Pregnancy is a time filled with immense joy and holds profound significance for couples eagerly anticipating the arrival of their child. However, it is crucial to recognise that certain conditions can arise during pregnancy, potentially leading to adverse outcomes. In order to assist pregnant women in monitoring their well-being and optimising prenatal care, I would like to shed light on some of these conditions.
- Foetal neural tube defect (NTD): One common condition that can arise during pregnancy is a foetal neural tube defect (NTD). NTD encompasses various structural anomalies in the foetus, such as an open spine or the absence of a skull. It is often associated with insufficient levels of folic acid in the mother, a family history of NTD, or certain maternal medications like Dilantin or phenobarbital. The good news is that we can easily prevent NTD by ensuring an adequate intake of folic acid. A daily dose of at least 0.4 mg is recommended, starting at least one month before conception. It is important to consult a doctor regarding any medications being taken prior to pregnancy to ensure their safety and discuss any necessary adjustments.
- Preeclampsia: Another condition to be aware of is preeclampsia, which arises from an abnormal connection between the placental and uterine vessels during implantation. However, signs and symptoms typically manifest after 20 weeks of gestation. Preeclampsia is characterised by high blood pressure (typically exceeding 140/90 mmHg) and kidney protein leakage in the urine. Regular urine examinations are necessary during prenatal care to monitor for this condition. In severe cases, individuals may experience severe headaches, blurred vision, or even convulsions. Additionally, preeclampsia can result in foetal growth restriction, placental abruption, and preterm delivery.
If you have any risk factors for preeclampsia, such as a family history, age over 40, or preexisting hypertension, it is crucial to seek early prenatal care. Aspirin may help reduce the risk of developing preeclampsia, so it's important to discuss this option with your healthcare provider. Additionally, screening blood tests for preeclampsia between 11 and 14 weeks of gestation can be an alternative approach to assessing your risk for this condition.
By being aware of these conditions and taking necessary precautions, pregnant women can better monitor their well-being and ensure optimal prenatal care throughout their pregnancy journey.
- Gestational diabetes mellitus (GDM) is a condition that arises during pregnancy due to increased levels of certain hormones, typically around the 24-28 week mark of gestation. These hormonal changes can make it more challenging to regulate blood sugar levels during pregnancy. Women at risk for GDM, such as those with previous GDM, a family history of diabetes, or sugar in their urine, should undergo a blood glucose test to assess their condition.
If diagnosed with GDM, it is essential to implement strict dietary control, seek guidance from an endocrinologist and a nutritionist, and engage in appropriate exercises to manage blood glucose levels. In cases where other measures cannot adequately control blood sugar, insulin injections may be necessary. GDM can have various effects on the foetus, including excessive birth weight (foetal macrosomia), excessive amniotic fluid (polyhydramnios), difficulties during vaginal delivery, and shoulder dystocia (when the baby's shoulder becomes stuck during delivery).
Pregnant women at risk of GDM must undergo regular screenings and follow the recommended guidelines for managing their condition to mitigate potential risks and ensure the well-being of both mother and baby.
- Preterm delivery, occurring before 37 weeks of gestation, poses risks to the health of both the mother and the baby. Ideally, babies should be born healthy at full term. However, in some countries, the rate of preterm delivery remains high, and the exact causes are unknown in nearly 80% of cases. It is important to note that preterm babies may experience long-term health issues such as lung problems, eye issues due to high oxygen exposure, and intestinal dysfunction.
Certain conditions can increase the risk of preterm birth, including infections, uncontrolled maternal medical diseases, and a history of previous preterm deliveries. Therefore, when planning for conception, it is advisable to consult with a doctor regarding your medical condition, ensuring that it is well controlled or resolved at least one month before attempting to conceive. In the case of a previous preterm delivery, the doctor may prescribe progesterone to prevent preterm labour in the current pregnancy. Additionally, some medical institutions now recommend vaginal ultrasounds to assess cervical length between 16 and 22 weeks of gestation. If a short cervix is detected, progesterone can help prevent preterm labour (please discuss this option with your doctor).
As pregnancy progresses, it is common to experience Braxton Hicks contractions, also known as "false labour." These contractions may feel like cramps, occur irregularly without a specific pattern, and typically subside after rest or lying down. However, if you experience regular contractions (occurring every 10 minutes or less) and/or notice vaginal bleeding or leakage of fluid, it is crucial to go to the hospital immediately. Seeking medical attention at the right time allows doctors to administer medications to halt labour and mitigate the risk of preterm delivery.
- Foetal growth restriction (FGR) refers to a condition in which the foetal weight falls below the normal range. Many health issues contribute to FGR, some of which can be addressed or prevented before conception. To mitigate the risk of FGR, it is important to focus on improving pre-pregnancy maternal health. This can be achieved by ensuring a well-balanced and nutritious diet, addressing any underlying medical conditions such as low protein intake, anaemia, or thyroid issues, and reducing exposure to environmental pollutants, including PM 2.5. These measures can positively impact healthy foetal growth and reduce the risk of FGR.
It's crucial to consult with a medical doctor before pregnancy to assess your overall health, address any pre-existing medical conditions, and receive personalised recommendations tailored to your specific circumstances. A preconception checkup can provide valuable insights and guidance to optimise your health before getting pregnant.
Additionally, undergoing couple screening for sexually transmitted diseases (STDs) is important to ensure both partners are healthy and to prevent any potential complications during pregnancy. Managing medications and discussing their safety during pregnancy is essential, as certain medications may need to be adjusted or substituted to ensure the well-being of both the mother and the baby.
Taking folic acid supplements at least one month before conception is highly recommended to prevent neural tube defects and support healthy foetal development. It's also essential to stay up to date with the essential vaccines recommended for pregnant women. Vaccinations can protect you and your baby from potentially harmful infections during pregnancy.
By taking these proactive steps and seeking personalised advice from healthcare professionals, you can optimise your health and reduce the risk of complications during pregnancy. Every individual's situation is unique, so it's important to consult with healthcare providers who can provide tailored guidance and support. Best wishes as you embark on your journey to complete your family!
Author: Sornpin Armarttasn, MD. Obstetrician & Gynaecologist, Foetal Medicine specialist, Obstetrics & Gynaecology Clinic, MedPark Hospital Tel. +66 2023 3333.
Series Editor: Katalya Bruton, Healthcare Content Editor and Director, Dataconsult Ltd. Dataconsult’s Thailand Regional Forum at Sasin provides seminars and documentation to update business on future trends in Thailand and the Mekong Region. Contact: info@dataconsult.co.th Tel: 662-233-5606/7
