Pregnancy can be a worrying at the best of times, but if you also have a chronic illness or medical complaint it can be even more so.
Long-term conditions including diabetes, depression and mental health problems, rheumatoid arthritis and epilepsy, often need medication, which may or may not be safe for your baby. This is why it's so important to see a health professional as soon as possible – ideally before you conceive when you're planning your pregnancy to discuss the implications of pregnancy for your medical condition. Medical conditions may also affect your pregnancy – for instance having poorly controlled blood sugar can result in you having a large baby.
The good news is that obstetrics specialists can offer highly personalised care for you and your baby with more check-ups and ultrasound scans if needed to check your baby's growth and development.
If you have a medical condition your GP or midwife will usually refer you for specialist care by an obstetrician and they'll keep a close eye on you and tell about what medication is safe to take in pregnancy or best avoided. Do not be alarmed by this – instead be reassured that the likelihood is you'll still have a healthy pregnancy and baby – they're just making sure any risks posed by your condition are minimised.
Pregnancy and diabetes
Diabetes is the medical name for when your blood sugar (glucose) is too high. The best way to make sure you have a healthy pregnancy is to get your blood sugar under control before you become pregnant. Experts say you should aim for an HbAlc test score of 6.5 per cent or less.
There are various types of diabetes including:
• Type I: This is where the body stops producing a hormone called insulin which helps regulate blood sugar. It usually begins in childhood and those affected need insulin injections or insulin via a wearable pump.
• Type 2: Caused by your body not producing enough insulin, type 2 diabetes is usually lifestyle-related to obesity. It can be controlled with lifestyle changes and tablets to lower blood sugar.
• Gestational diabetes: This is a specific type of diabetes that develops in pregnancy, in the second or third trimester and is usually detected by a blood sugar test in the 24 – 28 week window. It happens when pregnancy hormones disrupt the production of insulin.
If you have any of the above and your blood sugar is not controlled, there's a risk you could have a very large baby and need a caesarean delivery. That's why you'll be offered more frequent check-ups and blood and urine tests and ultrasound scans to check your baby is not growing too big. Do not worry too much though – pregnant women with diabetes do have health pregnancies and babies.
Pregnant women with diabetes are also advised to take a higher dose of folic acid supplements, 5mg a day as opposed to the 400mcg recommended by the Department of Health.
Epilepsy and Pregnancy
Epilepsy is the medical name for an intense burst of electrical activity in the brain and can cause disruption to the normal function of the brain or seizures. It affects 600,000 people in the UK and many take anti-seizure drugs to prevent attacks.
Ideally, you should discuss your care with a neurologist before you become pregnant as some types of anti-epileptic drugs do carry a risk of birth defects and you may need to change your tablets before you conceive. You may also be advised to take a higher dose of folic acid of 5mg a day.
However, if you become pregnant while taking epilepsy medication do not stop taking your tablets without seeing a doctor first. Stopping you medication suddenly could result in an increased numbers of seizures. See your GP as soon as possible and they can recommend you about what to do.
If your seizures are well controlled you may not need specialist care, but if your seizures become more frequent or severe in pregnancy you may need to be under the care of a neurologist and an obstetrician.
Mental health problems in pregnancy
If you are on medication for a mental health condition such as depression do not stop taking your medication without discussing it with your doctor first. Abrupt discontinuation can worsen your condition. Talk through your options with your doctors; although antidepressants are not usually recommended in pregnancy they can be prescribed if the benefits outweigh the risks.
Rheumatoid arthritis is an autoimmune condition where the bodies own antibodies attack the lining of joints causing swelling, pain, inflammation and joint damage.
Seventy five per cent of women with RA report their symptoms actually improve and go into temporary remission during pregnancy though, usually in the second trimester. Symptoms usually return about six weeks after giving birth.
Talk to your specialist before you plan to become pregnant though as there are some drugs you may need to stop as they can affect fertility. Many RA drugs are considered safe in pregnancy so discuss the risks and benefits with your consultant.
Multiple Sclerosis (MS) in pregnancy
MS is a neurological condition, which affects 100,000 people in the UK. It affects three times as many women as men and is commonly diagnosed between the 20 to 40 age groups.
Women MS can with have healthy babies and pregnancies but there are some drugs they may need to discontinue before they try for a baby, so they should discuss this with their neurologist. The usual advice is to wait three months before trying to conceive.