During pregnancy, pregnant women have one or more health complications. Some women may have a health condition before getting pregnant while some may develop health conditions as a result of the pregnancy.
In this article, we will be discussing the possible complications that might be experienced within the fetal period and their management.
Pregnant women are more likely to experience the following health conditions
- Intrahepatic cholestasis of pregnancy (ICP)
- Epilepsy and pregnancy
- Acute pancreatitis and pregnancy
- Acute fatty liver and pregnancy
- Heartburn and Indigestion
- Constipation and hemorrhoid
- Thyroid disease and pregnancy
- Iron deficiency anemia
INTRAHEPATIC CHOLESTASIS OF PREGNANCY
Intrahepatic cholestasis of pregnancy (ICP) is a liver disease that is seen during pregnancy. This condition occurs when there are abnormalities in the flow or circulation of bile. Bile is a substance produced in the liver. It is made up of bile salts, bile pigment and other substances dissolved in an electrolyte solution. Bile is used for emulsification, digestion, and absorption of fats.
When these abnormalities cause the build-up or accumulation of bile acids (bile acids are components of the liver and they are produced by hepatocytes from cholesterol. They are cholic acid and chenodeoxycholic acid) in the maternal blood, excessive build-up or accumulation of bile acid causes severe skin itching in pregnant women.
SYMPTOMS OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY (ICP)
Intrahepatic cholestasis of pregnancy symptoms ranges from mild to intense. Symptoms are often noticeable in second to the third trimester. The most frequent symptoms include:
- This is a yellow tint of the skin and whitening of the eyes and it is caused when there is an excess build-up of substances called “bilirubin” in the blood. Bilirubin is a chemical that is produced when blood cells break down. Thereby causing liver disorder and reduction in the bile circulation or flow.
- SKIN ITCHING. Itching is most intense on the soles of the feet and palms of the hands. However, itching is most severe all over the body of pregnant women.
If these symptoms occur in pregnant women, it is important to seek the help of health care providers.
EFFECT OF INTRAHEPATIC CHOLESTASIS IN PREGNANCY
Intrahepatic cholestasis in pregnancy can sometimes be unbearable in pregnant women, it can even affect the fetus. Pregnant women with intrahepatic cholestasis often deliver premature babies (delivery early than the expected date). Also, premature babies are at high risk of having health conditions throughout their life span. Intrahepatic cholestasis increases the risk of stillbirth in pregnant women.
Therefore, it is very important to diagnose and treat intrahepatic cholestasis in pregnancy (ICP) as early as possible to prevent serious complications.
HOW TO DIAGNOSE INTRAHEPATIC CHOLESTASIS IN PREGNANCY
There are several conditions that can trigger skin disorders in pregnancy that can result in skin itching. However, most of these conditions do not usually affect the mother and baby.
In other to diagnose whether the maternal is suffering from intrahepatic cholestasis in pregnancy, a blood test will be carried out. This blood test often includes the measure of different chemicals that show how well the pregnant woman liver is functioning and the number of bile acids present in her blood.
CAUSES OF INTRAHEPATIC CHOLESTASIS IN PREGNANCY
Intrahepatic cholestasis in pregnancy can either be hereditary or caused by hormones. People with a family history of liver disorder usually have this condition running in the family. Also, multiple pregnancies (twins, triplet and quadruplet) play a major role in intrahepatic cholestasis in pregnancy due to the increase in hormone levels. However, symptoms of intrahepatic cholestasis in pregnancy often go away after delivery. Although, it can be experienced or develop again in another pregnancy.
TREATMENT OF INTRAHEPATIC CHOLESTASIS IN PREGNANCY
Intrahepatic cholestasis in pregnancy is usually treated with a medication called ursodeoxycholic acid (Antigall). This medication helps to suppress skin itching, prevent stillbirth and also helps to control liver abnormalities.
The health care provider should also keep a close look at the fetus’s condition either with ultrasound or a test that can be used to monitor the heart rate of the fetus. However, if the baby is having any form of difficulties, the health care provider may suggest early delivery of the fetus to prevent and reduce the risk of stillbirth or any form of future complications.
Amniocentesis is an invasive procedure in which a needle is passed through the mother’s lower abdomen into the amniotic cavity inside the uterus and it is used to look for certain birth defects such as Down syndrome, neural tube defect, and it is also used to determine the fetal lung maturity. This procedure can be recommended by health care providers in other to know the status of the fetal lungs whether the fetal lungs are mature enough before inducing early childbirth to prevent weak lung.
EPILEPSY AND PREGNANCY
Epilepsy is a neurological disorder (central nervous system disorder). Epilepsy causes abnormal brain activity which can lead to seizures, loss of unawareness and unusual behaviors. Women who are suffering from epilepsy are at high risk of having several complications during pregnancy. It is important to keep an eye on women who are with this health condition.
Epilepsy affects pregnant women in different ways. Some women may experience little or no seizure in pregnancy. However, women who are suffering from epilepsy before they become pregnant are at higher risk of facing different health complications than pregnant women without epilepsy. These epilepsy pregnant complications may include vaginal bleeding, high blood pressure (hypertension) and placental abruption.
EFFECT OF EPILEPSY IN PREGNANCY
When seizures occur in pregnant women, it can lead to the following
- Decreased oxygen level in fetus
- Seizures slow heart rate of the fetus
- It can cause premature birth
- Premature separation of the placenta from the uterus also known as placental abruption.
- It can cause miscarriage due to trauma
- Fetal injury
TREATMENT OF EPILEPSY IN PREGNANCY
Anti-seizure medications when taken during pregnancy can affect your baby. Birth defects such as neural tube defects, cleft palate, skeletal abnormalities, urinary tract defects, and congenital heart can be seen in the fetus when taking anti-seizure in pregnancy.
However, if you haven’t had a seizure for 12 months or more, your health care provider may advise you to suspend anti-seizure medications before you become pregnant or while you are pregnant.
It is also important to take prenatal medications such as prenatal vitamins supplement and folic acid, as they can help prevent certain types of birth defects. Also, it is also necessary to make healthy lifestyle choices such as taking a healthy diet (eating food rich in vitamins and avoid food with saturated fats), avoid smoking, caffeine, alcohol, and illegal use of drugs.
Folic acid helps to prevent serious abnormalities of the brain, neural tube defects, and spinal cord. Folic acid is an important medication for all pregnant women.
HEPATITIS IN PREGNANCY
Hepatitis is known as the inflammation of the liver and it is a viral infection (caused by a virus). However, there are other causes of hepatitis. Hepatitis can occur as a result of drugs, medication, alcohol, and toxins, and autoimmune hepatitis. Autoimmune hepatitis is caused when your body makes antibodies against your liver tissue.
There are five types of viral hepatitis and they are hepatitis A, B, C, D, and E. However the most common and well-known hepatitis are hepatitis A, B, and C.
HEPATITIS A. This is caused by an infection with hepatitis A virus. Hepatitis A is usually transmitted by consuming water or food contaminated by feces from an infected person.
HEPATITIS B. This type of hepatitis is transmissible when an individual without this viral disease comes in contact with an infected person’s body fluids. These body fluids can be inform of blood, sweat, the needle used by an infected person, sharing a towel or razors with an infected person increase one’s risk of being infected with hepatitis B.
HEPATITIS C. Hepatitis C is transmitted through direct contact with body fluid that has hepatitis C either through sexual contact or other forms of direct contact with infected body fluid.
HEPATITIS D. Hepatitis D is a serious liver complication caused by the hepatitis D virus. It is also known as “Delta Hepatitis”. Hepatitis D can be contracted through direct contact with an infected person’s blood. It is a rare form of hepatitis that occurs in collaboration with hepatitis B infection.
HEPATITIS E. hepatitis E is known as a waterborne disease caused by the hepatitis E virus. It is often found in areas with poor sanitation or hygiene and it is usually as a result of ingesting fecal matter that contaminates the source of water.
SYMPTOMS OF HEPATITIS
Symptoms of hepatitis can range from mild to intense. Although some infected individuals don’t usually have symptoms at an early stage. However, symptoms can only be seen when damage is affecting the function of the liver. Common symptoms of hepatitis include:
- Upper abdominal pain
- Loss of appetite
EFFECT OF HEPATITIS IN PREGNANCY
Hepatitis A is a short-term illness and it doesn’t really have any serious effect on the fetus. However, Hepatitis B can be dangerous during pregnancy. Women with the hepatitis B virus whether it is acute or chronic can be transmitted to the fetus during labor and delivery. Babies who are infected at birth often develop chronic hepatitis B infection and they are at higher risk of having liver disease and liver cancer.
Hepatitis C can also be transmitted from mother to fetus during labor and delivery. However, the risk of transmitting this infection from mother to fetus is not as high as that of hepatitis B.
TREATMENT OF HEPATITIS
There are no specific medications to treat acute hepatitis infections. Although, there are medications that are used to treat chronic hepatitis B and C. Although these medications are not recommended for pregnant women. Chronic hepatitis C can be treated with the use of two antiviral drugs such as ribavirin and pegylated interferon alfa-2a. However, these drugs are said to contribute to miscarriage and birth defects. Before using any drugs, it is very important to seek the advice of a health care provider. Also, these drugs are not to be used when breastfeeding.
ACUTE PANCREATITIS AND PREGNANCY
Acute pancreatitis can be defined as the sudden inflammation of the pancreas that can be caused by nausea, dehydration, and abdominal pain. This condition can progress or lead to severe disease if not properly treated, it can also lead to death. There are different causes of acute pancreatitis. However, the two major causes are gallbladder or bile duct disease and excessive intake of alcohol.
Acute pancreatitis in pregnancy is a rare case. Although when it occurs it is usually caused by gallstone disease. Hormonal changes that are often experienced in pregnancy can cause the formation of gallstones which later moves to bile ducts to obstruct the pancreas duct outflow. Acute pancreatitis in pregnancy can also be caused as a result of high fat levels in the blood flow, alcohol use, trauma to the pancreatitis duct and side effect or some reaction to certain medications.
TREATMENT OF ACUTE PANCREATITIS IN PREGNANCY
Acute pancreatitis in pregnancy treatment is quite the same in people that are not pregnant treatment and are suffering from the same condition. Although, there is little exception such as in the case of gallstone pancreatitis, gallbladder removal is deferred until after delivery in pregnant women. However, the removal of the gallbladder can be carried out at any time in people that are not pregnant. However, if waiting till delivery will results in serious damage, the removal of the gallbladder can be carried out safely by a surgeon.
Acute pancreatitis caused high fat levels in the blood called triglycerides can be treated with some certain medication. Also, dietary modifications can help prevent a frequent attack.
ACUTE FATTY LIVER IN PREGNANCY
Acute fatty liver in pregnancy is a very rare condition and it is a life-threatening condition in pregnancy. This condition is characterized by excessive build-up or accumulation of fat in the liver cells.
SYMPTOMS OF ACUTE FATTY LIVER IN PREGNANCY
Symptoms of this health condition usually begin in the third trimester of pregnancy. When the following symptoms are being experienced by a pregnant woman, the help of a health care provider should be sought. These symptoms include:
- Pain in the upper right abdomen or in the stomach
- Frequent nausea and vomiting
RISKS OF ACUTE FATTY LIVER IN PREGNANCY
Without proper treatment, it can cause organ failure, it can lead to the death of the mother and baby and it can also lead to coma.
TREATMENT OF ACUTE FATTY LIVER IN PREGNANCY
Blood transfusion may be carried out on the mother in other to stabilize her condition. The baby must be delivered as soon as possible in other to prevent serious complications in the baby.
HEARTBURN AND INDIGESTION
Heartburn is a well-known condition and it often affects women during pregnancy. However, heartburn can also be seen in people that are not pregnant. Heartburn is not a dangerous condition, it can be relieved with an antacid solution or tablet and it is also avoidable and preventable by eating small meals, avoid spicy foods and avoid lying down after a heavy meal as this can worsen heartburn.
CONSTIPATION AND HEMORRHOID
Pregnant women often experience constipation. This happens when individual bowel motions are hard and it is very difficult to excrete or pass down feces. Untreated constipation can lead to hemorrhoids (piles) which appear in forms of swollen veins around the anus.
Constipation can be prevented when there is an increase in fibers intake by eating cereals and wholegrain, fresh and dried fish, nuts, beans, and vegetables. Also, an accurate intake of water can help prevent constipation.
However, when hemorrhoid is developed, a cold pack of ice can be put in a towel and it should be placed on the swollen anus as this will help to reduce pain and also return the anus back to its normal size.
THYROID DISEASE AND PREGNANCY
Thyroid disease is a health condition that affects the thyroid hormone. The thyroid gland is a small, butterfly-like in shape and it is located in the anterior part of the neck. Thyroid glands secrete thyroid hormones. Thyroid hormones play an important role in growth, differentiation, and metabolism. It also helps to control energy.
Over secretion of this hormone is referred to as hyperthyroidism while under secretion of this hormone is known as hypothyroidism.
ROLE OF THYROID HORMONES IN PREGNANCY
The thyroid hormone is an important hormone in the healthy development of the baby brain and nervous system in pregnancy. During the first trimester (the first three months of pregnancy) the baby usually depends on the supply of thyroid hormones through placenta. Fetus thyroid begins to work on its own around 12 weeks. However, the fetus doesn’t make adequate hormones until 18 to 20 weeks of pregnancy.
HYPERTHYROIDISM IN PREGNANCY
Symptoms of hyperthyroidism in pregnancy often occur in normal pregnancies. Symptoms of hyperthyroidism include:
- Faster heart rate
- Shaky hands
- Irregular and fast heart rate
- Drastic weight loss
CAUSES OF HYPERTHYROIDISM IN PREGNANCY
Hyperthyroidism in pregnancy is usually caused by an autoimmune disorder. This is a situation whereby an individual immune system makes antibodies that cause the thyroid to make too much thyroid hormone than needed. This antibody is referred to as Thyroid stimulating immunoglobulin (TSI). Too much thyroid hormone in the body system can harm one’s health. However, in pregnant women, it can harm the mother and the baby.
EFFECT OF HYPERTHYROIDISM
Untreated hyperthyroidism in pregnant women can lead to the following
- Congestive heart failure
- Premature birth
- Thyroid storm
TREATMENT OF HYPERTHYROIDISM IN PREGNANCY
Pregnant women with mild hyperthyroidism don’t require any serious treatment. However, if the hyperthyroidism is connected to hyperemesis gravidarum, treatment for vomiting and dehydration is necessary. Pregnant women with intense or severe hyperthyroidism may need anti-thyroid medication which helps to reduce the production of thyroid hormone and also prevent too much of thyroid hormone from getting into the fetus bloodstream. Also, anti-thyroid medications are to be used based on doctor prescription.
HYPOTHYROIDISM IN PREGNANCY
Symptoms of hypothyroidism seen in pregnant women are not different (it is quite similar) from the one seen in people that are not pregnant. Symptoms of hypothyroidism include
- Muscle cramps
- Severe constipation
CAUSES OF HYPOTHYROIDISM IN PREGNANCY
Hypothyroidism in pregnancy is also caused by an autoimmune disorder known as Hashimoto’s disease. In Hashimoto’s disease, the immune systems produced antibodies that attack or damage the thyroid. This damage causes inflammation of the thyroid and makes it produce fewer thyroid hormones.
EFFECTS OF HYPOTHYROIDISM IN PREGNANCY
Untreated hypothyroidism in pregnancy can lead to the following health condition such as
- Congestive heart failure
- Extreme low birth weight
TREATMENT OF HYPOTHYROIDISM IN PREGNANCY
Hypothyroidism in pregnancy can be treated by replacing the hormone that cannot be made by a person’s thyroid. Levothyroxine medication is a thyroid drug that is quite similar to T4. T4 is one of the hormones that are normally produced in the thyroid gland. The doctor can prescribe levothyroxine for pregnant women since it is safe for the fetus.
IRON DEFICIENCY ANEMIA
Anemia occurs due to the low volume of hemoglobin. Iron deficiency anemia is one of the most popular types of anemia.
Iron is one of the important components of hemoglobin. It allows and enables blood to carry oxygen from the lungs. Iron deficiency in pregnant women can hinder the fetus development. Iron is usually required more than normal during pregnancy because of the amount of blood in the system and for the development of the fetus.
SYMPTOMS OF IRON DEFICIENCY IN PREGNANCY
Symptoms of iron deficiency in pregnancy include
- Shortness of breath
- Extreme tiredness
- Pregnant women tend to look pale when there is iron deficiency
- Body weakness
TREATMENT OF IRON DEFICIENCY IN PREGNANCY
The health care provider might recommend vitamin supplements or iron and folic acid supplements. However, before a pregnant woman can take any drugs it is very important to seek the advice of health care providers. Self-medication should be prevented during pregnancy.
Other health problems that can be developed during pregnancy include
- Frequent Urination
- Depression and anxiety
- Varicose veins in the genital area
- Vaginal thrush
- Gestational diabetes
- Kidney problems