Preparing for Pregnancy
Coping with Chronic Conditions Before and During Your Pregnancy
By Lynsey Caldwell Owen, MD, FACOG
Many women with chronic medical problems are able to achieve healthy pregnancies, but they may not know that preparation for pregnancy with a preexisting disease can be just as important as management of the condition after conception.
There are a few general guidelines for prepregnancy preparation that apply to all medical issues.
- Make sure that the physician managing your condition is aware that you are considering pregnancy. Some medications can affect a developing fetus even before a woman is aware that she has conceived. Therefore, a doctor may transition you to a different drug that has a better safety profile in pregnancy a few weeks or even months prior to initiating efforts to achieve pregnancy.
- If possible, gain or maintain good control of your disease a few months prior to conception. Though many women with serious medical conditions like diabetes, high blood pressure, or thyroid disease can have healthy pregnancies, poor control of these diseases can lead not only to worsening health of the mother, but can also cause issues with babies – like birth defects, complications related to prematurity, and other serious problems.
- Keep all of your appointments with your obstetrician or midwife and also with your specialists. Some women with chronic medical conditions will be referred to a high risk pregnancy doctor (or perinatologist). Your OB will also want to have the ability to contact the provider who manages your medical conditions.
In addition to these important tips, here are some specific actions that you can take in order to maximize the chances of having a healthy pregnancy for some of the most common chronic diseases.
Allergies: Try to avoid contact with your allergy triggers. Use air conditioning instead of opening windows and avoid outdoor activities when the pollen count is high. If you have indoor allergies, vacuum with a HEPA filter to reduce allergens. Buy covers for mattresses and pillows that protect against dust mites and keep your home as clean as possible to minimize dust.
Asthma: Have an Asthma Action Plan, which is an individualized algorithm for what you can do to control your asthma, keep it from getting worse, and know when to call your doctor. Make sure you have your rescue inhaler with you at all times. Know your asthma triggers and do your best to minimize exposure to them.
Depression: Recognize that the hormones and life changes associated with pregnancy and delivery can worsen mood symptoms, even in women who previously had reached a stable point. Ensure that you have a mental health provider with whom you have good rapport. Maximize your good sleep, exercise, and participation in activities that you enjoy. Even if depression or anxiety were problems you had in the past, tell your obstetric provider so he/she can help assess your mood throughout the pregnancy.
Diabetes: Do your best to get reach a healthy weight prior to getting pregnant. See a nutritionist and make sure you have a good understanding of the diabetic diet. Be aware that most women will need to increase or change their medications during pregnancy, even if they were in perfect control before conception.
Hypertension: Weight loss to reach a healthy weight is important and may even negate the need for medication. Minimize salt intake and maintain a healthy diet. Talk to your doctor about starting a baby aspirin towards the end of the first trimester to decrease your risk for developing preeclampsia, a serious pregnancy complication for which women with preexisting hypertension are at higher risk.
Migraines: One third of women note improvement in headaches during pregnancy, one third see no change, and one third have more serious symptoms. Always make sure that you are well hydrated and do your best to get good sleep. Identify your migraine triggers and try to avoid them if possible. Some women benefit from starting a magnesium supplement, as this can help prevent headaches. Talk to your doctor about whether this could be a good idea for you.
Musculoskeletal problems: Back pain, plantar fasciitis, neck pain, carpal tunnel syndrome . . . All of these conditions can get worse as you gain weight, retain fluid, and change your center of gravity in pregnancy. A good physical therapy or exercise regimen can help stabilize or improve these symptoms and minimize dependence on medications.
Skin issues: If you are using over-the-counter medications to manage acne, wrinkles, eczema, etc, make sure to read the labels and ask if you have any questions about whether the ingredients are safe to be used in pregnancy. Wear sunscreen every day, as pregnancy can increase the skin’s sun sensitivity.
Again, it is imperative that you consult your physician when you have a history of medical problems and are considering conception. Maximizing your control of chronic conditions from the beginning can greatly improve your chances of having a healthy and happy pregnancy.