Managing Preexisting Illnesses During Pregnancy
Diabetes and epilepsy
Whether you have a preexisting medical condition, or acquire an illness or infection during pregnancy, always consult your doctor before taking medication or before stopping any prescribed medication.
If you have a condition such as high blood pressure or diabetes prior to pregnancy, your pregnancy will be classified as high risk and you'll need to be monitored carefully. If you become pregnant while taking medication for a condition, don't stop taking the medication, but consult your doctor as soon as possible. You may find that your existing medication is safe, or you may need to change to another type of medication. The most important thing is to control your condition during pregnancy to minimize the risks to you and your baby, which will usually mean continuing with medication.
Diabetes
If you have diabetes and are planning to conceive, you need to get advice on how to manage your condition. Meet with your doctor while you're thinking about conceiving to discuss the best way to control your blood sugar levels and talk about how diabetes will be managed in pregnancy. Women with diabetes are advised to take a prenatal vitamin with folic acid before trying to conceive and for the first three months of pregnancy. Diabetic women who are overweight may be advised to lose weight before getting pregnant, and they'll likely be told to monitor their blood sugar more frequently and take their medications on time during their pregnancy. Babies born to diabetic women also have a greater risk of other problems, such as having a large birth weight, respiratory problems at birth, jaundice, and low blood sugar at birth.
As soon as you're pregnant, you should be referred to an obstetrician who specializes in pregnancy and diabetes where you'll receive extra care. You will have more frequent prenatal visits, additional scans, and extra blood tests to monitor your blood sugars. You may need diabetes medication and/or insulin injections each day; the dose usually changes throughout pregnancy and needs to be monitored. The better your blood sugar control, the less likely you or your baby is to experience problems during pregnancy.
Since diabetic women have an increased risk of late pregnancy problems such as preeclampsia and premature labor, you may be advised to have an induction of labor a week or so before your due date .
Once in labor, your blood sugar levels will be closely monitored, and you will probably be given an insulin IV. After the birth, your baby's blood sugar levels will be closely monitored too for around 24 hours. If you're planning to breast-feed, which is recommended, your insulin dose may need to be changed after the birth.
Epilepsy
If you have epilepsy, it's very important to discuss pregnancy with your doctor before you become pregnant, since certain drugs carry a small risk of causing harm to the developing baby. Nonetheless, it's also important that your epilepsy is controlled, so your doctor will try to ensure that you're on the lowest possible dose of medication before you get pregnant. When you are pregnant, the anomaly scan at around 20 weeks will check for problems such as cleft palate, which are slightly more common with certain medications. If your condition worsens in pregnancy, contact your doctor.
Systemic lupus erythematosus
This is an autoimmune disorder that can affect many parts of the body, including the kidneys, joints, skin, nervous system, heart, and lungs. The condition is more common in women, and particularly in those of childbearing age. Some women find that the symptoms for this condition ease during pregnancy, however for some they can worsen. It's important to control the condition during pregnancy since it can affect the developing baby, with an increased risk of miscarriage, poor growth, premature labor, and stillbirth. Most medications for lupus are safe to use during pregnancy, but some aren't, so you need to check with your doctor about whether you need to change your current medication. From around 32 weeks, your baby will be closely monitored and his growth and well-being will be checked. If there are concerns about you or your baby, labor may be induced early, or you may have a planned cesarean.
Continuing with asthma medication is important to keep symptoms under control in pregnancy.
High blood pressure, thyroid problems, and bowel disease
High blood pressure
If you have high blood pressure that requires medication, check with your doctor that the medication you are on is safe to use during pregnancy. It's important to continue your medication so that your blood pressure is controlled, because high blood pressure can be dangerous both for you and your baby. Your doctor will frequently check your blood pressure, and will test your urine to check for the presence of protein, because high blood pressure and protein in the urine are symptoms of the condition preeclampsia. Your doctor may also recommend additional scans to check that your baby is growing well.
Thyroid problems
If you have an underactive thyroid gland for which you are taking thyroxine, you'll need to have a blood test to ensure that your thyroid is functioning well and that you're taking the correct dose, since sometimes the thyroxine requirement increases in pregnancy. It's important that you are not lacking in thyroxine, because this may affect the baby. If you are being treated for an overactive thyroid gland, check with your doctor that you're taking a thyroid medication that is safe in pregnancy. Your thyroid function will be monitored to check that your medication doesn't need to change.
Bowel diseaseWomen with inflammatory bowel conditions, such as ulcerative colitis or Crohn's disease, usually find that their condition improves during pregnancy, although you may relapse after the baby is born. Although it's unusual for bowel conditions to cause major problems during pregnancy, it is important to check that you are not anemic, which can be a side effect of some bowel conditions, and your doctor may recommend extra scans to check that the baby is growing well.
Continuing with asthma medication is important to keep symptoms under control in pregnancy.
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