Pregnancy & Pre-existing Medical Conditions

Assoc Prof Dr Tan Ay Eeng, Obstetrician & Gynaecologist

If you have a pre-existing chronic medical condition, you may be apprehensive about getting pregnant. Understand the risks and concerns connected with these medical conditions so you can prepare yourself for pregnancy. Know your health status When you plan to conceive, go for a full physical examination and blood test to see if you have any medical conditions. Or, if you know that you do have a particular condition, tell the doctor who is caring for you of your plans to get pregnant. Ask for a referral to an obstetrician/gynaecologist experienced in treating pregnant women with health issues. The following are some of the more common chronic conditions experienced by Malaysians:

Asthma, a chronic respiratory disease that causes periodic chest tightness, coughing, wheezing and breathing difficulty. Asthma varies in severity from person to person. Diabetes, a chronic disease in which the body is unable to properly process sugar. It can appear in childhood or adulthood and in varying levels of severity. Some women only acquire this disease in pregnancy (gestational diabetes) and most often will return to normal health after delivery. Women with gestational diabetes are more likely to develop chronic diabetes later in life. Hypertension, or high blood pressure, a condition where the force of your blood flow is consistently measured at a level above the ‘normal’ level of 140/90. The two numbers indicate the systolic and diastolic blood pressure, respectively. Systolic pressure is your blood pressure during each pump, or contraction, of the heart muscle, and diastolic pressure is the pressure between pumps. Cardiovascular disease describes any disease affecting the circulatory system. It includes heart diseases and disorders such as mitral valve prolapse, and diseases of the blood vessels such as arteriosclerosis. Depression is the term used to describe a group of medical conditions that result in various emotional and physiologic symptoms. It is caused by a combination of different factors. Depression is not just the condition of ‘feeling sad’; some people with clinical depression are not sad at all but may have an unusual amount of anger, increased apathy towards things they would normally be enthusiastic about, or other symptoms that have nothing to do with sadness. Like many other medical conditions, depression is often treatable with medication and therapy. Epilepsy, a range of seizure disorders resulting from abnormal electrical activity in the brain. Most people think of seizures as violent episodes of thrashing and unconsciousness, but there are many different types of seizures.

What are the risks? Asthma. During an asthma attack, the mother may experience low oxygen levels because of the interruption to the normal breathing pattern. This could be harmful to baby. The medications taken for asthma may also affect baby. However, under prudent medical guidance, it’s possible to minimise the risks to both mother and baby. Diabetes. Women with any type of diabetes do have a higher risk of having babies with birth defects than women without diabetes. Nevertheless, any pregnancy still has a more than 90% chance of resulting in a healthy baby. Diabetes sometimes causes weakness or abnormality in the blood vessels, resulting in poor blood flow to the placenta. Sometimes, the mother’s diabetes can cause the foetus to also have difficulty processing sugar because of insufficient insulin. One possible result of this is abnormally large babies, who are more prone to difficulties at birth. Another is that the baby experiences low blood sugar (hypoglycaemia) upon birth.

Hypertension. Current obstetrical practices have reduced most of the risks to the babies of hypertensive women, but extra care does need to be taken. Some medications for hypertension may be dangerous to baby, so the doctor will probably change the prescription until after the birth. A condition called pre-eclampsia sometimes occurs later in pregnancy, causing high blood pressure which could endanger both mother and baby. Being hypertensive increases the risk of having pre-eclampsia, but taking the right precautions will help women with and without hypertension to prevent this condition.

Depression. The direct effects of a mother’s depressed state on the foetus’ development have not been proven. However, depression can indirectly affect the body chemistry and functions such as breathing and pulse, which will in turn affect blood flow to the placenta. Medication taken for depression may also affect the foetus.