When you're pregnant, there are so many conditions you may have never thought of or even heard of before. Some may happen early on in pregnancy, some in the later stages of pregnancy, some during labour + birth, and others after the baby is born. This blog will give you some information about some of these conditions to help you understand them more. But before I go on, just remember that the info below is generalised. For more specific info relating to your pregnancy, bub and the management plan, always chat with your Doctor or Midwife.
Gestational Diabetes [GDM]
What is it?
GDM is diabetes during pregnancy.
Causes
It happens because hormones from the placenta can cause cells in your body to be resistant to insulin, which is used to regulate blood sugar levels. In response to this, the body makes more insulin, but some mamas' bodies don't respond this way, leaving them with Gestational Diabetes.
Diagnosis
GDM is diagnosed by doing a glucose tolerance test [GTT]. A mama will have a blood test, then drink a special drink that carries a 75g load of sugar after fasting overnight [if you've done this, you know how much it sucks ]. A mama will then sit and relax, with more blood being collected 1 hour post and again 2 hours post the initial sugar drink. The blood is tested and measured against pre-set levels. If the results show readings above what's considered 'normal', you'll be diagnosed as a Gestational Diabetic.
This test is usually conducted between 24-28 weeks of pregnancy but may be conducted earlier, around 12-16 weeks if risk factors are present. Some risk factors include mamas aged 40+, previous GDM, a random high blood sugar reading, previous bub being born 4.5kg+, pre-pregnancy BMI of 30+, PCOS and specific ethnic backgrounds, such as Asian, Middle Eastern or Polynesian.
Treatment
Some mamas will be able to control their blood sugar levels based on diet alone, while others will require insulin to maintain normal blood sugar levels.
What It Means for Your Pregnancy
If diagnosed with GDM, your health care provider will recommend you monitor and record your blood sugar levels at several intervals throughout each day. You may also have more regular ultrasounds during pregnancy, often every 2 weeks or so to monitor bub's growth, fluid levels and placenta function.
What It Means for Labour and Birth
If you were on insulin during your pregnancy, you'd generally be instructed to stop it the day you go into labour. If you're being induced, you may also be asked to halve your dose of insulin the night before. During labour, it is recommended that your blood sugar be tested every 2 hours if you take insulin or every 4 hours if you control your blood sugar with diet and exercise. You may also be recommended an induction earlier and CTG monitoring during labour.
What It Means for After Birth
After birth, all insulin will be stopped. If you were on insulin, you will still need your blood sugar checked for the first 24-48 hours after bub is born. It may also be recommended that you have another glucose tolerance test 6 weeks after birth.
Bub may also be recommended to undergo blood sugar monitoring. This will require your Midwife to prick bub's heel and collect some blood to measure bub's blood sugar level, with the first rest occurring around two hours after birth. The following tests are usually conducted four to six hours after the first, and should ideally occur before bub's next feed, or at least an hour after the last feed to make sure bub is maintaining their blood sugar between feeds.
A reading of 2.6mmol or above is generally accepted as normal, depending on hospital policy. If bub's sugar is below this, it is considered low, and the exact actions will depend on your hospital policy. In general, bub will be encouraged to breastfeed or have some formula [if formula fed]. Bub may also receive glucose gel as well as a top-up of expressed colostrum. The glucose gel acts as a short-term treatment to boost the blood sugar level quickly, while the breast milk/ formula acts as long-acting maintenance.
The blood sugar level will then be rechecked 30 min after treating the initial low sugar to make sure it comes up. Bub's blood sugar level will then be monitored repeatedly until 24 hours have passed since the last low blood sugar level. If bub has repeated low blood sugar levels, they may require further blood tests to look for infection or other reasons for being unable to maintain their blood sugar level, and their doctors may recommend topping baby up with formula until your milk comes in. In severe cases, bub may be admitted to the nursery for close monitoring and require a glucose drip, but this is uncommon.
Obstetric Cholestasis
What Is It?
Cholestasis in pregnancy [AKA Obstetric Cholestasis] is a liver condition in pregnancy that usually strikes in the 3rd trimester. It impacts the flow of bile, causing bile acids to build up in the blood. This leads to itching, particularly of the hands and soles of the feet, which may be worse at night.
Causes
The exact cause isn't yet known, but it's thought to be from a mix of pregnancy hormones, genetic factors and environmental influences. If you have Obstetric Cholestasis, the risk of it recurring in subsequent pregnancies goes up significantly.
Symptoms
The main symptom is itching, particularly of the hands and feet.
Diagnosis
While there's no single test that diagnoses it, if your pregnancy care team suspects Cholestasis, they will collect some blood and perform some tests to monitor your liver function. Once everything else has been ruled out, this diagnosis may be made. Close monitoring will begin for you and bub if you're diagnosed with it, including regular blood tests, ultrasounds and CTG monitoring.
Treatment
- Skin creams and ointments like plain sorbolene lotion, calamine lotion or pinetarsol solution - discuss these with your pharmacist before use
- Cool baths/ cool packs on the itchy areas
- Loose-fitting cotton clothing
- Medication such as Ursodeoxycholic acid or Rifampicin, which will be prescribed by your doctor if required
- Anti-histamines, again, as prescribed by your doctor to help itching
As for the cure, there's only one: bub being born.
What It Means for Your Pregnancy
This condition is not only annoying for a mama; it can also have significant health impacts on her and her growing bub. SA Health tells us that bubs born to mamas with severe Obstetric Cholestasis have increased risks of the following:
- Pre-term birth
- NICU admissions
- Stillbirth
What It Means for Labour + Birth
Depending on the severity of your Cholestasis, your baby may be recommended to be born earlier or exactly at 37 weeks. So, you may be offered an induction or a c-section earlier. It will also be recommended to use CTG monitoring during labour.
What It Means for After Birth
The itching should stop within a few days of bub being born, but it may be recommended to have ongoing blood tests after birth to monitor the level of bile acid in your blood.
Important to Note
It's important to note that some itching can be normal in pregnancy as your skin grows, especially if you have skin conditions like eczema, but always mention it to your pregnancy care provider.
Vasa Previa
What Is It?
Vasa previa is when the blood vessels that run through the baby's cord and the sac in the placenta are close to the opening in the cervix, where bubs go through when born vaginally.
Causes
Usually, these blood vessels are inserted straight into the placenta, but when it comes to Vasa Previa, these vessels are inserted into the sac and are exposed. Why that happens for some people, we don't know.
Diagnosis
Vasa previa may be diagnosed during pregnancy on ultrasound or during labour when a Doctor or Midwife feels the blood vessels in the membranes during a vaginal examination.
Treatment
If a Vasa Previa does occur, a c-section will be recommended. However, if it's diagnosed during the second trimester [approx 13-28 weeks], research tells us that 15% of these cases of vasa previa will self-resolve, meaning a vaginal birth is possible. Otherwise, there is nothing specifically that can be done to treat Vasa Previa; we just monitor it closely.
What It Means for Your Pregnancy
Usually, it carries the biggest risk for bubs in a mama's belly, with the main risk being an accidental rupture of a blood vessel [whether spontaneously or artificially during an induction]. This may lead to bleeding from the placenta, impacting baby's blood supply, or cause bub to become stressed with a risk of bub passing away from too much blood loss. When this condition is known about during pregnancy, 97% of bubs have good outcomes. However, it may require a stay in the hospital during pregnancy and potentially baby being born early. This depends on your individual circumstances, so the best person to talk further with is your OB.
What It Means for Labour + Birth
If a Vasa Previa does occur, a c-section will be recommended. However, if it's diagnosed during the second trimester [approx 13-28 weeks], research tells us that 15% of these cases of vasa previa will self-resolve, meaning a vaginal birth is possible.
What It Means for Labour + Birth
Because bub and the placenta have been delivered, the risk of vessel rupture is now gone.
Low-Lying Placenta (Placenta Praevia)
What Is It?
A low lying placenta or placenta previa is when your placenta is close to, touching or completely covering the os [the cervical hole that opens up for bub to exit vaginally].
Causes
The following factors put a mama at increased risk of a placenta previa:
- If the fertilised egg implants low in the uterus
- Placenta abnormalities
- Pregnant with more than one bub
- A mama who has had six or more bubs
- Differences in the uterus [like endometriosis or fibrioids]
Diagnosis
Placenta previa + low-lying placentas can be seen on ultrasound. If this is found at your 20-week scan, you'll be rescanned around 32 weeks to check it has moved upwards, which most will do, and closely monitored for bleeding. There are four grades of a placenta previa depending on how close or how much of the os it covers, and your OB will let you know which one you have.
Treatment
Again, there's nothing specific we can do to treat this condition other than monitor and wait to see if the placenta moves out of the way.
What It Means for Your Pregnancy
During pregnancy, a mama may be recommended to stay in the hospital or on bed rest. They will be closely monitored for bub's growth, the location of the placenta and any bleeding. It's also really important to avoid things such as sex, as this can cause bleeding.
What It Means for Labour + Birth
If a mama has Placenta Previa, it's recommended that baby is delivered by C-Section. That's because if the placenta is partly covering the exit, it may cause complications during birth, particularly as the cervix dilates, or may not be possible at all.
What It Means for After Birth
Immediately after birth, your OB or Midwife may take some blood to make sure your levels are normal if you had bleeding during pregnancy. If they are low, you may be recommended an iron or blood transfusion. If bub was born early, they might be admitted to the nursery for monitoring or help with breathing. It's also important to know if you had a placenta previa once, you're at an increased risk of it happening again next time.
Pre-Eclampsia
What Is It?
Pre-eclampsia is a condition that occurs during pregnancy after 20 weeks. It's when a mama has high blood pressure, along with one or more other symptoms. It can affect many systems within the body, which is why there is a big range of symptoms such as protein in the urine, swelling or upper abdo pain.
Causes
The exact cause of pre-eclampsia is still unknown. However, there are a lot of theories, some of which relate to the way the placenta implants into the uterus and genetics.
Symptoms
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Persistent headaches [which can be mistaken for an epidural headache after birth]
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Visual disturbances Epigastric pain [pain below the ribs, at the top of your stomach]
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Abnormal swelling, particularly if it's present in the mornings
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High blood pressure
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Protein in the urine
Diagnosis
Pre-eclampsia is usually first picked up during a routine pregnancy check when a Midwife or OB finds high blood pressure and protein in the urine. A range of blood tests and a urine test will be ordered to confirm the diagnosis, as well as an ultrasound to check on bub's growth and the placenta flow [as pre-eclampsia can impact the placenta].
Treatment
If a mama is diagnosed with Pre-Eclampsia, they may be admitted to the hospital for monitoring and management of their blood pressure. They may be started on medications to bring down and maintain their blood pressure. The only cure for Pre-Eclampsia is for bub to be born, but keep in mind that postpartum Pre-Eclampsia can still develop in the days and weeks after bub is born.
What It Means for Your Pregnancy
During pregnancy, a mama may be recommended to stay in the hospital to monitor their blood pressure, the severity of the condition and bub. If a mama's condition becomes severe, there is a chance she may have seizures [which is known as eclampsia]. This may also cause damage to the kidneys, liver and impact on bub. If the blood pressure is rising, your OB team may recommend bub is born early or start an IV drug known as Magnesium Sulfate to help prevent eclamptic seizures from occurring during labour or after birth.
What It Means for Labour + Birth
Bub may be recommended to be born early by induction or immediately by c-section if a mama's condition is severe enough or bub is showing signs of being stressed. If a mama has pre-eclampsia and goes into labour on her own or is induced, she will be recommended to have CTG monitoring and a cannula.
What It Means for After Birth
Pre-eclampsia can still continue or even develop in the days or weeks after birth. That's why it's important for a mama to continue taking her blood pressure medications, keep up with the blood tests and continue to watch for signs of pre-eclampsia, even after bub is born.
I hope that helps you understand some of the more common pregnancy-related conditions. If you've got any more Q's or are unsure, book into our Antenatal Course for all things pregnancy, labour and birth and postnatal related.
First published on 26/09/2022
