Every time you have an antenatal check-up I will check your blood pressure. That is because one of the most common complications women experience in pregnancy is high blood pressure. Having a family history and some medical conditions increase your chances of developing high blood pressure. For most women who get high blood pressure in pregnancy, it comes on late and other than maybe needing to have your baby a bit earlier doesn’t have too much impact. Other women however may find it comes on much earlier in pregnancy and is associated with your baby not growing to his or her full potential. So there are risks to both you and your baby with this condition and increased monitoring of you both is generally required to figure out the best time for you to have your baby.
Diabetes may be present before pregnancy and you already know about it and hopefully have been keeping your blood glucose levels in the ideal range for pregnancy from the time you got pregnant. It can also be present and you may not know about it so if you have risk factors we might test early for that. Most women however are not diabetic at the start of pregnancy but about 10% will develop it during pregnancy and I test women who don’t already have diabetes at 26-28 weeks so that for women who have developed diabetes we can utilise the opportunity to control your blood sugar levels and optimise the health of your baby. Once diabetes is diagnosed the idea is try to keep your blood sugar levels in quite a narrow range between 4 and 7 mmol/L. Women are often a little upset when they learn that they have gestational diabetes, but the good news is if you can control your sugars it needn’t have any negative impact on you or your baby. Even better, it usually goes away once your baby is born! Initially you are taught how to measure your blood sugar levels and then you measure your levels before and after meals. You also have an opportunity to discuss your diet with a dietitian and if despite that, it is not possible to keep your blood glucose levels in the desired range you may be prescribed medication by one of my obstetric physician colleagues (tablets or injections) to help keep it stable. This can happen even to women who are following a healthy diet so is not always within your control. If medication is required, I will discuss an earlier delivery to help to minimise the risks to your baby. That will involve an induction of labour or an earlier caesarean section if that was the plan
The risks of diabetes in pregnancy are different for mother and baby.
For mother they are:
- Having too much fluid around your baby (polyhydramnios) and so the waters breaking early or going into labour early
- A difficult delivery if baby is large
- A higher risk of abnormal bleeding after birth
- A higher chance of developing diabetes later in life
For baby they are:
- Being born early
- Being a big baby which can mean there is a risk of injury during a vaginal birth for example baby’s shoulders getting stuck
- Low blood glucose after birth so needing to go to the nursery for monitoring
Some of these risks sound fairly scary however rest assured if you have diabetes we will be discussing what is the best way to manage your situation to minimise these as much as possible.
Growth problems can affect some babies and we will check how your baby is growing by measuring your womb and where necessary getting an ultrasound scan to get a more accurate estimate if we are concerned. Some babies don’t grow to their full potential and will be small and some babies seem to grow bigger than would be healthy for them. Your weight gain in pregnancy has a big impact on this and so it is important to keep eating a healthy diet and monitor what your weight is doing. A normal amount of weight to gain for a women of normal pre-pregnancy weight is around 10-15kg. There is a weight tracker we can use for you to monitor your weight as you go along and I will explain this to you. If your baby is not growing well we will arrange extra monitoring and sometimes you may need to have the baby born early. Babies that appear to be large though are often still able to be born vaginally and waiting for labour to start naturally is still usually the best way to have your baby in most cases. I don’t tend to organise ultrasound scans for growth of babies who might be a bit large as scans in this situation are not very accurate and tend to cause unnecessary anxiety for everyone.
Other things you might experience which are not normal
You should contact the Pregnancy Assessment and Observation Unit (PAOU) at Mater if any of the following happen:
- If you have any bleeding from the vagina. If you are not sure if it is a show or abnormal bleeding ring and speak with the midwife. In most cases they will suggest you come in for a review and I would see you there. If there is heavy bleeding (more than a period) you should go to hospital as quickly as possible and phone PAOU to tell them you are coming. The PAOU staff will contact me.
- If you lose clear or green fluid from the vagina your membranes (waters) may have broken. Sometimes you may be uncertain as it is not always the big gush you read about, but get it checked out either way as it is important to know about it at any stage of pregnancy.
- Abdominal pain which is persistent or severe.
- Any change in your baby’s usual pattern of movements. Usually your baby will be fine, but just in case, it is worth having your baby monitored to check everything is okay. You should phone as soon as you recognise this, not wait until tomorrow.
The phone number for PAOU is (07)3163-7000