“High risk” are two little words capable of causing big worries for expectant moms. Yet through technology and highly specialized medicine, much can be done to address the different risk factors of pregnancy.
Les Heddleston, MD, Perinatologist with the Avera Medical Group Maternal Fetal Medicine, said a healthy, proactive concern is more productive than worry and anxiety. “If you do nothing but worry, you waste energy. If you’re concerned, take time to become educated, work with your provider and do what you can to lessen the risks.”
Among risk factors are a history of preterm labor or delivery, a history of pregnancy loss, an incompetent cervix, high blood pressure, diabetes and medical conditions such as thyroid disease or blood clotting disorders.
Previous problems in pregnancy or difficult deliveries indicate a woman might have similar problems again. Even situations like twins or triplets on the way, being over the age of 35 or significant weight issues can present risks during pregnancy.
Maternal Fetal Medicine is a subspecialty of obstetrics/gynecology dealing with high-risk pregnancy. If complications arise, perinatologists work in cooperation with a patient’s regular care provider, as well as other sub-specialists.
Most complications can be treated and managed for a good outcome. “Our goal is a healthy mom, and a healthy baby,” said Heddleston.
One common complication is gestational diabetes, which happens in up to 9 percent of pregnancies. Gestational diabetes is high blood sugar that happens only during pregnancy. Typically, pregnant women are screened for high blood sugar in their 24th to 28th week. If a woman is at high risk, her provider might choose to screen her earlier.
For the health of the mother and baby, gestational diabetes is not something to be ignored, Heddleston said. It can lead to preterm delivery and risks to mother or baby at the time of delivery.
Even if all goes fine with pregnancy and delivery, uncontrolled diabetes during pregnancy might cause the child to experience future problems with obesity, motor function or hyperactivity.
When gestational diabetes is detected, doctors prescribe special dietary instructions that include carb counting and regular exercise. If diet and exercise aren’t enough to control blood sugars, the condition can be treated with oral medications or insulin.
For most women, gestational diabetes disappears after the pregnancy, although it increases your chances of getting type 2 diabetes later in life.
Another example is preeclampsia, in which blood pressure in a pregnant woman can rise to a life-threatening level. A condition that happens in 5 to 10 percent of pregnancies, preeclampsia tends to show up in the second or third trimester with symptoms such as high blood pressure, headaches, blurry vision or abdominal pain. OB providers regularly screen for this condition, and if it happens, your doctor might prescribe high blood pressure medications and/or bed rest. In severe cases, women may require hospitalization and even premature delivery.
“These are cases in which we can make a dramatic impact,” Heddleston said, cases in which the mother or baby would not survive without immediate intervention.
Other times, the work of a perinatologist is a matter of waiting and watching for the best time to deliver – late enough for the baby’s optimal development, and early enough for the health of the mother. Heddleston recommends that patients find a provider they are comfortable with, and then follow their provider’s advice. “It’s always better for patients to be proactive in understanding their risk factors.”