Antenatal Conditions

Pregnancy is a huge life event and will of course effect your mood. Two of the main hormones involved in pregnancy are oestrogen – which is a known mood elevator, and progesterone – which often has the opposite effect in depressing your mood. It’s completely normal to experience crying or anxiety in pregnancy for no apparent reason. Most women experience this in the first 10 or so weeks of their pregnancy. Having a supportive and understanding partner, family and friends is really important at this time and knowing that you have that support can really help with your mood too. While feeling emotional is completely normal, antenatal depression is a condition that can affect up to 10% of women. If you feel that your mood swings are distressing you it’s really important that you let me know so that we can get started on helping you.

Morning sickness is a common side effect of pregnancy with 3 out of 4 pregnant women experiencing nausea and vomiting. It usually begins about 6 weeks into pregnancy and generally ceases by 14 weeks. Despite its name – morning sickness can persist all day, but it’s often worse in the morning. It is more common in first pregnancies and often worse with multiple pregnancies. The good news is that there are a few things that can help. Eating small, healthy carbohydrate rich meals (grains, potatoes, rice etc) at frequent intervals or trying home remedies such as ginger have been known to reduce the nausea. It’s worthwhile trying Vitamin B6 and Doxylamine which are over the counter medications or I can prescribe Maxolon or Ondansetron. If your vomiting is very severe you may need to be admitted to hospital for intravenous fluids and anti-nausea medication.

Gestational diabetes is a condition that some women experience in pregnancy and is brought about by the hormonal changes happening in the body. Glucose – which is required to produce energy, is taken into the body’s cells by a hormone called insulin. During pregnancy, women can become insulin resistant. This causes high blood sugar (glucose levels) in the mother’s circulation and subsequently, the body produces more insulin in an effort to keep the blood sugars normal. If the blood sugars can’t normalise – gestational diabetes occurs.

The problem with gestational diabetes is that it can produce a large baby which may be at risk of birth trauma as well as increasing the likelihood of having to have a caesarean section – which carries its own risks. Mothers with gestational diabetes have an increased risk of pre-eclampsia (high blood pressure). Babies with diabetic mothers are more likely to have problems with breathing, low blood sugars at birth and a high risk of a high bilirubin level which causes jaundice. We can test for Gestational diabetes by performing a glucose tolerance test at 26 – 28 weeks.

If you do develop gestational diabetes in your pregnancy it can be mostly controlled by diet. I usually advise my patients to see a dietician and as with typical diabetes, you can monitor your glucose levels with finger prick tests and a glucometer. We keep a close eye on your blood sugars at each visit and we will do extra ultrasounds and possibly a fetal heart tracing to monitor your baby’s wellbeing. If your sugars remain well controlled you would expect to have a very normal outcome for your pregnancy. If your sugars are not well controlled, we may need to start some oral medications such as Metformin or even commence insulin. If you require insulin, I will normally have you see a physician who manages diabetes.

If you develop gestational diabetes in your first pregnancy it’s likely that you will experience it in any future pregnancies. We normally perform a glucose tolerance test six weeks after delivery to make sure that your sugar tolerances have returned back to normal. We advise you to have a glucose tolerance test done every 2 years, as having had gestational diabetes means that you have a near 50% chance of developing diabetes in middle age.

Haemorrhoids (or piles) are varicose veins in the rectum and although uncomfortable they are quite common in pregnancy. They often appear because of increased venous pressure and straining due to constipation. Occasionally people experience bleeding or itchiness when having a bowel motion and at times discomfort. The best way to help is to try and avoid constipation by eating a diet that is high in natural fibre and drinking plenty of fluids, and sometimes using stool softeners can be useful. Occasionally thrombosis (or clotting) of external haemorrhoids can occur which is quite painful. If the issue worsens there can sometimes be the need for surgical treatment.

Twins or multiples pregnancies can happen in two ways. The first way is that two sperm, fertilise two eggs (aka. fraternal or dizygotic twins). The second, which is less common is that one sperm fertilises one egg and this fertilised egg splits into two which results in identical twins. Identical twins can have the same placenta and are usually the same sex, blood type and general appearance. We usually diagnose these twins by ultrasound and they occur more frequently in IVF pregnancies or with older mothers. If you become pregnant with twins you will have a larger weight gain during pregnancy and we normally advise taking supplements like iron and Folate.

It’s important to note that there are added risks with twin pregnancies. There is a higher risk than with a single pregnancy of developing anaemia or blood pressure and sometimes one baby or both babies may be small. You are more likely to develop gestational diabetes or pre-eclampsia, and because twin pregnancies are more likely associated with complications there is a high chance of a caesarean delivery. Twin pregnancies require much more surveillance with more ultrasounds and possibly more fetal heart monitoring. If you have identical twins, a condition called twin-twin transfusion syndrome may occur. Because twins share a placenta sometimes blood can go from one twin to the other creating a larger twin with more amniotic fluid and a smaller twin with less amniotic fluid. Fortunately, this is not a common occurrence but we can monitor very carefully through ultrasounds and the condition normally leads to an early delivery.

Pre-eclampsia affects about 1 in 10 women in pregnancy. It’s a condition in which there is elevation of blood pressure, fluid retention and protein in the urine. There are also changes in kidney, liver and coagulation function (the bloods ability to clot) with changes in the blood vessels. All of this happens not only to the mother but also to the placenta. Because of this, pre-eclampsia can have an effect on the wellbeing of your baby. You are more at risk of pre-eclampsia if it is your first pregnancy, if you have a family history, if you have a multiple pregnancy (twins), if you are over 35, if you have had I.V.F. or pre-eclampsia in a previous pregnancy and if you are obese.

There are a number of medical conditions including pre-existing hypertension, autoimmune disease such as S.L.E., diabetes or kidney disease, that may make pre-eclampsia more frequent. This is one of the reasons that we check your blood pressure at every antenatal visit and why antenatal visits are so important. Blood pressure can certainly be treated and the baby’s wellbeing and your wellbeing can be monitored carefully with blood tests and ultrasounds. In some cases, your blood pressure may need to be treated with either oral or intravenous medication and in others, your baby may need to be delivered earlier.

Severe pre-eclampsia is serious and careful monitoring and treatment is required. The good news is that the majority of the time, blood pressure can be treated early and outcomes for both mothers and babies are generally very good.