What are effective strategies for managing chronic disease in pregnant women?

Some more common chronic diseases are diabetes and hypertension, and although they are common, they can result in complications for both you and the baby if not managed well during pregnancy. If someone with chronic disease is thinking of getting pregnant, my advice would be to optimize the management of the condition and their health as much as possible before pregnancy. In some cases, this may mean you are able to wean off some medications or even transition to medications that are safe for pregnancy. Planning ahead will help reduce the chance that you have uncontrolled chronic disease when pregnant and/or are on medications that are unsafe for pregnancy.

Becoming pregnant is an exciting milestone that many couples look forward to. However, before taking the plunge into parenthood, it is important for women to understand how their health can impact both themselves and their developing child. Chronic diseases, such as diabetes and hypertension, can significantly complicate pregnancy and increase the likelihood of adverse outcomes. As a practicing reproductive endocrinologist who frequently sees patients for pre-conception counseling, I urge patients to take charge of their health and seek the support they need before conceiving a child. This includes asking their family about their pregnancies, getting a routine physical exam, and maintaining a healthy lifestyle before conceiving.

In my experience as a holistic fertility therapist, working on the mind, body and GUT is crucial to managing any illness one has let alone a chronic one. So many illnesses stem from poor gut or liver health which if not worked on can manifest into chronic issues and complications. As someone who underwent infertility, went through holistic changes, got pregnant with IVF, I still developed pre-eclampsia in my pregnancy (thankfully at the very end of it) but I also had severe hypermesis. I would urge anyone looking to conceive works on themselves for at least a good 3-6 months with a nutritionist to balance their nutrition and manage their conditions or put them into remission. Your baby will also thank you for it through their own health.

Knowing your risks during pregnancy is vital. In addition to potential complications, consider factors like lifestyle, genetics, and family history. Understanding these aspects will help you and your healthcare provider develop a comprehensive plan for a healthier pregnancy, ensuring timely interventions and support.

Managing chronic diseases in pregnant women requires a specific and tailored approach according to the condition and needs of the patient. Some of the most effective strategies are : • Regular prenatal care • Regular check ups to monitor the condition • Medication adjustments to ensure the safety for both the mother and the baby • Maintaining a healthy lifestyle, that includes; following a proper and sustainable diet, staying physically active as advised by the healthcare provider, managing stress levels with by learning to regulate the nervous system, with breath-work, meditation and mindfulness. Always keeping a good communication with the doctor to ensure the best possible outcome for both the mother and the baby.

Nutrition and Diet: Consult a dietitian for a pregnancy-specific diet tailored to your condition. Lifestyle Changes: Incorporate exercise and stress management for better health. Regular Monitoring: Schedule routine check-ups and tests to track your condition's progression. Educate Yourself: Gain knowledge about your condition's impact on pregnancy for informed decision-making. Support Network: Build a strong support system for emotional well-being. Emergency Plan: Prepare for potential complications with an emergency plan. Birth Plan: Collaborate with your healthcare provider on a personalized birth plan. Mental Health: Address emotional well-being with counseling or therapy as needed.

Balancing your blood sugar levels and ensuring you are eating the 3 main food groups in every meal (Protein, fats and carbohydrates) will help with the inflammation that chronic conditions present. It is also about being able to provide the baby with the right nutrition but ensuring you are not being depleted. Certain medications can deplete the body of vital nutrition e.g Metformin depletes the body of Folate (folic acid) and B12 - both needed for methylation, and detoxification processes but also the development of the baby. Know what your medication is depleting and work to put that nutrition back into your body ideally with food. MethylFolate (and not synthetic folic acid) is important for the prevention of spina bifida in a baby.

One of the most significant reasons for knowing your health before getting pregnant is to reduce the risk of complications during pregnancy. Poorly controlled chronic diseases, like hypertension and diabetes, can lead to several complications during pregnancy, such as preeclampsia (hypertension accompanied by organ damage) or gestational diabetes. These complications can increase the risk of preterm labor, fetal growth restriction, and even fetal loss. Although scary, these conditions can often be prevented through healthy lifestyle modifications and making sure someone is in their "best health" before challenging their body with carrying a pregnancy.

As a patient, it is essential to take the initiative to seek support from your healthcare provider before planning a pregnancy. Your healthcare provider can help you understand the impact of chronic diseases on pregnancy and develop a plan to manage and treat your condition. Additionally, they can provide adequate preconception education, monitor your health during pregnancy, and find appropriate specialists if needed. Most importantly, if someone doesn't feel well during pregnancy, don't just assume it is a pregnancy symptom, tell your provider.

Monitor your blood pressure and be aware if it increases during the SECOND trimester because it should become lower, not higher. It's a subtle but important sign of possible forthcoming preeclampsia or gestational hypertension. Request a maternal-fetal medicine (MFM) consultation if you have high-risk conditions. Always monitor fetal movement and immediately contact your physician/midwife if the movement has slowed down to avert a preventable stillbirth.

It’s very important to be educated on the signs/symptoms of pregnancy-related complications. For example, if you have chronic hypertension, you are at an increased risk for preeclampsia - a condition that can be life threatening if not managed well. Symptoms such as changes in vision, swelling and headache can sometimes be secondary to preeclampsia. Your blood pressure may also increase and you may have protein in your urine. In short, if you have a chronic medical condition it’s important to be educated on what pregnancy complications you are at a higher risk for and what the signs/symptoms of those are so you can be best prepared to recognize and act on these changes as soon as possible.

During pregnancy, what you eat and drink affects the growth and development of your baby. It is essential to consume a balanced and healthy diet that includes protein, vitamins, minerals and fiber. Whole-grain bread, fruits, vegetables, and lean meats such as chicken and fish are excellent choices. Avoid consuming foods that are high in sugar, fat, and salt. Exercising regularly during pregnancy is vital for a healthy pregnancy. You do not have to engage in intense workouts, but 30 minutes of gentle exercise such as walking, prenatal yoga, or swimming will help you stay active. Regular physical activity can also reduce your risk of developing gestational diabetes, high blood pressure, and other common conditions.

Doctors now recommend a whole-food, plant-based diet during pregnancy, especially for those at risk of gestational diabetes due to insulin resistance.

Le mode de vie à un impact indéniable dans le bon déroulement de la grossesse mais un changement vers un mode de vie sain ne doit pas seulement être appliqué lors de la grossesse, ce dernier devrait être mis en place dès le désir de grossesse. L'encadrement par des spécialistes est crucial dans la mesure où la définition d'un mode de vie sain n'a pas une définition mais une pléthore, notamment quand on commence à surfer sur la toile. Eviter le café, bannir l'alcool mais aussi s'assurer de manger suffisamment d'aliment à fortes valeurs nutritives (légumes frais et de saison, fibres, lipides de qualité, protéines en suffisance, apport adéquate en calcium mais aussi en fer).

Speak to your healthcare professional about walking as a means of exercise. Try to see a nutritionist to discuss the healthiest foods to eat during your pregnancy. Things you want to avoid: Smoking = small babies Excessive carbohydrates = increased chance of Gestations Diabetes (GDM) Excess calories = obesity, increased risk of GDM, large babies Excess sodium = increased risk of hypertension Alcohol = Fetal Alcohol Syndrome, liver problems, small babies

Well before you decide to fall pregnant (3-6 months ahead), it is worth looking into your diet and lifestyle and checking that your nutrition supports your conception journey. A baby is created with the egg and sperm that are created 3 months ago and what you have been doing in these 3 months will depict the quality of the egg and sperm thus the embryo. Once you are pregnant, continue to eat healthy, remember you only need an additional 200 calories on top of your normal eating. Eating a well balanced diet consisting of all 3 food groups (Protein, Fats and Carbs) is essential. Hydration, sleep and exercising are also important but take on an activity your body won't stress out over like walking or yoga. Manage your stresses well.

Having support during pregnancy is essential. Ask about "group" prenatal visits. Seek assistance from a social worker or social services if you're having transportation issues, food insecurity, or have been exposed to domestic violence.

Get to know the doulas, childbirth educators, and lactation consultants in your area. Having a doula by your side for advocacy, emotional support and resources to more knowledge can be extremely helpful. Statistically, women who have doula support during the perinatal period experience more satisfaction and less interventions.

I cannot stress this part enough. Although having a birth plan in place does not mean it will go exactly as planned, (most of the time it doesn’t), it’s important to know what all your options are and make sure your wishes are known to your support system and providers. People with chronic conditions can be at an increased risk for cesarean delivery - obesity is a good example. Having a cesarean for a previous delivery does NOT mean you automatically must have a cesarean for future deliveries. I meet so many women that were not aware that they could try to have a vaginal birth after cesarean (VBAC). So it’s important to have all these discussions in advance, to plan for a birth where these options exist.

One important thing is to plan your pregnancy, unexpected pregnancy will make things worse, discuss with your doctor and choose when to get pregnant.

le post partum notamment lorsque la mère est une primigeste est une grande inconnue et si pour certaine, il est très bien vécu, pour d'autre c'est la catastrophe sans parler du baby blues qui ne devrait plus être tabou. En parler, s'entourer des bonnes personnes, mais aussi ne pas se mettre la pression me semble être des points fondamentaux

If you have a hypertensive disorder of pregnancy, it is imperative that you receive a cardiology consult during your pregnancy, especially during the postpartum period when 40% of complications occur. While it's important to have a birth plan, please either do your due diligence or ask your healthcare professional about the "risks vs benefits" of each decision you make, as it relates to pregnancy.

During pregnancy, healthy choices are imperative to the wellbeing of your baby and yourself. The above tips will help you make the right choices, not only for pregnancy but for long-term good health. Remember, always consult your healthcare provider, and if you experience any unusual symptoms, report them immediately. With healthy habits, you are positioning yourself and your baby for a healthy future!