Chronic disease. Impact on pregnancy. How not to die for your baby? Part 1 of 2. 2
Some medical diseases may induce obstetric complications. This is very well known. For example, the antiphospholipid syndrome is associated with obstetrical complications, such as preeclampsia, small for gestational age babies, placental abruption, etc. Dr. Anton Titov, MD. There is also something, which is less well known, or it is well known, but mothers don’t think about it. If there’s an acute complication in a mother, for example, acute heart failure, this may force the doctors to perform a premature delivery of a baby, which in turn may harm the baby. Some mothers tell us, “I’m ready to die for my baby.” Medical second opinion. And I tell them, “that it’s not a good idea, because if during the pregnancy you are going to be at risk of dying, we will have to either induce labor or perform a cesarean section very early. This may, in turn, harm the baby. Dr. Anton Titov, MD. So this is the other issue – obstetrical complications related directly or indirectly to the disease. Then there’s the question of the disease that the mother may transmit to her child. It may be transmitted by very different routes. For example, it may be a transmission of infection if a mother is affected by HIV, and the viral load is not well controlled. Then a risk exists of transmitting HIV to the baby. Of course, now mother-to-baby HIV transmission risk is easy to control with anti-retroviral drugs. Another example. Antibodies may be transferred from the mother to the baby. This can happen with myasthenia gravis or thyroid disorders. Then there’s the risk of genetic transmission. If a future mother has Marfan syndrome, which is an inheritable condition, there is a 50% risk of transmission of the gene for Marfan syndrome. She can pass this gene on to her baby. The problem with a lot of inherited diseases with an autosomal dominant fashion of transmission is they have variable expression. One affected person in the family may have died at 30, and another person may die at 80 with the same gene of the same disease. Dr. Anton Titov, MD. So knowing that you’re carrying the gene for a disease doesn’t mean that this or that is going to happen to you [with 100% certainty]. Dr. Marc Dommergues. Medical second opinion. And this is a problem. Dr. Anton Titov, MD. There’s also a difficult question, which is the question of parenthood. A disease may interact with parenthood in different ways. For example, if you have a severe motor disability, the question is, “how am I going to be able to provide routine care to a baby?” This includes changing the baby or feeding the baby, etc. Then it’s very important to anticipate this and to anticipate this by training by improving the environment. Dr. Anton Titov, MD. There are plenty of things that can be done. Dr. Marc Dommergues. Medical second opinion. And funny enough, our feeling is that parenthood difficulties with persons with a motor disability are not directly related to the severity of the disability, but probably to some other more subtle problems. It could be difficult to raise a child if you have no disability at all. The last point is when parents have a mental disability. Parenthood with patients with mental retardation is something extremely complicated. It is extremely difficult to discuss beforehand. When people have a severe mental illness, pregnancy may also be very difficult to discuss beforehand. On the other hand, if a woman has a straightforward and treatable psychiatry disorder, everything can be organized beforehand. Then usually, the outcome of pregnancy is extremely good. Dr. Anton Titov, MD. So this is the impact of the disease on pregnancy.
How can patients avoid mistakes when dealing with a medical problem? Leading doctors share wisdom: