Pregnancy Risks and Complications
Fortunately, most women have healthy pregnancies. However, complications do sometimes arise that can be frightening and confusing.
Some of the possible complications that can occur during pregnancy are listed here. Most of these can be managed to protect the health of the mother and the developing fetus.
- Iron Deficiency Anemia. Pregnant women need more iron than normal for the increased amount of blood in their body and for their developing child. Symptoms of iron deficiency include feeling tired or weak, looking pale, feeling faint, or experiencing shortness of breath. Your health care provider may recommend iron and folic acid supplements.
- Gestational Diabetes. Gestational diabetes occurs when blood sugar levels get too high during pregnancy. Most often the condition is discovered during the glucose challenge screening test around 24 to 28 weeks of pregnancy. Gestational diabetes increases the risk of a baby that is too large (macrosomia),preeclampsia, cesarean birth, and preterm delivery. Treatment includes controlling blood sugar levels through a healthy diet and through exercise and medication if blood sugar values remain high.
- Depression. Some women experience extreme sadness during pregnancy. There is no single cause of depression, but it may result from hormonal changes, stress, family history, or changes in brain chemistry or structure. Depression can harm your developing infant if you do not take care of yourself during pregnancy, including attending regular prenatal visits and avoiding alcohol and tobacco smoke. Talk to your health care provider about treatment options.
- Hyperemesis Gravidarum. Some women experience severe, persistent nausea and vomiting during pregnancy beyond the typical "morning sickness." Medication may be prescribed to help with the nausea. Women with hyperemesis gravidarum may need hospitalization to get the fluids and nutrients they need through a tube in their veins. Often, the condition lessens by the 20th week of pregnancy.
- High Blood Pressure Related to Pregnancy. Women with high blood pressure that starts after 20 weeks of pregnancy will need to be monitored closely because of the risk of preeclampsia.
- Group B Strep (GBS) Infection. Group B streptococcus (GBS) is a type of bacterial infection that can be found in a pregnant woman’s vagina or rectum. This bacteria is normally found in the vagina and/or lower intestine of 15% to 40% of all healthy, adult women. Those women who test positive for GBS are said to be colonized. A mother can pass GBS to her baby during delivery. GBS is responsible for affecting about 1 in every 2,000 babies in the United States. Not every baby who is born to a mother who tests positive for GBS will become ill. Although GBS is rare in pregnant women, the outcome can be severe, and therefore physicians include testing as a routine part of prenatal care.
- Fetal Problems. Possible problems in the fetus include decreased movement after 28 weeks of pregnancy and being measured as smaller than normal. These pregnancies often require closer follow-up including more testing such as ultrasound exams, non-stress testing and biophysical profiles as well as possible early delivery.
- Erythroblastosis fetalis. This is a potentially life-threatening blood disorder in a fetus or newborn infant. Erythroblastosis fetalis develops in an unborn infant when the mother and baby have different blood types. The mother produces substances called antibodies that attack the developing baby's red blood cells. The most common form of erythroblastosis fetalis is ABO incompatibility, which can vary in severity. The less common form is called Rh incompatibility, which can cause very severe anemia in the baby.
- Weakened Cervix. During pregnancy, as the baby grows and gets heavier, it presses on the cervix. This pressure may cause the cervix to start to open before the baby is ready to be born. This condition is called incompetent cervix or weakened cervix, and it may lead to a miscarriage or premature delivery. However, an incompetent cervix happens in only about 1 out of 100 pregnancies.
- Miscarriage. Pregnancy loss from natural causes before the 20th week is considered miscarriage. As many as 20% of known pregnancies end in miscarriage. The most common cause of first trimester miscarriage is chromosomal problems. Symptoms can include cramping or bleeding. Spotting early in pregnancy is common and does not mean that a miscarriage will occur.
- Breech Presentation. A few weeks before birth, most babies will reposition themselves so that their heads are pointed down towards the birth canal. This is the optimal position for birth. If this does not happen, the baby's buttocks or feet will be in place to be delivered first. This is called a breech presentation. Breech births occur in about 1 of 25 full-term births. Your healthcare provider may take steps to try to reposition the baby prior to delivery. If the baby is still in a breech position during labor, a c-section may be recommended to reduce the risk.
- Placenta Previa. This uncommon complication occurs when the placenta covers part of the opening of the cervix inside the uterus. It may cover the cervix, either partially or totally. When the cervix starts to open, the placenta may become detached from the uterus, resulting in painless vaginal bleeding during the second and third trimesters. The use of prenatal ultrasound usually detects placenta previa before a woman or her baby is in significant danger. The health care provider may recommend bed rest. Hospitalization may be required if bleeding is heavy or if it keeps happening.
- Placental Abruption. In some women, the placenta separates from the inner uterine wall. This separation, or abruption, can be mild, moderate, or severe. If severe, the fetus cannot get the oxygen and nutrients needed to survive. Placental abruption can cause bleeding, cramping, or uterine tenderness. Treatment depends on the severity of the abruption and how far along the pregnancy is. Severe cases may require early delivery.
- Preeclampsia. Preeclampsia starts after the 20th week of pregnancy. This condition causes high blood pressure, swelling of the hands and face, abdominal pain, blurred vision, dizziness, and headaches. In some cases, seizures can occur—this is called eclampsia. The only definite cure for preeclampsia and eclampsia is to deliver the baby. If this would result in a premature birth, then the maternal and fetal risks and benefits of delivery need to be balanced with the risks associated with the infant being born prematurely.
- Preterm Labor. Babies born between 37 and 42 weeks of pregnancy are called full term. Babies born before 37 weeks of pregnancy are called pre-term or premature. Premature birth is a serious health problem. Premature babies are at increased risk for newborn health complications, such as breathing problems. Most premature babies require care in a newborn intensive care unit, which has specialized medical staff and equipment that can deal with the multiple problems faced by premature infants.
Being aware of possible symptoms of these conditions and getting regular prenatal care can prevent health problems and help you get treatment as early as possible.
Who is at increased risk of developing health problems during pregnancy?
Some women are at increased risk for health problems during pregnancy. Important risk factors include the following:
- Overweight and obesity. Being overweight increases the risk for complications such as gestational diabetes and preeclampsia. Infants of overweight or obese mothers also have an increased risk of neural tube defects (NTDs), stillbirth, and being large for their gestational age.
- Young or old maternal age. One in seven infants born in 2006 in the United States was born to a woman over the age of 35. While common, pregnancy after age 35 does increase the risk for complications during pregnancy such as stillbirth and for NTDs. In addition, teenage mothers are more likely to deliver early, putting their infant at risk for complications.
- Problems in previous pregnancies. Women who have experienced miscarriage, stillbirth, or preterm labor are at increased risk for problems during pregnancy.
- Existing health conditions. Certain health conditions increase the risk for complications during pregnancy, including high blood pressure, diabetes, and HIV.
- Pregnancy with twins or other multiples. Women who are expecting more than one baby are at increased risk for preeclampsia and preterm birth.
Women with high-risk pregnancies may need more frequent care and may need care from a team of health care providers to help promote healthy pregnancy and birth.
Reference: National Institutes of Child Health and Human Development