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Coping with Chronic Conditions

Managing preexisting diseases before and during pregnancy.

You may be aware that many women with chronic medical problems are able to achieve healthy pregnancies, but you may not know that preparation for pregnancy with a preexisting disease can be just as important as management of the condition after conception. There are a few general guidelines for pre-pregnancy preparation that apply to all medical issues.

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1. Make sure that the healthcare provider managing your condition is aware that you are considering pregnancy. Some medications can affect a developing fetus even before a women is aware that she has conceived. Therefore, a provider may transition you to a different drug that has a better safety profile in pregnancy a few weeks or even months prior to initiating efforts to achieve pregnancy.
2. If possible, gain or maintain good control of your disease a few months prior to conception. Though many women with serious medical conditions such as diabetes, high blood pressure or thyroid disease can have healthy pregnancies, poor control of these diseases can lead not only to the worsening health of the mother, but can also cause issues with babies — like birth defects, complications related to prematurity and other serious problems.
3. Keep all of your appointments with your provider and specialists. Some women with chronic medical conditions will be referred to a high-risk pregnancy doctor ( or perinatologist). Your provider will also want to have the ability to contact others who manage your medical conditions.

In addition to these tips, here are some specific actions you can take to maximize the chances of having a healthy pregnancy for some common chronic diseases.

Allergies
Try to avoid contact with your allergy triggers. Use air conditioning instead of opening windows, and avoid outdoor activities when the pollen count is high. If you have indoor allergies, use a HEPA filter vacuum to reduce allergens. Buy covers for the mattresses and pillows to protect against dust mites, and keep your home as clean as possible to minimize dust.

Asthma
Have an asthma action plan, which is an individualized algorithm for what you can do to control your asthma, keep it from getting worse and determine when to call your provider. Make sure you have your rescue inhaler with you at all times. Find out your asthma triggers, and do your best to minimize exposure to them.

Depression
Recognize that the hormones and life changes associated with pregnancy and delivery can worsen mood symptoms, even in women who previously had reached a stable point. Ensure that you have a mental health provider with whom you have a good rapport. Maximize your good sleep, exercise and participation in activities you enjoy. Even if depression or anxiety was a problem you had in the past, tell your provider, who can help assess your mood during pregnancy.

Diabetes
Do your best to reach a healthy weight prior to pregnancy. See a nutritionist and make sure you have a good understanding of a healthy diet for diabetes. Be aware that most women will need to increase or change their medications during pregnancy, even if they were in perfect control before conception.

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Hypertension
Weight loss to reach a healthy goal is important and may even negate the need for medication. Minimize salt intake and maintain a healthy diet. Talk to your provider about starting a baby aspirin towards the end of the first trimester to decrease your risk for developing preeclampsia, a serious pregnancy complication for which women with preexisting hypertension are at higher risk.

Migraines
One third of women note improvement in headaches during pregnancy, one third see no change and one third have more serious symptoms. Always make sure that you are well hydrated and do your best to get good sleep. Identify your migraine triggers and try to avoid them if possible. Some women benefit from starting a magnesium supplement, as this can help prevent headaches. Talk to your provider about whether this could be right for you.

Musculoskeletal Problems
Back pain, plantar fasciitis, neck pain and carpal tunnel syndrome can worsen as you gain weight, retain fluid and change your center of gravity. A good physical therapy or exercise regimen can help stabilize or improve these symptoms and minimize dependance on medications.

Skin Issues
If you are using over-the-counter medications to manage acne, wrinkles or eczema, etc., make sure to read the labels and ask your provider about whether the ingredients are safe to be used in pregnancy. Wear sunscreen every day, as pregnancy can increase the skin’s sun sensitivity.

Maximizing your control of chronic conditions from the beginning can greatly improve your chances of having a healthy and happy pregnancy.

Lynsey Caldwell Owen, MD, FACOG, is an obstetrician/gynecologist at Arlington Women’s Center and Virginia Hospital Center in Arlington, VA.

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Written by Lynsey Caldwell Owen, MD, FACOG

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