American Medical Association Family Medical Guide - American Medical Association [287]
Treatment
The earlier high blood pressure is diagnosed, the better your chances of having a healthy pregnancy. If you have mildly elevated blood pressure, your doctor will want to monitor it closely to make sure it is under control during your pregnancy. If your blood pressure is high, your doctor will prescribe medication to lower it. He or she may also order regular blood and urine tests to monitor the function of your kidneys, and ultrasound scans (see page 509) to make sure the fetus is developing at the normal rate.
Heart Disorders
Pregnancy puts an extra workload on your heart. If you have an underlying heart defect such as a congenital heart defect (see page 389), or a heart valve disease caused by rheumatic fever, you have a risk of heart failure. Your doctor should know about any heart conditions before you get pregnant—or at least as soon as the pregnancy is confirmed. Your doctor may refer you to a cardiologist (heart specialist) for additional care during your pregnancy. The cardiologist will monitor your health throughout your pregnancy for any possible complications related to the heart disorder.
Sometimes a heart disorder such as a murmur (abnormal heart sounds) shows up for the first time during pregnancy from the extra demands placed on the heart. Most heart murmurs discovered in the first 3 months of pregnancy are insignificant, but the doctor may order tests such as an ultrasound image of the heart (echocardiogram; see page 561) or a recording of the electrical activity of the heart (electrocardiogram; see page 559) to evaluate the condition.
If you have a heart condition, you will have to deliver in a hospital. If you have no complications, your pregnancy should be healthy and you should go into labor normally at full term. When you go into labor, your doctor will help make sure that the delivery is as easy as possible for you—with a minimum of pushing, which puts a strain on the heart and deprives it of oxygen.
Treatment
The main treatment for a heart disorder during pregnancy is rest to reduce strain on the heart, which is already working harder than usual. When you are lying down, keep shifting your position and relaxing and contracting your muscles to keep the blood moving through your legs to prevent blood clots. Restrict your intake of salt and salty foods to prevent fluid retention. Many standard antihypertensive medications have potentially harmful effects on the fetus and usually are not recommended during pregnancy.
Gestational Diabetes
Gestational diabetes is a form of diabetes that can develop during pregnancy. The condition can occur because the placenta produces hormones that can block the effects of the hormone insulin, which moves glucose into cells for energy. This insulin-blocking effect usually develops between the 20th and 24th weeks of pregnancy. The pancreas can usually overcome this effect by producing more insulin, but if it cannot make enough insulin to overcome the effects of the insulin-blocking hormones, glucose builds up in the pregnant woman’s blood, causing gestational diabetes. The condition goes away after pregnancy because there is no placenta to produce the insulin-blocking hormones.
You are at increased risk of having gestational diabetes if you are obese, have a family history of diabetes, previously gave birth to a very large infant (weighing more than 9 pounds, 14 ounces), had gestational diabetes in a previous pregnancy, had a stillbirth (see page 530) or a child with a birth defect, or are older than 25.
When diagnosed and treated, gestational diabetes usually does not cause problems for either the pregnant woman or the fetus. If not treated, however, gestational diabetes