Common Pregnancy Concerns

Learn about common pregnancy health concerns for mothers-to-be. Burton Rochelson MD Chief of Maternal Fetal Medicine and Obstectrics ai NS LIJ Healthcare System DrMDK

Dr. Rochelson: Obesity is more and more of a problem throughout this country and actually throughout the world and there are a variety of complications that occur in the overweight mother including neural tube infections, which we are going to talk about in a little while, high blood pressure, and gestational diabetes. This women are also with a higher risk for having a Caesarean delivery. Interestingly, a mother who is overweight if you look in the bottom column which is 16 to 29 BMI, their weight gain that is required in a woman that is heavy is less than a woman that is then. So in terms of being over weight, it is a burden to see these women, before they consider this well and try to get them on a diet that is going to be consistent with a modest amount of weight gain during their pregnancy. I see a lot of patients in my practice but all of what we do is high risk pregnancies and we see a lot women that unfortunately have the current pregnancy with us, which is defined as more than three miscarriages. Unfortunately, most of the causes of these are unknown or idiopathic and we just cannot explain why it happened. But a variety of them can be explained either on an infectious course or from the theory as I discussed or chromosomal. It is too much detail to go into in this thought but there are also issues of allergic type phenomena and metalogic courses of the current pregnancy laws but that is for another night. I just want to make one mention of what is called a cervical insufficiency or we used to use a term called cervical incompetence which I think is a very pejorative term and I think it is demeaning and so we much refer the term cervical insufficiency. This is a normal cervix and if you look at the cervix, you can see how long it is. It goes all the way from there to there and then I am going to show you a picture of a cervix that is opening up way before time and you could see that it is much, much shorter. And on these patients we will put a stitch in called the circloge to prevent further pregnancy loss and this will be limited to women who previously have had a number of pregnancy losses. There is something called autosomal recessive conditions where either the father or the mother are carriers of a certain gene and if they both carry the gene and there is a list of conditions that affect Eastern European Jews Ashkenazi Jews and if both the mother and father carry that gene. The chances of the baby is going to have one of these devastating conditions is about 25. It is not about, it is exactly 25%. Also, eastern European Jews are at a higher risk for having cystic fibrosis but they also have the type of cystic fibrosis that is identifiable in about 97% of cases. So let us talk about the fetus now, that is sort of the smorgasbord of the type of conditions that moms can have. The fetus can have a variety of congenital malformations which starts with a genetic background. The genetic tendency to have congenital problems and then during the teratogenic period of development of the organs, if they are exposed to alcohol, if they are exposed to medications or they are exposed to sugar and diabetes then the fetus is at much higher risk of having a congenital anomaly. Congenital anomaly is a medical term for birth defects. And certainly, for example congenital heart disease is related to a variety of different medications, to German Measles for example and to diabetes. The fetus can be at risk from a variety of insults such as infection, chicken pox for example can cause birth defects and medications and so on. Women that have twin gestation or triple gestations, those twins are triplets are also at a higher risk for having birth defects. The babies that are at the greatest risk are babies who are born to a family who had a previous effective pregnancy, a family history of a problem with genetic conditions and the type of condition that you might have is related to your ethnic background as well. As most of you probably know, people in my profession that do maternal fetal medicine do a lot of ultrasounds and we are now able to diagnose the majority of congenital malformations prior to birth or are we still not perfectly diagnosing congenital heart disease and its value in making this diagnosis. Obviously, even if the pregnancy is continuing in terms of the where the baby should be born. Preparing the mother and the family psychologically, emotionally, and medically for this and getting the appropriate consultations. For example, one of the examples would be, there are babies that are born with the intestines outside of the abdominal wall. You want that baby to be born in the place where surgery can be performed and you want the parents to see the pediatric surgeon prior to delivery.