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Healthy Pregnancy with Chronic Medical Conditions: It Is Possible
Every day in my obstetric medicine practice, I see women who are facing the challenges of pregnancy complications. Very often these women are scared and overwhelmed, worried about the health and well-being of themselves and their babies. Indeed, the current statistics on pregnancy risk in the United States can be scary.
The national rate of maternal deaths is rising, and the number one cause of these deaths is preexisting, chronic medical conditions. These conditions include heart disease, high blood pressure, kidney disease, diabetes, asthma, liver disease and substance use disorders. Preexisting medical conditions are also to blame for many pregnancy complications, including preterm delivery and stillbirth.
When a woman is diagnosed with a chronic condition, she may avoid discussing a future pregnancy with her health care team. She may fear being told she should not get pregnant. However, it is actually rare for the health risk to be so critical that pregnancy is an absolute restriction.
The benefits of counseling before pregnancy
All women diagnosed with one or more chronic conditions, who want to someday become pregnant, would benefit from preconception counseling. This consultation includes a thoughtful review of a woman’s health, including medical diagnoses, prior surgeries, social habits, and medications to clarify pregnancy risks and identify how they can be reduced.
Following preconception counseling, recommendations will be made to help a woman have a safe and healthy pregnancy. Those might include:
- stopping medications not recommended in pregnancy or switching to medications that are safe in pregnancy
- achieving blood pressure control
- reducing blood sugar
- smoking cessation
- addressing alcohol and substance use disorders
“The time to repair the roof is when the sun is shining." - John F. Kennedy
To paraphrase the above quote from JFK, the time to address pregnancy risk is before pregnancy.
Obstetric medicine providers at the Women’s Medicine Collaborative provide preconception and risk reduction consultations for women of child-bearing age who are planning a pregnancy and for women with medical problems in pregnancy and post-partum.
Courtney Clark Bilodeau, MD
Dr. Courtney Clark Bilodeau is a physician in obstetric medicine, with clinical and research interests that include breastfeeding, evidence-based complementary medicine, and peripartum management of chronic medical conditions from preconception through postpartum. She sees patients at the Women’s Medicine Collaborative in the Diabetes in Pregnancy Program which includes a team of physicians, nurses, and dieticians.
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