High-Risk Pregnancies: Gestational Diabetes

High-Risk Pregnancies

Pre-existing Conditions

Gestational Diabetes

• Initial assessment for gestational diabetes risk factors is essential, including obesity, prior gestational diabetes, and family history.
• Universal testing recommended for women at normal risk during 14-28 weeks of gestation.
• Testing methods:
  • 1-hour glucose challenge test: ≥140 mg/dL indicates potential GDM, followed by a 100-g OGTT on another day if elevated.
  • 100-g OGTT: Diagnostic if two or more of the following fasting levels are met: fasting ≥95 mg/dL, 1 hr ≥180 mg/dL, 2 hr ≥155 mg/dL, 3 hr >140 mg/dL.

Classes I-IV Cardiac Disease

• NY Heart Association classification impacts maternal-fetal risk:
  • Class I: No limitations or symptoms during ordinary activities.
  • Class II: Mild limitations with symptoms during ordinary activities.
  • Class III: Severe limitations; symptoms with mild activity.
  • Class IV: Inability to perform physical activities without severe symptoms.
• Classes III and IV carry maternal and fetal risks; continuous fetal monitoring is vital during labor to mitigate inadequate oxygen supply.

Cardiopulmonary Defects

• Common defects include tetralogy of Fallot and ventricular or atrial septal defects.
• Successful surgical correction typically poses no additional fetal risk; improper repairs or cyanotic defects increase the risk.
• Maternal conditions like Marfan's syndrome pose severe risks, including high mortality rates and potential fetal complications.

HIV/AIDS

• Women with HIV should continue antiretroviral medications prior to conception; efavirenz is contraindicated due to teratogenic effects.
• Treatment initiated during pregnancy reduces mother-to-fetus transmission rate to about 2%.
• Cesarean delivery may be indicated based on maternal viral load and treatment history.

Maternal Age

Adolescent Mothers

• Teenage mothers with appropriate prenatal care do not have higher risks compared to older mothers.
• Associated risks include smoking, inadequate weight gain, and complications like premature delivery and low birth weight.
• Common psychological responses include denial and distress regarding body changes.
• Concerns about partner support and socio-economic factors often prevalent.

Mature Mothers (Over 35)

• Increased pregnancy rates among women over 35 often correlate with better education and financial stability.
• Risks elevate with age, particularly for those over 40. Risks include preexisting health issues and congenital anomalies such as Down syndrome.
• Older mothers may also face enhanced emotional and logistical challenges related to aging and child-rearing.

Multiple Gestations

• Advances in reproductive technology have increased instances of multiple births.
• Higher likelihood for prematurity and low birth weight, proportionate to the number of fetuses.
• Genetic disorders are more common in multiple gestations, including increased risks for cerebral palsy.

Grand Multiparity

• Defined as having 5 or more deliveries; significant associations with placenta previa and hemorrhage.
• Risks also increase with poor prenatal care and may involve age-related complications.

Infertility

Female Infertility

• Non-patent fallopian tubes can result from conditions like PID or endometriosis, affecting fertility.

Male Fertility Tests

• Male infertility analysis includes:
  • Urogenital history and physical examination for abnormalities.
  • Semen analysis evaluating sperm count and motility.
  • Hormone level assessment for testosterone and other hormones.
  • Genetic testing for chromosomal abnormalities.

Assisted Reproduction Methods

• Techniques include ART with donor gametes, IVF, ICSI, and intrauterine insemination (IUI).
• GIFT allows fertilization within the fallopian tubes.

Gonadotropins

• Administered to stimulate ovarian follicle maturity and testosterone production in men.
• Risks include multiple gestations and hormone imbalances.

Fertility Drugs

• Bromocriptine and cabergoline lower prolactin levels in females and males, enhancing ovulation and sperm production.
• Clomiphene stimulates hormone production for increased ovulation in women.

Sexually Transmitted Diseases

Cytomegalovirus

• Common viral infection with potential severe outcomes for neonates, leading to neurological disorders.
• Can be transmitted during pregnancy or at birth, with symptomatic infants presenting high mortality.

Herpes Simplex Virus (HSV)

• Asymptomatic in many pregnant women; primary infections present higher transmission risks during delivery.
• Neonatal herpes presents with severe complications, requiring preventative C-sections for active infections.

Chlamydia

• Most prevalent STI in the U.S., requiring prophylactic eye treatment for newborns to prevent conjunctivitis and pneumonia.

Syphilis

• Congenital syphilis risks include spontaneous abortion and severe systemic infections in newborns; treated aggressively with penicillin.

Neisseria Gonorrhoeae

• Associated with recurrent infections and risk of ectopic pregnancies; often asymptomatic, necessitating broad-spectrum antibiotic treatment for pregnant women.### Substance Abuse and Pregnancy
• Women with multiple sexual partners or illicit drug use face increased health risks during pregnancy.
• Marijuana: Often used alongside alcohol and tobacco; potential effects include tremors and irritability lasting up to one year after birth.
• Phencyclidine (PCP): Maternal overdose can lead to hypertension, hyperthermia, or coma.
• MDMA (Ecstasy): Widely used by teens; associated with long-term learning impairments.

Amphetamines

• Amphetamines, especially methamphetamine, are central nervous stimulants.
• Maternal use risks include hypertension, tachycardia, miscarriage, placental abruption, and premature delivery.
• Neonates may exhibit small gestational age, lethargy, poor feeding, and abnormal reflexes among other symptoms.

Cocaine and Crack

• Cocaine crosses the placenta, causing growth restrictions and fetal hypoxia.
• Programmed cell death in fetal heart cells can lead to cardiac dysfunction.
• Additional risks from cocaine use include premature birth and various congenital defects.

Heroin Use

• Highly addictive with severe consequences for both mother and baby, including poor nutrition and increased susceptibility to HIV.
• Withdrawal symptoms may trigger premature labor or stillbirth.

Methadone Treatment

• Used for heroin addiction; prevents withdrawal symptoms but crosses the placenta.
• Risks associated with methadone include miscarriage, stillbirth, and low birth weight.

Alcohol Consumption

• No safe level of alcohol intake during pregnancy; can lead to Fetal Alcohol Syndrome (FAS).
• FAS affects facial features, brain development, and overall growth of the baby.

Tobacco Use

• Contains harmful substances like nicotine and carbon monoxide; increases risks of miscarriage and low birth weight.
• Infants may face health issues such as congenital defects and respiratory problems.

Termination of Pregnancy

• Surgical Methods: Include vacuum aspiration, suction curettage, dilation and extraction, and intact dilation and extraction.
• Medical Procedures: Mifepristone and misoprostol used in the first trimester for medication-induced abortion; require monitoring for complications.

Smoking Risks During Pregnancy

• Carbon monoxide displaces oxygen, impacting fetal oxygen delivery.
• Increases likelihood of miscarriage, congenital defects, and can lead to SIDS in infants.
• Cessation programs may aid pregnant women in quitting smoking for improved fetal health.

This quiz covers important aspects of assessing risk for gestational diabetes in high-risk pregnancies. It includes guidelines for testing and factors that contribute to elevated risk. Perfect for healthcare professionals and students looking to understand this critical condition.