High-risk pregnancies: what medical follow-up?

Some pregnancies require special monitoring. Here are the recommendations of the specialists, case by case.

I have asthma

What is the risk ?

In about 30% of cases, pregnancy worsens asthma, especially if it is severe … and poorly controlled asthma can have fetal consequences depending on the severity of the attacks and the lack of oxygen.

Pregnant and asthmatic, what to do?

The ideal is to anticipate and take stock of the treatment, respiratory function, smoking … with the pulmonologist, before starting a pregnancy. Then, the follow-up is individualized and multidisciplinary between the obstetrician, the pulmonologist and the general practitioner. If the asthma is severe and the attacks frequent, it is better to give birth in a type 2 or 3 maternity unit with a pulmonology department.

I already had preeclampsia during a previous pregnancy

What is the risk ?

Preeclampsia is a combination of high blood pressure and a high concentration of protein in the urine (proteinuria). It is a major cause of premature births and stunted growth. In severe and early forms, one can have serious maternal complications. When you have suffered from it during a previous pregnancy, you are immediately in the high-risk pregnancy category because of the risk of recurrence (between 10 and 30%).

Pregnancy and preeclampsia, what follow-up?

We are followed by the obstetrician of the maternity ward and we have a preventive treatment (aspirin) from the 3rd month of pregnancy. At the slightest alert (hypertension, swelling of the hands or face, protein in the urine, visual disturbances, headaches), head to the hospital to take stock and assess the possible impact on the fetus. We are taken care of in a maternity unit adapted to high-risk pregnancies by a whole team: obstetrician, cardiologist, nephrologist …

My thyroid is racing

What is the risk ?

When we synthesize too much thyroid hormones, we have an increased risk of spontaneous miscarriage, preeclampsia, maternal heart problems, but also a higher risk of preterm delivery and low birth weight babies, or even, in extreme cases, fetal death in utero.

Pregnancy and thyroid problem, what to do?

It must be managed jointly by the obstetrician and the endocrinologist. The goal is to bring hormonal overproduction back to the norm. As a result, synthetic antithyroid drugs to regulate the thyroid, rest and regular check-ups every 15 days / 1 month.

I am obese

What is the risk ?

With obesity, the potential risks are multiplied by 2 or 3. This concerns certain diseases such as gestational diabetes, hypertension, preeclampsia, but also complications during and after childbirth: cesarean section, thromboembolic risk (phlebitis, embolism pulmonary). It also affects the baby with an increased risk of birth defects, overweight and diabetes later.

I am obese and pregnant, do I have special follow-up?

When one suffers from obesity – 12% of pregnancies – one must be well surrounded for obstetric follow-up, especially as the level of obesity increases. We are increasing the number of consultations to make sure that all is well, the blood tests to detect diabetes. We monitor his weight gain (ideally between 5 and 9 kg) and practice a gentle physical activity adapted to his body size. Generally, childbirth takes place in an establishment with a technical platform capable of taking care of a possible maternal complication (level 2 or 3).

I have gestational diabetes

What is the risk ?

It is only screened for in those who have risk factors, such as a history of gestational diabetes, age over 35, overweight, in the 6th month thanks to a specific test (oral hyperglycemia). Unsupported, pregnancy diabetes can have repercussions: a baby that is too big … who may be low in sugar at birth.

Gestational diabetes: what follow-up?

In general, dietary measures are sufficient to achieve normal blood sugar levels and the pregnancy goes smoothly. When the diabetes is well balanced and there are no maternal or fetal complications, you can give birth in the maternity hospital of your choice. When this is not the case, the diabetologist prescribes treatment with insulin.

I am diabetic

What is the risk ?

When diabetes is under control, pregnancy is not a particular problem. On the other hand, if the blood sugar is not stabilized and the blood sugar level is too high (hyperglycemia), we are exposed to a higher risk of complications: spontaneous miscarriage, fetal malformations, too big a baby … We recommend therefore for diabetic mothers to plan their pregnancy and not start a baby until the glycemic balance has been reached.

Diabetic: what follow-up during pregnancy?

A whole team is set up for nine months: obstetrician endocrinologist, nutritionist, nurse or dietitian. With more frequent check-ups: blood tests, eye fundus, echoes, monitoring as the term approaches … We are vigilant on the diet side and we regularly check our blood sugar. When everything is going well, you can give birth in any type of maternity hospital.

I’m expecting twins

What is the risk ?

Compared to a single pregnancy, expecting twins slightly increases the risk of prematurity and low birth weight. The risk increases if we are dealing with a monochorial mono-amniotic pregnancy where both fetuses are the result of the late division of an egg, after the 8th day. Babies then have an amniotic cavity and a placenta in common. This type of twinning is rare (1%), but at risk of serious complications (transfusion-transfused syndrome).

Twin pregnancy, a particular follow-up?

During pregnancy, obstetric surveillance is increased with increased visits and ultrasound surveillance. At childbirth, a fully trained team (obstetrician, midwife, anesthesiologist and pediatrician) is essential, whatever the level of maternity. For a monochorial, mono-amniotic twin pregnancy, obstetrical follow-up in a type III maternity hospital, an opinion from the referral center and close ultrasounds (every 15 days) is recommended.

Almost one in twenty births concerns a mother over 40. Don’t panic, the majority of quadruple pregnancies go well!

Pregnant over 40

What is the risk ?

There is a higher risk of chromosomal abnormalities (thirty times more than at age 30), of miscarriage (increased by 10%), of seeing his blood pressure rise or of developing gestational diabetes. Finally, there are more cesarean sections or premature births.

What follow-up for a late pregnancy?

Ideally, we consult before conceiving to take stock of our history, perform a blood test, look for a disease that may complicate the pregnancy … We are prescribed folic acid supplementation, and we are given advice on tobacco consumption, alcohol, sports, diet… to get off to a good start. And as long as everything goes without a hitch, we have the choice of a midwife or a doctor.

I have hypothyroidism

What is the risk ?

If the thyroid does not secrete enough hormones and the dysregulation is not taken care of before pregnancy, there is an increased risk of miscarriage, premature birth, hypertension … More annoying, it can affect the baby’s brain development.

I have an hypothyroidism, what follow-up for me?

Moms at risk are offered screening, and those who are already under treatment are closely monitored. With, the key to a monthly assessment to assess the level of TSH (the hormone that regulates the thyroid) and a reassessment and adjustment of treatment if necessary. Usually, the doses are increased by 30 to 50% from the start of pregnancy. When hormone levels are right, childbirth and the aftermath go smoothly. After birth, we revert to pre-pregnancy dosages.