GESTATIONAL DIABETES

Gestational diabetes is diabetes diagnosed for the first time during pregnancy
(gestation). Like other types of diabetes, gestational diabetes affects how your cells
use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your
pregnancy and your baby's health.

While any pregnancy complication is concerning, there's good news. Expectant

mothers can help control gestational diabetes by eating healthy foods, exercising and,
if necessary, taking medication. Controlling blood sugar can keep you and your baby
healthy and prevent a difficult delivery.

In women with gestational diabetes, blood sugar usually returns to normal soon after
delivery. But if you've had gestational diabetes, you have a higher risk of getting type
2 diabetes. You'll need to be tested for changes in blood sugar more often.

Risk factors

Some women have a greater risk of gestational diabetes. Risk factors for gestational
diabetes include the following:

 Overweight and obesity.

 A lack of physical activity.
 Previous gestational diabetes or prediabetes.
 Polycystic ovary syndrome.
 Diabetes in an immediate family member.
 Previously delivering a baby weighing more than 9 pounds (4.1 kilograms).
 Race — Women who are Black, Hispanic, American Indian and Asian
American have a higher risk of developing gestational diabetes.
Complications

Gestational diabetes that's not carefully managed can lead to high blood sugar levels.
High blood sugar can cause problems for you and your baby, including an increased
likelihood of needing a C-section to deliver.

Complications that may affect your baby

If you have gestational diabetes, your baby may be at increased risk of:

 Excessive birth weight. Higher than normal blood sugar in mothers can cause
their babies to grow too large. Very large babies — those who weigh 9 pounds
or more — are more likely to become wedged in the birth canal, have birth
injuries or need a C-section birth.
  Early (preterm) birth. High blood sugar may increase women's risk of early
labor and delivery before the due date. Or early delivery may be recommended
because the baby is large.
 Serious breathing difficulties. Babies born early to mothers with gestational
diabetes may experience respiratory distress syndrome — a condition that
makes breathing difficult.
 Low blood sugar (hypoglycemia). Sometimes babies of mothers with
gestational diabetes have low blood sugar (hypoglycemia) shortly after birth.
Severe episodes of hypoglycemia may cause seizures in the baby. Prompt
feedings and sometimes an intravenous glucose solution can return the baby's
blood sugar level to normal.
 Obesity and type 2 diabetes later in life. Babies of mothers who have
gestational diabetes have a higher risk of developing obesity and type 2 diabetes
later in life.
 Stillbirth. Untreated gestational diabetes can result in a baby's death either
before or shortly after birth.
 Prevention
 There are no guarantees when it comes to preventing gestational diabetes —
but the more healthy habits you can adopt before pregnancy, the better. If you've
had gestational diabetes, these healthy choices may also reduce your risk of
having it again in future pregnancies or developing type 2 diabetes in the future.
 Eat healthy foods. Choose foods high in fiber and low in fat and calories.
Focus on fruits, vegetables and whole grains. Strive for variety to help you
achieve your goals without compromising taste or nutrition. Watch portion
sizes.
 Keep active. Exercising before and during pregnancy can help protect you
from developing gestational diabetes. Aim for 30 minutes of moderate activity
on most days of the week. Take a brisk daily walk. Ride your bike. Swim laps.
Short bursts of activity — such as parking further away from the store when you
run errands or taking a short walk break — all add up too.
 Start pregnancy at a healthy weight. If you're planning to get pregnant, losing
extra weight beforehand may help you have a healthier pregnancy. Focus on
making lasting changes to your eating habits that can help you through
pregnancy, such as eating more vegetables and fruits.
 Don't gain more weight than recommended. Gaining some weight during
pregnancy is normal and healthy. But gaining too much weight too quickly can
up your risk of gestational diabetes. Ask your doctor what a reasonable amount
of weight gain is for you.

PREECLAMPSIA

Preeclampsia is a pregnancy complication characterized by high blood pressure and

signs of damage to another organ system, most often the liver and kidneys.
Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood
pressure had been normal.
Left untreated, preeclampsia can lead to serious — even fatal — complications for
both you and your baby. If you have preeclampsia, the most effective treatment is
delivery of your baby. Even after delivering the baby, it can still take a while for you
to get better.

If you're diagnosed with preeclampsia too early in your pregnancy to deliver your
baby, you and your doctor face a challenging task. Your baby needs more time to
mature, but you need to avoid putting yourself or your baby at risk of serious
complications.

Rarely, preeclampsia develops after delivery of a baby, a condition known as

postpartum preeclampsia.

Risk factors

Preeclampsia develops only as a complication of pregnancy. Risk factors include:

History of preeclampsia. A personal or family history of preeclampsia significantly

raises your risk of preeclampsia.

Chronic hypertension. If you already have chronic hypertension, you have a higher
risk of developing preeclampsia.

First pregnancy. The risk of developing preeclampsia is highest during your first

pregnancy.

New paternity. Each pregnancy with a new partner increases the risk of preeclampsia
more than does a second or third pregnancy with the same partner.

Age. The risk of preeclampsia is higher for very young pregnant women as well as
pregnant women older than 35.

Race. Black women have a higher risk of developing preeclampsia than women of

other races.

Obesity. The risk of preeclampsia is higher if you're obese.

Multiple pregnancy. Preeclampsia is more common in women who are carrying twins,

triplets or other multiples.

Interval between pregnancies. Having babies less than two years or more than 10
years apart leads to a higher risk of preeclampsia.
History of certain conditions. Having certain conditions before you become pregnant
— such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney
disease, a tendency to develop blood clots, or lupus — increases your risk of
preeclampsia.

In vitro fertilization. Your risk of preeclampsia is increased if your baby was

conceived with in vitro fertilization.

Complications

The more severe your preeclampsia and the earlier it occurs in your pregnancy, the
greater the risks for you and your baby. Preeclampsia may require induced labor and
delivery.

Delivery by cesarean delivery (C-section) may be necessary if there are clinical or

obstetric conditions that require a speedy delivery. Otherwise, your doctor may
recommend a scheduled vaginal delivery. Your obstetric provider will talk with you
about what type of delivery is right for your condition.

Complications of preeclampsia may include:

 Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the

placenta. If the placenta doesn't get enough blood, your baby may receive
inadequate blood and oxygen and fewer nutrients. This can lead to slow growth
known as fetal growth restriction, low birth weight or preterm birth.
 Preterm birth. If you have preeclampsia with severe features, you may need to
be delivered early, to save the life of you and your baby. Prematurity can lead to
breathing and other problems for your baby. Your health care provider will help
you understand when is the ideal time for your delivery.
 Placental abruption. Preeclampsia increases your risk of placental abruption, a
condition in which the placenta separates from the inner wall of your uterus
before delivery. Severe abruption can cause heavy bleeding, which can be life-
threatening for both you and your baby.


HELLP syndrome. HELLP — which stands for hemolysis (the destruction of

red blood cells), elevated liver enzymes and low platelet count — syndrome is a
more severe form of preeclampsia, and can rapidly become life-threatening for
both you and your baby.

Symptoms of HELLP syndrome include nausea and vomiting, headache, and

upper right abdominal pain. HELLP syndrome is particularly dangerous because
it represents damage to several organ systems. On occasion, it may develop
 suddenly, even before high blood pressure is detected or it may develop without
any symptoms at all.




Eclampsia. When preeclampsia isn't controlled, eclampsia — which is

essentially preeclampsia plus seizures — can develop. It is very difficult to
predict which patients will have preeclampsia that is severe enough to result in
eclampsia.

Often, there are no symptoms or warning signs to predict eclampsia. Because

eclampsia can have serious consequences for both mom and baby, delivery
becomes necessary, regardless of how far along the pregnancy is.


 Other organ damage. Preeclampsia may result in damage to the kidneys, liver,
lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of
injury to other organs depends on the severity of preeclampsia.
 Cardiovascular disease. Having preeclampsia may increase your risk of future
heart and blood vessel (cardiovascular) disease. The risk is even greater if
you've had preeclampsia more than once or you've had a preterm delivery. To
minimize this risk, after delivery try to maintain your ideal weight, eat a variety
of fruits and vegetables, exercise regularly, and don't smoke.
Prevention

Researchers continue to study ways to prevent preeclampsia, but so far, no clear

strategies have emerged. Eating less salt, changing your activities, restricting calories,
or consuming garlic or fish oil doesn't reduce your risk. Increasing your intake of
vitamins C and E hasn't been shown to have a benefit.

Some studies have reported an association between vitamin D deficiency and an

increased risk of preeclampsia. But while some studies have shown an association
between taking vitamin D supplements and a lower risk of preeclampsia, others have
failed to make the connection.

In certain cases, however, you may be able to reduce your risk of preeclampsia with:

 Low-dose aspirin. If you meet certain risk factors — including a history of

preeclampsia, a multiple pregnancy, chronic high blood pressure, kidney
disease, diabetes or autoimmune disease — your doctor may recommend a daily
low-dose aspirin (81 milligrams) beginning after 12 weeks of pregnancy.
  Calcium supplements. In some populations, women who have calcium
deficiency before pregnancy — and who don't get enough calcium during
pregnancy through their diets — might benefit from calcium supplements to
prevent preeclampsia. However, it's unlikely that women from the United States
or other developed countries would have calcium deficiency to the degree that
calcium supplements would benefit them.

It's important that you don't take any medications, vitamins or supplements without
first talking to your doctor.

Before you become pregnant, especially if you've had preeclampsia before, it's a good
idea to be as healthy as you can be. Lose weight if you need to, and make sure other
conditions, such as diabetes, are well-managed.

Once you're pregnant, take care of yourself — and your baby — through early and
regular prenatal care. If preeclampsia is detected early, you and your doctor can work
together to prevent complications and make the best choices for you and your baby.

Asthma

Asthma is a condition in which your airways narrow and swell and may produce extra
mucus. This can make breathing difficult and trigger coughing, a whistling sound
(wheezing) when you breathe out and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem
that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can't be cured, but its symptoms can be controlled. Because asthma often
changes over time, it's important that you work with your doctor to track your signs
and symptoms and adjust your treatment as needed

Risk factors

A number of factors are thought to increase your chances of developing asthma. They
include:

 Having a blood relative with asthma, such as a parent or sibling

 Having another allergic condition, such as atopic dermatitis — which causes red,
itchy skin — or hay fever — which causes a runny nose, congestion and itchy
eyes
 Being overweight
 Being a smoker
 Exposure to secondhand smoke
 Exposure to exhaust fumes or other types of pollution
 Exposure to occupational triggers, such as chemicals used in farming,
hairdressing and manufacturing

Complications

 Asthma complications include:

 Signs and symptoms that interfere with sleep, work and other activities
 Sick days from work or school during asthma flare-ups
 A permanent narrowing of the tubes that carry air to and from your lungs
(bronchial tubes), which affects how well you can breathe
 Emergency room visits and hospitalizations for severe asthma attacks
 Side effects from long-term use of some medications used to stabilize severe
asthma
 Proper treatment makes a big difference in preventing both short-term and long-
term complications caused by asthma.