spanaki. (These grand mal seizures, characterized by loss of consciousness, falling down, or a loss of bowel and bladder control, present the greatest risks.) "They also compromise the blood flow to the baby," she explains. "You may also have preterm labor, in which case we may be concerned about the cognitive development and birth weight of the baby." Less serious, "partial" seizures during pregnancy haven't been studied.
Besides sticking to a well-monitored AED regimen, a woman should make getting enough sleep a top priority. Sleep deprivation can bring on seizures, says Dr. Spanaki, who stresses frequent naps and a good night's sleep "at any cost." A balanced diet is also important, and if morning sickness is causing vomiting that may impair absorption of your medication, talk to your doctor.
When it comes time for labor and delivery, you can rest a little easier: Seizures seldom occur during childbirth. "Although this is one of their biggest fears, women don't seem to have many seizures at this time," says Dr. Spanaki.
Lupus and Rheumatoid Arthritis
FACT: 75 percent of all autoimmune disorders, such as lupus, occur in women, most often during their childbearing years.
Autoimmune disorders like lupus and rheumatoid arthritis (RA) seem to primarily afflict women; in fact, some 75 percent of these conditions -- in which the body mistakenly attacks healthy tissue -- occur in women, and most often in their childbearing years, according to the American Autoimmune Related Diseases Association.
If you have lupus, the most common symptoms -- joint pain, fever, rashes, chest pain, and shortness of breath -- are likely to worsen while you're expecting, says Megan E.B. Clowse, MD, an assistant professor of rheumatology and immunology at Duke University Medical Center, in Durham, North Carolina. "Because lupus affects the joints, blood pressure, kidneys, and brain, it tends to cause more general problems than Rheumatoid Arthritis (RA), which essentially affects the joints."
To keep flare-ups at bay, you'll need to make a monthly trip to your rheumatologist to ensure that any signs of lupus are quickly controlled. Even when your lupus is well in hand, the condition can still increase your risk for preeclampsia (or pregnancy-induced hypertension), perhaps due to the fact that prednisone, often taken to control inflammation, can raise blood pressure. A 2006 study in Arthritis & Rheumatism found that the risk for hypertension was three times higher in women with lupus.
When it comes to rheumatoid arthritis, which usually causes pain in the joints, especially in the wrists and hands, pregnancy offers an upside. "About 75 percent of women with RA will improve during pregnancy,? says Dr. Clowse. In fact, you may even be able to stop your medication while pregnant." However, there's also some not-so-good news for RA sufferers: 25 percent will have a preterm birth, you're more likely to have a smaller baby, and the majority of patients who got a reprieve from symptoms while expecting will have what Dr. Clowse calls "a significant recurrence within the six months following delivery."
With either condition, make an appointment to see your rheumatologist within a month of arriving home from the hospital. "To ward off a big flare-up, which can happen with both RA and lupus, you want to get back as soon as possible on any medications that were stopped for the pregnancy," says Dr. Clowse.
But no matter what your condition, take heart in knowing that if you actively manage it over those nine months, you're apt to have a happy outcome.
How Pregnancy Affects Thyroid Disorders
Having a baby can do quite a number on the thyroid, a butterfly-shaped gland in your neck that releases hormones regulating nearly every process in the body. There are three ways pregnancy can affect your thyroid:
Hypothyroidism (Low Levels of Thyroid Hormone)
Hypothyroidism affects nearly one out of 50 pregnant women, according to the American Association of Clinical Endocrinologists. Some enter into pregnancy with the disorder; others develop the condition during pregnancy. Symptoms -- like fatigue, forgetfulness, weight gain, and constipation -- often overlap with those of pregnancy, so the condition can go undiagnosed. Plus, some women have no signs at all.
If you suspect you have hypothyroidism, ask your doctor for a simple blood test. Pregnancy complications such as premature birth and miscarriage have been associated with the condition, says Jeffrey R. Garber, MD, author of The Harvard Medical School Guide to Overcoming Thyroid Problems (McGraw-Hill), so you'll want to get treatment.
Hyperthyroidism (High Levels of Thyroid Hormone)
Hyperthyroidism is far less common, affecting about one in 500 pregnancies, but harder to treat because the drugs prescribed for it can harm a baby. It may also be confused with hyperemesis gravidarum, a severe form of morning sickness, says Dr. Garber. Symptoms include a fast heart rate, nervousness, weight loss, intolerance to heat, and bulging eyes.
Postpartum thyroiditis affects up to 10 percent of new moms, says the American Thyroid Association. Signs include anxiety, insomnia, fast heart rate, weight loss, and fatigue. Many of these are also the hallmarks of having just given birth, so it's not uncommon to confuse postpartum thyroiditis with postpartum depression. "Sometimes a goiter (enlarged thyroid) is a tip-off, and ob-gyns are attuned to that at the six-week postpartum visit," Dr. Garber says. But your doctor might not pick up on a thyroid issue that has less recognizable symptoms.
Lorie Parch is a freelance writer based in Scottsdale, Arizona.
Originally published in American Baby magazine, June 2007.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.