Pregnancy at risk: what are the symptoms?

Pregnancy should not be treated as a disease, but in some circumstances the risk that not everything goes as planned is higher than in others.

Defining whether a pregnancy is at low, moderate or high risk is important to allow the future mother to be followed in the most appropriate way by health professionals and thus avoid negative outcomes for maternal and fetal health.

In this regard, however, it should be noted, as also emphasized by the World Health Organization, that the risk in pregnancy is dynamic, that is, each gestation can present one or more risks and different degrees of risk at different times.

In particular, the first weeks of pregnancy are the most delicate, also because the fetus is being formed, and it is at this stage that more often there is a threat of abortion, while, for example, gestational diabetes is more frequent in the second and third trimesters.

In addition, a high-risk pregnancy can still have a positive outcome: a risk of abortion, for example, may not translate into an actual termination of the pregnancy.

Pregnancy at risk: the factors

To determine the risk in pregnancy contribute:

– women’s health conditions already exist before conception

– age and lifestyle of the expectant mother at the time of pregnancy

– disorders that may arise during gestation.

In fact, some health problems that the future mother suffers from, for example hypertension or polycystic ovary syndrome (a pathology that, interfering with ovulation, also causes difficulty getting pregnant), obesity, diabetes, kidney diseases, autoimmune diseases (ie immune system disorders) and those that affect the thyroid, but also cardiac or pelvic abnormalities They can increase the risk of complications such as miscarriage or preterm birth, but not only. In general, pre-existing chronic diseases can worsen with pregnancy or somehow hinder it and interfere with its course.

Even under the age of 17 or over 35, smoking, alcohol consumption and certain conditions that can develop during gestation can put you at risk of pregnancy. Among these, one of the most frequent is gestational diabetes, but let’s not forget also preeclampsia, conditions of severe anemia, abnormalities of the placenta, as well as some infections contracted in the nine months (such as toxoplasmosis, rubella, cytomegalovirus). In addition, a diagnosis of depression in pregnancy should not be underestimated: if left untreated, it can lead to incorrect maternal behavior or even dangerous for fetal health.

Even the expectation of twins configures a pregnancy at risk, because twin gestation has a high probability of ending with a preterm birth.

Finally, even complications found in previous pregnancies (previous miscarriages or malformations of the fetus, preeclampsia or eclampsia, preterm births, placental diseases or uterine surgery) can lead the gynecologist to consider a new gestation equally at risk.

Gestational diabetes

Gestational diabetes is a condition affecting women who have never dealt with diabetes before pregnancy. It tends to appear especially from the second trimester.

In reality, the appearance of a resistance to the action of insulin during gestation is normal and serves to “divert” the sugars introduced with the diet to the developing baby.

However, in some conditions this phenomenon is excessively accentuated and leads to the onset of a real form of diabetes which, if not kept under control, increases the risk of unwanted events such as preterm birth or dangerous glycemic drops in the baby shortly after cutting the umbilical cord.

In addition, a fetus overnourished by excessive amounts of sugar can experience fetal macrosomia, which occurs when the newborn weighs more than 4.5 kg at birth. This can cause a premature birth or may require a caesarean section, precisely because of the disproportion between the size of the newborn and those of the birth canal.

In most cases, gestational diabetes remains asymptomatic (although it can in some cases cause an increased need to drink and a greater frequency of urination in the pregnant woman); This is why it is important to undergo the blood glucose checks prescribed by the doctor: only in this way is it possible to notice any diabetes and manage it in the best possible way. In particular, to confirm or not the diagnosis of pregnancy diabetes, the gynecologist prescribes some tests to the patient, the loading glycemic minicurve and the complete glycemic curve.

The diet, usually established by the gynecologist in consultation with a diabetologist, is the simplest and most decisive system to keep gestational diabetes at bay, but if it is not sufficient, insulin administration may be necessary to the pregnant woman.

Preeclampsia

Another problem that can complicate pregnancy is preeclampsia, a syndrome characterized by a sudden increase in blood pressure that, if not properly treated, can lead to eclampsia itself, which is characterized by seizures and, in severe cases, coma.

Also known as gestosis, preeclampsia tends to occur after the twentieth week of gestation with a triad of symptoms, whose coexistence makes diagnosis easier:

– pressure increase above 140/90 mmHg

– increased protein levels in the urine (proteinuria)

– diffuse edema, especially in the lower limbs.

To these symptoms may then be added others.

Generally, as mentioned, the first sign of preeclampsia is a sudden increase in pressure above 140/90 mmHg; Symptoms that may accompany it include severe headaches, vision problems (sensitivity to light, foggy field of vision or temporary blindness), pain in the upper right side of the abdomen, reduced urine output, nausea or vomiting, shortness of breath and sudden swelling (especially in the hands and feet). To these symptoms can be added signs such as alterations in the functioning of the kidneys (detectable for example with the presence of proteins in the urine) or liver and with a reduction in blood platelets.

In more serious conditions it is also possible to deal with bright red vaginal discharge and with the absence or strong reduction of the baby’s movements. In fact, preeclampsia is a risk factor for placental abruption, and among the most common symptoms of the latter are included vaginal bleeding, to which cramps or abdominal sensitivity can be added.

The extent of the bleeding depends on how much placenta has broken off. Sometimes blood accumulates between the placenta and the wall of the uterus and blood loss can be very mild; In the most serious situations, however, bleeding is abundant and the child may move less than usual or not move at all. In all cases it is good to consult a doctor as soon as possible.

Since gestosis resolves with childbirth, doctors use, if possible, supportive therapies until sufficient fetal maturity is reached, keeping the state of health of the future mother under control. The medications, prescribed by the doctor, are used to avoid complications related to increased pressure, such as placental abruption, heart failure and cerebral hemorrhage.

Dangerous infections in pregnancy

If the pregnant woman contracts some infections, she can expose the fetus to very important risks, especially if the infection occurs in the first trimester of pregnancy.

Among the most feared infectious agents we remember:

– the rubella virus, which if contracted during gestation exposes the fetus to mental retardation, blindness, deafness, but also to the risk of abortion and intrauterine death

– cytomegalovirus, which can cause disability in the newborn

– toxoplasma, parasite responsible for toxoplasmosis, which exposes to the risk of miscarriage or serious congenital fetal lesions.

In adults, these infections are often asymptomatic or manifest themselves with non-specific symptoms (such as general malaise and sometimes fever), so much so that at the beginning of a pregnancy, to know if the woman has already contracted these infections in the past, specific blood tests are carried out. If successful, the woman has generally developed an immunization that will protect her for nine months.

Otherwise, it will be necessary to repeat the examinations on a regular basis for the duration of the pregnancy, in order to identify any contagion in good time and proceed, when possible, with the appropriate care.

Recognizing a threat of abortion

Finally, in case of pregnancy at risk it is possible to find yourself struggling with a threat of abortion. The period most at risk is the first trimester of pregnancy.

Symptoms that allow you to recognize it include abdominal or back pain. These discomforts are not always associated with vaginal discharge. For this reason, regardless of the presence of bleeding, it is good to consult a doctor whenever a discomfort leads to suspect a possible miscarriage.

According to experts, however, it is certainly necessary to go to the emergency room or undergo a specialist visit in a short time in the presence of blood loss and pain localized to the lower abdomen or kidneys (comparable to what is felt during menstruation). Healthcare professionals will thus be able to determine if and how to intervene.

In some cases, the expectant mother may be prescribed pharmacological therapies (for example based on progesterone, which acts, among other things, by reducing uterine contractions),hyposus in bed, abstention from sexual intercourse or hospitalization to monitor the situation.

Prevention strategies

It is not always possible to prevent a high-risk pregnancy, but in certain circumstances it is possible to implement certain strategies that help reduce the dangers even before conception.

If the aspiring mother, for example, already has health problems, it is advisable to carefully evaluate with the gynecologist how to proceed in view of a pregnancy. Even healthy women who intend to have a child should undergo some tests in advance, such as those to evaluate a possible immunization to dangerous infections in pregnancy.

During gestation, especially if it is not planned, it is important to undergo all prenatal screening recommended by doctors, follow a healthy lifestyle, avoiding alcohol and smoking in particular, but also taking care of nutrition and following the indications and hygienic-sanitary precautions suggested by the gynecologist.

Fundamental, in particular, is the intake of folic acid, if possible from a month before conception and for the first trimester of pregnancy (but it can also be useful during breastfeeding) which reduces the risk of some malformations of the child, in particular affecting the neural tube (structure from which the central nervous system originates).

In addition, for those who are already pregnant, vaccinations against seasonal flu and whooping cough are recommended.