Gestational diabetes, hypertension, infectious diseases … We speak of a pathological or at risk pregnancy when complications arise during pregnancy. But rest assured, pregnant women benefit from more regular follow-up or special care. Update with midwife Sandrine Brame
Each year in France, 20% of women face pathological pregnancies which pose a risk to the health of the mother as well as that of her baby. This is why, from the start of pregnancy, medical monitoring is put in place to prevent or diagnose the earliest possible complications that could arise. We take stock with Sandrine Brame, hospital midwife in Pas-de-Calais also a member of the Order of Midwives.
Pregnancy is often an indicator of the patient’s future health: “If she is prone to hypertension or diabetes later, these conditions are likely to appear at this time” notes Sandrine Brame. Do you already suffer from a pathology? In principle, this will not prevent you from getting pregnant, but you will enter the category “pathological pregnancy “ involving more serious follow-up.
Among the main complications of these so-called pregnancies “at risk” there is the occurrence of a Gestational Diabetes towards the end of the 2nd quarter. It can last for the duration of pregnancy or be indicative of previous diabetes and is manifested by glucose intolerance. As a result, the blood sugar level increases in pregnant women which can, in the most serious cases, lead to a pre-eclampsia or one premature delivery. The fetus receives an overdose of glucose which can cause macrosomia, respiratory distress, neonatal hypoglycemia and a risk of developing type 2 diabetes while growing. Hence the need to screen it so that the future mother can follow a treatment avoiding this type of complications.
The most common pregnancy complication,high blood pressure pregnant or HTA is an increase in blood pressure on the wall of the arteries. It usually develops during 3rd trimester of pregnancy and its main complication is the pre-eclampsia. High blood pressure that developed during pregnancy usually disappears within 6 weeks after delivery but involves monitoring during pregnancy, in particular to ensure the proper growth of the fetus.
Examinations during pregnancy also consist in detecting and treating a possible urinary tract infection, detect the toxoplasmosis and rubella (if the expectant mother is not immune), the listeriosis (bacteria present in particular in raw milk cheeses, cold meats and crustaceans), cytomegalovirus or a sexually transmitted infection (STD) that can cause serious damage to the fetus. In addition, “some risky behaviors like tobacco consumption, ofalcohol, of medication where the substance addiction can increase the risks of having a pathological pregnancy “ warns the midwife.
Certain factors can increase risks of pathological pregnancies. This is the case for multiple pregnancies especially due to more frequent preterm deliveries. It also depends on the type of twin pregnancy.“Vigilance is increased in the event of monochorionic pregnancy (a single ovum is fertilized and divided in two) because the cords can become tangled, and monochorionic bi-amniotic pregnancy (1 placenta and 2 pockets) blood may circulate more in one of the fetuses and cause a anemia at the other “ explains Sandrine Brame. Finally, on the mother’s side, a twin pregnancy can be more difficult to manage in terms of blood pressure and immune system.
Obesity and late pregnancy
The late pregnancy and theobesity are also aggravating factors. Indeed, age and overweight tend to weaken the metabolism which is more difficult to adapt to the changes that are taking place. “Obesity in particular involves monitoring blood pressure and diabetes which may increase or develop during pregnancy” emphasizes the midwife. However, “There are pregnancies that go very well at 40, especially if it is the youngest because the body is already prepared for the process“.
Sometimes also, the mother does not suffer from any pathologies but his collar opens early where pocket of waters breaks prematurely. There is then a risk of preterm delivery or late miscarriages. Hospitalization and examinations are then necessary to ensure the good health of the fetus, but “if labor continues or there is a risk of infection, the child is born” .
A pathological pregnancy involves more regular monitoring of the expectant mother and her unborn baby in order to ensure the good progress of pregnancy. In some cases, the gynecologist may decide to perform an IMG (medical termination of pregnancy) or to start childbirth if the state of health of the fetus and / or mother requires it. A pathological leave may also be proposed to the future mother by her attending physician, her gynecologist. This leave then lengthens the length of maternity leave classic 2 weeks before delivery and is 100% compensated by social security.
If your pregnancy is considered “pathological”, you will benefit from a reinforced medical follow-up and will have to choose one type III maternity that is to say having a neonatal resuscitation unit.“It is the obstetrician who will possibly redirect towards another maternity as the onset or the evolution of the pathology” specifies Sandrine Brame. Indeed, she recalls “from the moment the pregnancy is identified as pathological, it is no longer followed by a midwife, the obstetrician takes over”. Consult our maternity guide.