Pregnancy is a time of change in a parent’s life. As you prepare your homes and adjust your lives for the arrival of the little one. What else do you anticipate? These nine months of pregnancy are akin to a roller coaster ride, packed with a slew of emotions.  Your body upgrades during pregnancy. Each and every system changes to accommodate your growing baby. And to monitor this change, you would visit your General Practitioner. To ensure that you and your baby remain healthy on this journey, it is important to visit your GP at scheduled appointments. You would undergo a series of lab tests and ultrasound imaging all to make sure that your body is functioning optimally and that your baby is in good health. However, despite the normal changes you will experience, there are a few important medical issues related to pregnancy to be aware of. Prevention and timely management of these medical issues will prevent pregnancy-related complications.

Hyperemesis Gravidarum (HG)  

An annoying consequence of pregnancy is to deal with morning sickness or formally known as Nausea and Vomiting of Pregnancy. But when incessant vomiting occurs between nine to twenty weeks of gestation, that is termed as Hyperemesis Gravidarum. This would typically lead to weight loss, difficulty gaining weight and dehydration. It can also lead to a severe electrolyte imbalance which may require hospitalisation.   The initial management is conservative, which is consuming small frequent meals high in protein and carbohydrates, increasing fluid intake, and nutritional supplementation. However, pharmacological treatment may be required if vomiting is not controlled.

Hypertensive Disorders of Pregnancy (HDP)  

The increase in blood pressure after 20 weeks of gestation is known as Gestational Hypertension. Pre-eclampsia is defined as gestational hypertension and the presence of protein in the urine. And the term Eclampsia is defined as the presence of seisures in a patient of pre-eclampsia.   These hypertensive disorders of pregnancy are the major cause of maternal and fetal morbidity and mortality. To reduce the likelihood of developing HDP, pregnant women should exercise regularly to maintain health and appropriate body weight.

Pre-eclampsia increases the risk of developing eclampsia, however the incidence of eclampsia can be reduced by the use of low dose aspirin and magnesium sulfate. Women who develop HDP are also associated with the risk of developing future maternal cardiovascular disease and mortality.  To lower your blood pressure, medications will be prescribed. To prevent complications associated with HDP, your blood pressure will be monitored frequently and your urine will be checked for the presence of protein. Blood will be drawn at timed intervals to assess hemoglobin levels, platelet count, and tests of liver and renal function.

Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus (GDM) is the most common medical complication during pregnancy. It is diagnosed during 24-28 weeks of gestation using the Glucose Tolerance Test. The prevalence of gestational diabetes mellitus is increasing in Australia.

Obesity has now become a major concern for antenatal care and is strongly associated with GDM. It is also predictive of adverse pregnancy outcomes such as induction of labor, cesarean section, shoulder dystocia, and small for gestational age.

GDM had increased risk of gestational hypertension, pre-eclampsia, induction of labor, cesarean section, large for gestational age, neonatal hypoglycemia, and respiratory distress. Women who were diagnosed with GDM are also at an increased risk for developing Type 2 Diabetes Mellitus later in life. However, this risk can be reduced with an appropriate diabetes prevention program.

The first step in managing GDM is lifestyle modification. This is achieved by maintaining a healthy balanced diet and engaging in appropriate physical activity. You would also be asked to regularly check your blood glucose levels using a home monitoring device. If your glucose levels still do not fall, pharmacotherapy can be added to the treatment regimen.

Pregnancy is a long journey, and the most important passenger that a pregnant woman is accompanied by is her General Practitioner. It is vital to building a trusting relationship with your GP and effortlessly communicate your problems with them. They will not only maintain your physical health, but you can rely on them to support you mentally and socially. They are there to assist you along every step of the way, provide you with information, and ensure that you and your baby remain healthy during and after pregnancy. We have female GPs specialising in women’s health and pregnancy related issues at Liverpool Plaza Medical Centre. Book online to make an appointment.

REFERENCES

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2)    Moses, R.G., Wong, V.C., Lambert, K., Morris, G.J. and San Gil, F. (2016), The prevalence of hyperglycaemia in pregnancy in Australia. Aust N Z J Obstet Gynaecol, 56: 341-345. doi:10.1111/ajo.12447

3)    Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program O’Reilly SL, Dunbar JA, Versace V, Janus E, Best JD, et al. (2016) Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program. PLOS Medicine 13(7): e1002092. https://doi.org/10.1371/journal.pmed.1002092

4)    Moses, R.G., Goluza, I., Borchard, J.P., Harman, A., Dunning, A. and Milosavljevic, M. (2017), The prevalence of diabetes after gestational diabetes – An Australian perspective. Aust N Z J Obstet Gynaecol, 57: 157-161. doi:10.1111/ajo.12581

5)    Charlene Thornton, Hannah Dahlen, Andrew Korda, Annemarie Hennessy, The incidence of preeclampsia and eclampsia and associated maternal mortality in Australia from population-linked datasets: 2000-2008, American Journal of Obstetrics and Gynecology, Volume 208, Issue 6, 2013, Pages 476.e1-476.e5, ISSN 0002-9378, https://doi.org/10.1016/j.ajog.2013.02.042.

6)    Pollock, W., Peek, M.J., Wang, A., Li, Z., Ellwood, D., Homer, C.S., Jackson Pulver, L., McLintock, C., Vaughan, G., Knight, M. and Sullivan, E.A. (2020), Eclampsia in Australia and New Zealand: A prospective population-based study. Aust N Z J Obstet Gynaecol, 60: 533-540. doi:10.1111/ajo.13100

7)    Fejzo, M.S., Trovik, J., Grooten, I.J. et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers 5, 62 (2019). https://doi.org/10.1038/s41572-019-0110-3