Pregnancy Complications

Complications of pregnancy are health problems that occur during pregnancy. They can involve the mother's health, the baby's health, or both. Some women have health problems that arise during pregnancy, and other women have health problems before they become pregnant that could lead to complications. It is very important for women to receive health care before and during pregnancy to decrease the risk of pregnancy complications.

Before Pregnancy

Make sure to talk to your doctor about health problems you have now or have had in the past. If you are receiving treatment for a health problem, your health care provider might want to change the way your health problem is managed. For example, some medicines used to treat health problems could be harmful if taken during pregnancy. At the same time, stopping medicines that you need could be more harmful than the risks posed should you become pregnant. In addition, be sure to discuss any problems you had in any previous pregnancy. If health problems are under control and you get good prenatal care, you are likely to have a normal, healthy baby.

 

During Pregnancy

Pregnancy symptoms and complications can range from mild and annoying discomforts to severe, sometimes life-threatening, illnesses. Sometimes it can be difficult for a woman to determine which symptoms are normal and which are not. Problems during pregnancy may include physical and mental conditions that affect the health of the mother or the baby. These problems can be caused by or can be made worse by being pregnant. Many problems are mild and do not progress; however, when they do, they may harm the mother or her baby. Keep in mind that there are ways to manage problems that come up during pregnancy. Always contact your prenatal care provider if you have any concerns during your pregnancy.

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The following are some common maternal health conditions or problems a woman may experience during pregnancy—

 

Anemia
Anemia is having lower than the normal number of healthy red blood cells. Treating the underlying cause of the anemia will help restore the number of healthy red blood cells. Women with pregnancy related anemia may feel tired and weak. This can be helped by taking iron and folic acid supplements. Your health care provider will check your iron levels throughout pregnancy.

Urinary Tract Infections (UTI)
A UTI is a bacterial infection in the urinary tract. You may have a UTI if you have—

• Pain or burning when you use the bathroom.
• Fever, tiredness, or shakiness.
• An urge to use the bathroom often.
• Pressure in your lower belly.
• Urine that smells bad or looks cloudy or reddish.
• Nausea or back pain.

If you think you have a UTI, it is important to see your health care provider. He/she can tell if you have a UTI by testing a sample of your urine. Treatment with antibiotics to kill the infection will make it better, often in one or two days. Some women carry bacteria in their bladder without having symptoms. Your health care provider will likely test your urine in early pregnancy to see if this is the case and treat you with antibiotics if necessary.

Mental Health Conditions
Some women experience depression during or after pregnancy. Symptoms of depression are:

• A low or sad mood.
• Loss of interest in fun activities.
• Changes in appetite, sleep, and energy.
• Problems thinking, concentrating, and making decisions.
• Feelings of worthlessness, shame, or guilt.
• Thoughts that life is not worth living.

When many of these symptoms occur together and last for more than a week or two at a time, this is probably depression. Depression that persists during pregnancy can make it hard for a woman to care for herself and her unborn baby. Having depression before pregnancy also is a risk factor for postpartum depression. Getting treatment is important for both mother and baby. If you have a history of depression, it is important to discuss this with your health care provider early in pregnancy so that a plan for management can be made.

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Hypertension (High Blood Pressure)
Chronic poorly-controlled high blood pressure before and during pregnancy puts a pregnant woman and her baby at risk for problems. It is associated with an increased risk for maternal complications such as preeclampsia, placental abruption (when the placenta separates from the wall of the uterus), and gestational diabetes. These women also face a higher risk for poor birth outcomes such as preterm delivery, having an infant small for his/her gestational age, and infant death. The most important thing to do is to discuss blood pressure problems with your provider before you become pregnant so that appropriate treatment and control of your blood pressure occurs before pregnancy. Getting treatment for high blood pressure is important before, during, and after pregnancy.

 

Gestational Diabetes Mellitus (GDM)
GDM is diagnosed during pregnancy and can lead to pregnancy complications. GDM is when the body cannot effectively process sugars and starches (carbohydrates), leading to high sugar levels in the blood stream. Most women with GDM can control their blood sugar levels by a following a healthy meal plan from their health care provider and getting regular physical activity. Some women also need insulin to keep blood sugar levels under control. Doing so is important because poorly controlled diabetes increases the risk of—

• Preeclampsia.
• Early delivery.
• Cesarean birth.
• Having a big baby, which can complicate delivery.
• Having a baby born with low blood sugar, breathing problems, and jaundice.

Although GDM usually resolves after pregnancy, women who had GDM have a higher risk of developing diabetes in the future. Learn more about postpartum diabetes testing.

Obesity and Weight Gain
Recent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of pregnancy complications, including preeclampsia, GDM, stillbirth and cesarean delivery. Also, CDC research has shown that obesity during pregnancy is associated with increased use of health care and physician services, and longer hospital stays for delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies. Learn more about ways to reach and maintain a healthy weight before you get pregnant.

Infections
During pregnancy, your baby is protected from many illnesses, like the common cold or a passing stomach bug. But some infections can be harmful to you, your baby, or both. Easy steps, such as hand washing, and avoiding certain foods, can help protect you from some infections. You won’t always know if you have an infection—sometimes you won’t even feel sick. If you think you might have an infection or think you are at risk, see your health care provider. Read more about specific infections that can be harmful during pregnancy, and learn the symptoms and what you can do to keep healthy.

Hyperemesis Gravidarum
Many women have some nausea or vomiting, or "morning sickness," particularly during the first 3 months of pregnancy. The cause of nausea and vomiting during pregnancy is believed to be rapidly rising blood levels of a hormone called HCG (human chorionic gonadotropin), which is released by the placenta. However, hyperemesis gravidarum occurs when there is severe, persistent nausea and vomiting during pregnancy—more extreme than "morning sickness." This can lead to weight loss and dehydration and may require intensive treatment.

Learn more about pregnancy complications from womenshealth.gov.

 

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Research

CDC's Division of Reproductive Health conducts research to better understand  pregnancy-related problems, with the aims of making pregnancy healthier, preventing or managing complications, and reducing poor pregnancy outcomes, including death—the most extreme adverse outcome. There are approximately 6 million pregnancies each year in the United States. Small advances in preventing pregnancy-related complications can improve the quality of life for thousands of pregnant women. We can further the development of evidence-based public health prevention with improved sources of maternal health data, and methods for measuring and studying the data. Highlights of some of our research follow

 

Obesity

In the United States, obesity during pregnancy is common and it increases obstetrical risks. In collaboration with Kaiser Permanente Northwest, CDC conducted a study to assess associations between indicators of use of health care services and body-mass index before pregnancy or in early pregnancy and found that obesity during pregnancy is associated with increased use of health care services. A higher-than-normal BMI was associated with significantly more prenatal fetal tests, obstetrical ultrasonographic examinations, medications dispensed from the outpatient pharmacy, telephone calls to the department of obstetrics and gynecology, and prenatal visits with physicians. It was also associated with significantly fewer prenatal visits with nurse practitioners and physician assistants. Most of the increase in length of stay associated with higher BMI was related to increased rates of cesarean delivery and obesity-related high-risk conditions. (Association between obesity during pregnancy and increased use of health care. N Engl J Med 2008;358:1444–53.)

CDC has supported university investigators from Brigham and Women’s Hospital to develop Balance after Baby, a lifestyle intervention program tailored specifically to meet the needs of postpartum women. The primary aim of this study was to assist women with a new baby to return to a normal weight through an Internet-based program of healthy eating and physical activity, which they could participate in at their convenience.

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Gestational Diabetes Mellitus (GDM)

In the United States, almost all doctors now screen for GDM during prenatal visits. In addition, both the American Congress of Obstetricians and Gynecologists and the American Diabetes Association recommend postpartum diabetes testing for all women who developed GDM to assess the woman’s risk for type 2 diabetes; however, only about 50% of women who need the test actually get it. The postpartum period may be an especially hard time for women who had GDM to return to their provider for testing and to include exercise and a healthy diet into their schedules. New mothers are recovering from delivery, caring for a newborn and often other children, and some are returning to work.

To address this public health problem, CDC researchers have developed several collaborative projects targeted particularly for postpartum women who had a GDM affected pregnancy.  

• CDC and Kaiser Permanente Northwest (KPNW) conducted a study that revealed that postpartum glucose screening among women who had GDM was very low. These findings were used to develop a process improvement program for postpartum glucose testing within the KPNW system. The study intervention included staff education sessions, revised GDM patient care protocols, electronic physician orders for lab tests, and an electronic system to trigger reminder calls to women who had not completed postpartum glucose testing within 3 months of delivery. These strategies led to increased orders for postpartum tests, increased test completion, enhanced counseling, and better follow-up of affected women (Postpartum screening for diabetes after a gestational diabetes mellitus–affected pregnancy. Obstet Gynecol. 2008;112:868–874; and A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. Am J Obstet Gynecol 2012;207:283.e1-6).
• In another project, CDC funded Los Angeles County and University of Southern California to conduct a study using a Promotora, a Spanish-speaking community health worker, to provide counseling, reminder phone calls, and individualized attention to improve postpartum diabetes screening. Results showed that a Promotora-based program in a Hispanic community can be effective in improving care following pregnancies complicated by GDM.
• Diabetes prevention strategies that have been effective in other populations have not been tested in postpartum women with a recent history of GDM. The Diabetes Prevention Program (DPP) was a large randomized trial among adults with glucose intolerance and impaired fasting glucose. Results identified intervention strategies that reduced the incidence of type 2 diabetes. Intervention strategies included lifestyle modification (i.e., a healthy diet, exercise, and weight management) or medication. The lifestyle intervention was more effective than the medication. (Reduction in the incidence of type 2 Diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403).
• CDC has worked with investigators from Brigham and Women’s Hospital to develop a modified version of the DPP, tailored specifically for postpartum women. In focus groups, women with a new baby reported that an Internet-based lifestyle intervention program would help alleviate barriers and facilitate their participation (Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes. BMC Pregnancy and Childbirth. 2011; 11:23). The researchers created and implemented Balance after Baby, a Web-based lifestyle intervention to help women engage in physical activity, eat a healthy diet, and return to their pre-pregnancy weight. Investigators are currently analyzing data to determine the success of the program. If successful, investigators will work with the Massachusetts Department of Health and CDC to determine how to disseminate the intervention.

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Severe maternal morbidity in the United States

Maternal morbidity includes physical and psychologic conditions that result from or are aggravated by pregnancy and have an adverse effect on a woman’s health. The most severe complications of pregnancy, generally referred to as severe maternal morbidity (SMM), affect more than 50,000 women in the United States every year. Based on recent trends, this burden has been steadily increasing.

Rises in SMM are likely driven by a combination of factors, including increases in maternal age, pre-pregnancy obesity, pre-existing chronic medical conditions, and cesarean delivery. The consequences of the increasing SMM prevalence are wide-ranging and include higher health service use, higher direct medical costs, extended hospitalization stays, and long-term rehabilitation. The review of SMM cases provides an opportunity to identify points of intervention for quality improvements in maternal care. Tracking SMM will help monitor the effectiveness of such interventions.

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