Pregnancy and other life situations

1. Suffering from a chronic illness

In order for a woman suffering from a chronic health problem to enjoy pregnancy, it is recommended that she plan her pregnancy so that it occurs at a time when the disease has stabilized. A pregnant woman with a chronic illness may need specific controls, but she, like any other woman, may benefit from the advice of the health team or preparation groups for birth, childbirth and parenting.

The woman needs to inform the health team specializing in her illness of gestational desire, as she will be responsible for advising her on changes in habits (diet, physical activity, rest, hygiene). posture, etc.) that will help you achieve and maintain your pregnancy.

In most cases, a pregnant woman with a chronic illness is considered a high-risk obstetric pregnant woman, so pre-conception visits are especially important.

Pregnancy monitoring is usually done at the hospital, as high risk gestation requires special monitoring with specific controls, depending on the pathology or chronic illness.

• Health Tips: Food and Pregnancy and Chronic Diseases

1.1 Endocrinological problems

• Thyroid disease
  
  La thyroid gland suffers from an overload during pregnancy, so the woman with thyroid problems should visit the endocrinologist to adjust her medication before gestation. Today, drugs for treating thyroid disorders are compatible with pregnancy.
  
  Hypothyroidism is of particular importance because it can lead to infertility and infertility and increase the risk of abortion during the first trimester. One of the causes of hypothyroidism is iodine deficiency in the diet, an essential element for the production of thyroid hormones. It should be borne in mind that after the 10th week of pregnancy, the fetus no longer depends on the maternal thyroid hormones, but on its own thyroid, so it needs a sufficient iodine supply from the maternal intake. . This is especially important in women with hypothyroidism and in populations where this health condition is endemic and has a very high rate of neonatal hypothyroidism. or. That is why it is recommended that the entire population use iodine salt and all pregnant women, with or without thyroid problems, should take an iodine supplement.

• Diabetes mellitus
  
  Diabetes can be pre-pregnancy or gestational if it is detected during pregnancy. It may also be insulin-dependent or not. In all cases, it is considered a high risk gestation. It is advisable for women with diabetes to plan their gestation time so that their blood sugar levels are as balanced as possible.
  
  It must be remembered that pregnancy is already a diabetes process in itself (it raises your blood sugar), with some insulin resistance. High levels of sugar during pregnancy can adversely affect the fetus and gestation, as they carry risks of abortion, fetal malformations and death.
  
  Severe chronic complications of diabetes (nephropathy, retinopathy and heart disease) are considered an absolute or relative contraindication to gestation, depending on the type and severity of the complication, as pregnancy can aggravate the symptoms and even endanger the life of the woman.
  
  The endocrinologist or specialist nurse is the one who helps women adjust their diet, insulin and physical activity to the new state, in order to prevent sudden changes in glycemia (hypoglycemia or hyperglycemia). good metabolic control. So the woman is monitoring her pregnancy with the obstetrician, but she also needs close control of the endocrine team.
• Health Tips: Diabetes

1.2 Liver and digestive problems

The gestation is characterized by a slowdown in intestinal transit due to the relaxation of the digestive system muscles and the displacement of the abdominal organs by uterine growth. This causes the existing health problems, such as constipation, gastroesophageal reflux (the passage of gastric contents to the esophagus), pirosis (burning sensation in the esophagus), and gastritis to be worse or worse. inflammation of the gastric mucosa), gastric ulcer, or liver colic. Uterine growth also causes an increase in pressure on the rectum and can lead to or aggravation of hemorrhoids, which can lead to thrombi.

In these cases, hygienic-dietetic changes and pharmacological (gastric or antacid protective) or surgical (in the case of thrombosed hemorrhoids) treatment are recommended if necessary.

• Health Advice: Eating Disorders in Pregnancy

1.3 Cardiovascular problems

Another feature of gestation is the overload of the cardiocirculatory system, due to the increased volume (volume of circulating blood) and the retention of fluid in the tissues.

• Heart disease
  
  Heart disease causes the heart to work harder. So the pregnant woman with a heart disease should be as stabilized as possible. In severe heart disease (grade IV), pregnancy is contraindicated. If heart disease is congenital, an early prenatal diagnostic study is recommended.

• Varicose veins on the legs
  
  A woman with varicose veins in her legs may see a worsening of her health problem. During gestation, the venous return of the lower extremities is directly affected by the increase in abdominal pressure, due to the increase in uterine volume, which hinders the return of blood from the lower extremities to the heart. Varicose veins may also appear, which can be asymptomatic (without discomfort) or very painful. The need to adopt physical and postural hygiene measures must be evaluated in each case.

• Hypertension
  
  Hypertension in a pregnant woman can have serious consequences for both the fetus (for example, prematurity and delayed fetal growth) and the pregnant woman. Pregnant women suffering from hypertension may worsen their condition, which can lead to miscarriage during the first and second trimester, and even to eclampsia (seizures due to HTA that can occur second and third quarters). It is necessary to maintain the TA below 140/90 mmHg, but without lowering it to the point where it compromises the circulation between the uterus and the placenta (uteroplacental circulation).
  
  Both in the case of the woman with HTA Pregnancy is considered to be high risk in the case of those who suffer it for the first time during pregnancy, and preconception counseling involves changes in medication and dietary habits.

1.4 Hematological problems

Women with hematological problems are more at risk of abortion and thromboembolism (tamponade of a vein). That is why it is advisable to inform the health care team of the desire to become pregnant and to carry out specific analytical monitoring.

Anemia, altered coagulation or plateletopenia (decrease in the number of platelets in the blood) have an impact on labor (they can be vaginal or by cesarean section) and on the type of analgesia to use (for altered coagulation is a contraindication to epidural analgesia).

1.5 Respiratory problems

The woman with respiratory problems may be aggravated by her condition, especially from the 24th week onwards due to pulmonary compression caused by the displacement of the abdominal viscera. Dyspnea (shortness of breath) and tiredness can be significantly increased and aggravated byanemia and edema (inflammation) of the nasal mucosa of pregnancy.

Asthma women can usually continue their usual treatment during the preconception period and during gestation.

1.6 Musculoskeletal problems

Pregnancy causes a number of changes in the woman's appearance. These changes can aggravate chronic injuries such as lordosis (excessive curvature of the lumbar portion of the spine) or scoliosis (lateral deviation from the normal curvature of the spine) and cause pain and sciatica.

1.7 Urinary problems

Asymptomatic bacteriuria is an infection of urine that can go unnoticed in the pregnant woman. If you have previous kidney or urinary problems, you may develop acute pyelonephritis (inflammation of the kidneys and ureters due to a urinary tract infection or ureteral or renal obstruction) with serious consequences, such as the threat of preterm birth (APP).

1.8 Neurological problems

The approach to gestation in women with neurological problems depends on the type of disorder, the degree of involvement and the stage of the disease. Not all neurological diseases affect pregnancy, but some increase the risk of fetal and maternal complications.

• Epilepsy
  
  Anticonvulsant treatments interfere with folic acid uptake, so the preconceptional dose of 0,4 mg / day, which is given in normal pregnancies, should be increased to 5 mg / day. The usual epilepsy medication should be changed or discontinued as the anticonvulsants are teratogenic (they can cause fetal malformations). It should also be borne in mind that partial seizures and absences do not affect the fetus, but they do affect seizures, which can also have serious consequences for the mother.

• Headache (migraine)
  
  Headaches usually improve during the second and third trimesters, except for tension-type ones. It is important to know that the pregnant woman with headache may undergo medical treatment with paracetamol or more potent painkillers without prejudice to the pregnancy or the fetus. It is also important for the woman to be aware of non-pharmacological alternatives, such as complementary therapies: yoga, body techniques, etc.

1.9 Mental problems

Pregnancy is a period when the symptoms of psychic disorders become significantly worse, as often women have to give up regular medication; in addition, the physiological changes characteristic of gestation and childbirth may also lead to an aggravation of symptoms. The period of greatest risk is postpartum: during pregnancy, symptoms of diseases such as schizophrenia or bipolar disorder decrease, but they exacerbate in the postpartum period, increasing the risk of postpartum depression.

1.10 Cancer

Pregnancy does not aggravate or minimize cancerous processes, except in the case of breast cancer and melanoma. If the diagnosis and treatment has been made during the period of conception or during the first trimester of pregnancy, it should be borne in mind that radiotherapy is highly teratogenic (it can cause Advice before pregnancy to the fetus). The risk involved in delaying anticancer therapy to postpartum should be evaluated for the woman, and the risks involved in treatments such as hormone therapy, chemo, or surgery for the fetus.

• Health Tips: Cancer

1.11. Infections

Infections can be caused by viruses, bacteria, protozoa, plasmodia and fungi.

• There is a group of diseases infectious, calls TORCH (toxoplasmosis, rubella, cytomegalovirus and herpes), with various causal agents, but with similar characteristics in terms of effects on the fetus. The TORCH have the following characteristics:

  - They are asymptomatic or mild to the woman;
  - They affect the fetus in a variable way;
  - They cause delay in uterine growth;
  - Causes irreversible chronic sequelae;
  - They can be diagnosed with an analytical one.
  
  The fetal involvement of the infection depends on the time of gestation at which the infection occurs and on the type of microorganism. Transmission occurs through the placenta, during gestation, or through the birth canal.

In particular, sexually transmitted diseases must be taken into account, and women with basic immunological problems should be considered and counseled and, more specifically, in the prevention of infectious and communicable diseases.

• HIV infection
  
  With good control of HIV-infected mothers and current treatments, the likelihood of transmitting the disease to the baby is very low.
  These pregnant women need to be controlled by a team of expert professionals.
   

1.13. Dermatological problems

During pregnancy, skin changes may also occur, which may be temporary, such as an increase in the amount of facial hair or the appearance of acne, or permanent, such as stretch marks. There are some skin diseases or dermatopathies typical of pregnancy that cause the appearance of spots or dermatitis, usually with itching (itching), which disappear after childbirth.
 

"Chronic disease", d'Virtual Nurse, content under license CC BY-NC-ND 3.0 ES, with modifications made by the Gynecology and Obstetrics Service of the Hospital de Sabadell

2. Occupational risk activity

The risk in the labor activity is one of the aspects that are evaluated during the preconception visit or the first follow-up visit of pregnancy. There is a specific regulation that regulates the exposure of the pregnant woman to risk agents in the labor activity and which establishes the following risk assessment criteria.

• Teratogenic agents. Some drugs, radiation, anesthetic gases, CO₂, pesticides, chemicals, smoke and dust can all have effects teratogens.
• Postures and loads of weights. Bipedation for three hours or more increases the risk of prematurity. In addition, it can aggravate the presence of varicose veins. Loading more than 3 kg increases the risk of low back pain, especially in antiergonomic and repetitive conditions. Extreme activities from the 5th month are not recommended (competition sports, dance, etc.).
• Night work. Night work is considered a working day between 22pm and 7am. Although the adverse effects of nighttime on gestation are unclear, the pregnant woman is not advised to work during these hours.
• Infectious agents. It is not recommended to be exposed to infectious agents such as rubella, cytomegalovirus, hepatitis B, toxoplasma, herpes or syphilis.
• Extreme temperatures. The labor regulations state that the optimum temperature for working is between 17 ºC and 27 ºC, although it may vary depending on the type of activity and the environment where it takes place; it also sets the degree of humidity and the speed of the air. Extreme heat (more than 36 ° C) clearly increases the risk of miscarriage. On the other hand, continued exposure to cold can have negative consequences (numbness, insensitivity, pain and freezing) or general (loss of concentration, confusion, disorientation and hypothermia); thus, work environments with temperatures below 0 ° C adversely affect pregnancy.
• Noise. A working environment of more than 100 dB is considered noisy. Exposure to such an environment can lead to hearing loss and effects on the nervous or cardiovascular system. Pregnant women should not be exposed to atmospheres greater than 80 dB from the 20th or 22nd week.
• Vibrations. Exposure to vibrations during pregnancy increases the risk of placental abruption, premature birth, and miscarriage. The magnitude of the effects of vibrations depends on the frequency and amplitude - the wider it is, the more negative its effects on the body and pregnancy.

"Occupational risk activity" d'Virtual Nurse, content under license CC BY-NC-ND 3.0 ES

3. Twin and multiple gestation

THEtwin pregnancy and multiple pregnancywhether spontaneous or assisted reproduction techniques are considered high and very high risk, respectively. Follow-up is recommended at specialized hospital centers, as more intensive fetal ultrasound monitoring is required. In these types of gestations, it is normal for the typical physical manifestations of pregnancy to increase, such as vomiting and nausea, due to high levels of the hormone in the pregnancy, and to appear early, constipation, hemorrhoids. , low back pain, varicose veins, difficulty breathing (related to increased abdominal volume), tachycardia (related to cardiac overload), and anemia.

Twin and multiple pregnancies have the highest incidence of maternal and fetal complications, such as:

• abortion
• preterm birth,
• hypertensive disease of pregnancy,
• intrauterine growth retardation,
• postpartum hemorrhage,
• detachment of placenta.

Recommendations for birth of twins depend mainly on the state of maternal and fetal health and the placement of the fetuses.

In a multiple pregnancy, a caesarean section is recommended, but these days it is a controversial measure and vaginal birth is being evaluated according to the characteristics of each gestation.

"Twin gestation", d'Virtual Nurse, content under license CC BY-NC-ND 3.0 ES

4. Traveling Pregnant

Traveling, for pleasure or for personal or professional issues, is a common activity in the life of a woman, i traveling pregnant is becoming more and more common. The precautions to take into account depend on the means of transport, the distance and the destination.

It is not contraindicated in healthy pregnant women to have a healthy pregnancy or to ride a motorcycle or bicycle, although they are not the most convenient means of transportation.
 

"Traveling pregnant", d'Virtual Nurse, content under license CC BY-NC-ND 3.0 ES