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Preventing a high-risk pregnancy before you're pregnant

October 05, 2017 | UC Irvine Health
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Experts agree: the best way to avoid or reduce the complications of a high-risk pregnancy is to start planning before conception.

Of course, that can seem like a Catch-22: How do you know that you’ll have a high-risk pregnancy before you even get pregnant?

Up to 10 percent of all pregnancies are high risk, according to maternal-fetal specialists with UC Irvine Health, a leading center in Southern California for pregnancies that threaten the health of the babies or their mothers, or both. Having a specialist care for a woman’s high-risk pregnancy pays off. Among women who seek out expert care for their high-risk pregnancies, 95 percent give birth to healthy babies.

Ensuring optimal health before pregnancy

Through preconception counseling, a specialized doctor can help the woman achieve optimal health before pregnancy begins and prevent complications. The doctor can help the mother-to-be manage any existing health conditions that could affect the baby’s development and health.

Further, this care can continue seamlessly through the pregnancy, from the critical earliest weeks of fetal development through childbirth, helping to ensure the health of both mother and baby.

Who should get preconception counseling?

Who should seek preconception counseling?

Preconception counseling is recommended for women who have a history of:

  • High blood pressure
  • Diabetes
  • Cancer
  • Other chronic conditions, such as heart disease or lupus
  • Complications with a previous pregnancy or childbirth
  • Uterine conditions, such as endometriosis and fibroids
  • Uterine surgery, including cesarean section

“We’re advocates of preconception counseling for anyone who has had pre-existing chronic medical issues,” says Dr. Carol Major, director of the UC Irvine Division of Maternal and Fetal Medicine.

“With diabetes, for example, the most important time to make sure the condition is under control is early in the pregnancy.”

That’s because high blood sugar levels in the first trimester can lead to birth defects and increase the risk of miscarriage.

What happens during counseling? 

  • Tests. During preconception counseling, UC Irvine Health high-risk pregnancy experts, called perinatologists, will run tests — such as measuring blood sugar levels over a period of time — to ensure a woman’s condition is well managed before trying to conceive.
  • Medication review. The perinatologist will also make sure the patient is not taking any medications that could cause problems during the pregnancy. For example, ACE inhibitors that are used to treat high-blood pressure can cause fetal renal failure. These types of medications can easily be replaced with safe alternatives prior to pregnancy or very early in the pregnancy.
  • Health history. Other women who should seek preconception counseling are those who have had complications during previous pregnancies, including multiple miscarriages, or who have had previous high-risk pregnancies. There are also uterine conditions that both affect a pregnancy and make it harder to conceive. These include uterine fibroids, endometriosis, uterine surgery or anything else that could scar the uterus or cause irregularities within the lining of the uterus.

In these cases, preconception counseling would include ultrasounds or other imaging studies that would allow the specialist to get a complete picture of the reproductive organs. The perinatologist can provide support both to maximize the chances of getting pregnant and to successfully carry the pregnancy.

Reducing the risk of maternal death

Previous cesarean sections and other types of uterine surgeries may lead to scarring that can also cause problems during delivery of the baby.

In these cases, irregularities in the lining of the uterus can lead to abnormal development of the placenta. A serious complication, called a placenta accreta, can result when the placenta abnormally grows into the uterus in areas that have had previous scarring. This abnormal growth of the placenta can result in hemorrhage — excessive bleeding — during delivery. Hemorrhage is the leading cause of maternal death in the U.S.

“We strongly recommend that anyone who has had previous cesarean deliveries or previous uterine surgeries be carefully scanned for a placenta accreta,” Major says. “All of our perinatologists are skilled in making the diagnosis of a placenta accreta.”

By being proactive with preconception counseling, women who have a history of medical conditions can reduce their risk of complications during pregnancy that could threaten their life or that of their baby.

“If you have medical problems, if you’ve had a previous pregnancy with complications or if another doctor tells you that you can’t get pregnant, we’d really like to see you,” she adds. “With proper management you likely can have a healthy baby.”

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