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What is it about ?
Systemic diseases arise because the human immune system produces antibodies that turn against its own body. These are therefore autoimmune diseases that can affect various organs and tissues, such as the cardiovascular system, nervous system, kidneys, muscles and joints, lungs, etc. Cancer and diabetes can also be grouped under this denominator.
If left untreated, systemic diseases reduce the fertility. They can also cause problems during pregnancy and childbirth. It is therefore absolutely necessary to pay special attention to systemic diseases during pregnancy.
Some important systemic diseases:
Cardiovascular illnesses
During pregnancy, the load on the heart increases. He must pump 30-50% more blood than usual. The heart will also change position due to the size of the uterus, and the backflow of oxygen-poor blood will be prevented by the pressure exerted on the large veins.
The muscle of the heart (myocardium) and the valves of the heart can be affected in systemic diseases, and there may be birth defects. This increases the risk of complications, such as heart rhythm disturbances and fluid buildup in the lungs (pulmonary edema) in the mother. A high blood pressure (hypertension) can also have a negative impact on mother and child. If hypertension (> 130/80) is associated with the presence of protein (albumin) in the urine, the risk of preeclampsia is 70% higher. As a result, the placenta may have difficulty performing its function, which can lead to stunted growth in the child. On the mother’s side, there is a risk of brain disorders and heart failure. Treatment is started as soon as the blood pressure reaches 140/90. As the situation may cause too slow heart rate and low blood pressure during childbirth, close monitoring is required.
The blood
Women who have ever had a deep vein thrombosis (formation of a blood clot in a vein) or pulmonary embolism (obstruction of a blood vessel in the lung by a blood clot) in the past are particularly at an increased risk of recurrence. The risk is up to 40x higher during pregnancy. This is the reason why a blood test will be systematically carried out in search of bleeding disorders. Treatment consists of administering anti coagulants, most often by subcutaneous injections, of the 6e at the 24e week of pregnancy and up to 3 months after childbirth. Treatment is suspended 12 hours before delivery to reduce the risk of bleeding.
Metabolic disorders
Diabetes
the diabetes is associated with an increased risk of malformations in the baby, but this risk can be reduced with good control of sugar (blood sugar) levels during pregnancy. The disorder also increases the risk of having a higher birth weight, miscarriage, of premature birth and adjustment problems immediately after birth. The mother is essentially exposed to the risk of deregulation of blood sugar,renal failure, of eye problems, of preeclampsia and forming an abnormal amount of amniotic fluid. Diabetes should therefore be controlled as carefully as possible during pregnancy. First of all, it is advisable to take care of your lifestyle, adopting a healthy diet and practicing regular physical activity. If this is not enough, the mother is usually put on insulin treatment.Childbirth usually takes place vaginally, although the number of cesarean sections is higher in mothers with diabetes.
Thyroid disorders
A lazy thyroid (hypothyroidism) can decrease fertility and cause miscarriages. Women with this condition usually take tablets containing thyroid hormones. In early pregnancy, the dose should be increased by 25-50 µg per day. A slight overdose is safe for mother and child. A blood test is then performed to accurately determine the dose to be administered. After childbirth, the new mother goes back to the initial dose she took before she became pregnant. The iron tablets affect the absorption of thyroid hormone and should therefore be taken at another time.
An overactive thyroid (hyperthyroidism) can lead to miscarriage and premature labor. Medicines that inhibit (slow down) the production of thyroid hormone are prescribed. Again, the correct dose is determined by a blood test.
Obesity
THE’obesity is associated with the increase in a number of risks. A weight over 90 kg before childbirth increases the risk of hypertension by 4 and the risk of diabetes by 1.5. The risk of blood clots is also increased. On the other hand, maternal obesity increases the likelihood of having a birth weight over 4 kg, which can lead to a long and difficult delivery and increase the risk of cesarean section. It is therefore recommended that obese mothers gain a maximum of 9 kg during pregnancy. On the other hand, non-obese mothers can gain between 11 and 16 kg.
Nervous system disorders
Epilepsy
Two problems arise in the case ofepilepsy :
- Antiepileptic drugs are potentially harmful to the fetus, in which they can cause abnormalities such as an open back (spina bifida). This risk is higher when several drugs are combined. If possible, treatment will therefore be limited to one drug (monotherapy). Medication that has already been taken before fertilization will be continued.
- A seizure can cause a temporary lack of oxygen in the baby. This oxygen deprivation also increases the risk of birth defects. A lack of oxygen is more dangerous than the possible side effects of drugs.
Therefore, the concentration of drugs in the blood will be checked once a month for the duration of pregnancy. The dose can thus be adjusted if necessary. A daily dose offolic acid is also prescribed.
Most of the time, a woman can give birth normally. However, the risk of cesarean section is twice as high. The possibility of breastfeeding depends on the type of medicine and the possible side effects for the baby.
Migraine
The migraine attacks are most common during the first trimester and the last month of pregnancy; they are rather rare during the second trimester. The possible drug treatment varies depending on the stage of pregnancy.
Blood circulation disorder in the brain
There is an increased risk ofstroke due to the formation of a blood clot (thrombosis). The risk of bleeding is also increased, especially in women with abnormalities in the blood vessels. The treatment remains the same whether the woman is pregnant or not.
Psychic problems
Pregnancy, childbirth and the arrival of a baby mark an additional stressful time for the mother. The psychiatric disorders which were already present before pregnancy therefore constitute an additional risk. At time prescribe medication, an assessment is made between possible side effects and the well-being of mother and child.
Internal affections
Kidney disease
The flow of blood to the kidneys increases by 30-50% during pregnancy.
A chronic decrease in kidney function increases the risk of high blood pressure and loss of protein from the kidneys. This can result in poor placental function, stunted growth of the baby and premature birth. If a bacterial bladder infection, which often goes without symptoms, goes untreated for the first half of the year, there is a 40% chance that it will be followed by renal pelvis infection, which will need to be treated with (stronger) antibiotics.
After a kidney transplant, it is recommended to wait at least 1 to 2 years before considering pregnancy.
Rheumatic ailments
The rheumatoid arthritis (RA) improves during pregnancy in 75% of women from the end of the first trimester. A relapse occurs after childbirth, usually in a more serious form. Many of the classic rheumatism medicines cannot be used during pregnancy.
the systemic lupus erythematosus (SLE) is a serious threat to pregnancy. The disease worsens in 30% of cases. Possible complications include clot formation, abnormalities in the placenta, stunted growth of the baby, miscarriage, congenital heart defects and death of the baby in the womb. Treatment is difficult and consists of anticoagulants and cortisone.
Asthma
THE’asthma improves in 1 in 3 pregnant women, but it may also get worse in 1 in 3 pregnant women. The treatment remains the same whether the woman is pregnant or not. There is no evidence that the drugs can cause birth defects. The occurrence of a asthma attack during childbirth is an additional risk due to the lack of oxygen associated with it. As a result, the number of cesarean sections is higher among women with asthma.
Cancer during pregnancy
One in 1,000 to 2,000 pregnant women has cancer. The most frequent forms are breast cancer, the leukemia, the cancer of the cervix and ovaries, bowel cancer and skin cancer. The latter is the only one in which the malignant cells spread to the baby.
All cancer treatments such as surgery, chemotherapy and radiation therapy are dangerous for the child. Each situation will therefore be examined on a case-by-case basis. After an operation for breast cancer, it is advisable to wait at least 2 years before having another pregnancy.
Sources
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