8.5.2: Maternal Health

Learning Objectives

1. Identify and define the most common risk factors, potential effects on the mother and fetus, and how each is managed during pregnancy.

Gestational Diabetes

Seven percent of pregnant women develop gestational diabetes (March of Dimes, 2015a). Diabetes is a condition where the body has too much glucose in the bloodstream.

Figure \(\PageIndex{1}\): A gestational diabetes kit. Image by Jessica Merz is licensed under CC BY 2.0.

Most pregnant women have their glucose level tested between 24 and 28 weeks of pregnancy. Gestational diabetes usually goes away after the mother gives birth, but it might indicate a risk for developing diabetes later in life. If untreated, gestational diabetes can cause premature birth, stillbirth, the baby having breathing problems at birth, jaundice, or low blood sugar. Babies born to mothers with gestational diabetes can also be considerably heavier (more than 9 pounds), making the labor and birth process more difficult. For expectant mothers, untreated gestational diabetes can cause preeclampsia (high blood pressure and signs that the liver and kidneys may not be working properly), which is discussed later in the chapter.

Risk factors for gestational diabetes include age (being over age 25), being overweight or gaining too much weight during pregnancy, family history of diabetes, having had gestational diabetes with a prior pregnancy, and race and ethnicity (African-American, Native American, Hispanic, Asian, or Pacific Islander have a higher risk). Eating a healthy diet and maintaining a healthy weight during pregnancy can reduce the risk of gestational diabetes. Women who already have diabetes and become pregnant need to attend all their prenatal care visits and follow the same advice as those for women with gestational diabetes, as the risk of preeclampsia, premature birth, birth defects, and stillbirth is the same.

High Blood Pressure (Hypertension)

Hypertension is a condition in which the pressure against the walls of the arteries becomes too high. There are two types of high blood pressure during pregnancy, gestational and chronic. Gestational hypertension only occurs during pregnancy and goes away after birth. Chronic high blood pressure refers to women who already had hypertension before the pregnancy or to those who developed it during pregnancy, and it did not go away after birth.

Figure \(\PageIndex{2}\): A woman having her blood pressure taken. Image by rawpixel on Unsplash.

According to the March of Dimes (2015b), about 8 in every 100 pregnant women have high blood pressure. High blood pressure during pregnancy can cause premature birth and low birth weight (under five and a half pounds), placental abruption, and mothers can develop preeclampsia.

Rh Disease

Rh is a protein found in the blood. Most people are Rh positive, meaning they have this protein. Some people are Rh negative, meaning this protein is absent from their blood. Mothers who are Rh negative are at risk of having a baby with a form of anemia called Rh disease (March of Dimes, 2009). A father who is Rh-positive and a mother who is Rh-negative can conceive a baby who is Rh-positive. Some of the fetus’s blood cells may get into the mother’s bloodstream, and her immune system is unable to recognize the Rh factor.

The immune system begins to produce antibodies to combat what it perceives as a foreign invader. Once her body produces immunity, the antibodies can cross the placenta and start to destroy the red blood cells of the developing fetus. As this process takes time, the first Rh-positive baby is often not harmed. However, as the mother’s body continues to produce antibodies to the Rh factor throughout her lifetime, subsequent pregnancies can pose a greater risk to an Rh-positive baby. In the newborn, Rh disease can lead to jaundice, anemia, heart failure, brain damage, and death.

Weight Gain during Pregnancy

According to the March of Dimes (2016), during pregnancy, most women require only an additional 300 calories per day to support the growth of the fetus. Gaining too little or too much weight during pregnancy can be harmful. Women who gain too little may have a baby who is low birth weight, while those who gain too much are likely to have a premature or large baby. There is also a greater risk for the mother developing preeclampsia and diabetes, which can cause further problems during the pregnancy.

The table below shows the healthy weight gain during pregnancy. Gaining weight slowly is best. Mothers who are concerned about their weight gain should talk to their healthcare provider.

Table \(\PageIndex{1}\): Weight Gain during Pregnancy

If you were a healthy weight before pregnancy:	If you were underweight before pregnancy:	If you were overweight before pregnancy:	If you were obese before pregnancy:
Gain 25-35 pounds 1-41⁄2 pounds in the 1st trimester 1 pound per week in the 2nd and 3rd trimesters	Gain 28-30 pounds 1-41⁄2 pounds in the 1st trimester A little more than 1 pound per week thereafter	Gain 12-25 pounds 1-41⁄2 pounds in the 1st trimester A little more than 1⁄2 pound per week in 2nd and 3rd trimesters	11-20 pounds 1-41⁄2 pounds in the 1st trimester A little more than 1⁄2 pound per week in 2nd and 3rd trimesters

Stress

Feeling stressed is common during pregnancy, but high levels of stress can cause complications, including having a premature baby or a low-birthweight baby. Babies born early or too small are at an increased risk of health problems. Stress-related hormones may cause these complications by affecting a woman’s immune system, resulting in an infection and premature birth. Additionally, some women deal with stress by smoking, drinking alcohol, or taking drugs, which can lead to problems during pregnancy. High levels of stress in pregnancy have also been correlated with problems in the baby’s brain development and immune system functioning, as well as childhood problems such as trouble paying attention and being afraid (March of Dimes, 2012).

Depression

Depression is a significant medical condition in which feelings of sadness, worthlessness, guilt, and fatigue interfere with one’s daily functioning. Depression can occur before, during, or after pregnancy, and 1 in 7 women are treated for depression sometime between the year before pregnancy and the year after pregnancy (March of Dimes, 2015c). Women who have experienced depression previously are more likely to have depression during pregnancy. Consequences of depression include the baby being born premature, having a low birthweight, being more irritable, less active, less attentive, and having fewer facial expressions.

About 13% of pregnant women take an antidepressant during pregnancy. It is important that women taking antidepressants during pregnancy discuss the medication with a healthcare provider, as some medications can cause harm to the developing fetus.

References, Contributors and Attributions

Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

March of Dimes. (2009). Rh disease. Retrieved from http://www.marchofdimes.org/complica...h-disease.aspx

March of Dimes. (2012). Stress and pregnancy. Retrieved from http://www.marchofdimes.org/pregnanc...pregnancy.aspx

March of Dimes. (2015a). Gestational diabetes. Retrieved from http://www.marchofdimes.org/complica...-diabetes.aspx

March of Dimes. (2015b). High blood pressure during pregnancy. Retrieved from http://www.marchofdimes.org/complica...pregnancy.aspx

March of Dimes. (2015c). Depression during pregnancy. Retrieved from http://www.marchofdimes.org/complica...pregnancy.aspx

March of Dimes. (2016). Weight gain during pregnancy. Retrieved from http://www.marchofdimes.org/pregnanc...pregnancy.aspx