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Special Considerations: Heart Disease, Paralysis, Obesity

Jessica Evert, MD, edited by Benjamin McDonald, MD

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Heart Disease

heart imageWomen with a history of heart disease such as congenital heart defects or rheumatic heart disease are likely to experience pregnancy complications. Being pregnant necessarily changes your heart and blood vessels as your body adapts to the needs of being pregnant. As pregnancy progresses, blood pressure decreases as the amount of blood in the body increases to accommodate both mother and growing fetus. The strain from these changes, in combination with pre-existing heart problems, can lead to serious symptoms such as shortness of breath, headache, loss of concentration, fatigue, and chest pain. Additionally, women born with congenital heart disease are at risk of having a baby who inherits similar heart defects. Additional tests may be required during the course of prenatal care so as to monitor fetal health.

Many heart disease symptoms can be treated with lifestyle modifications and medicine. If you have been medicated for your heart disease prior to becoming pregnant, you will want to work with your doctor to make sure your medicines are safe to use during pregnancy. Additionally, the extra strain on the heart and circulatory system caused by being pregnant can be minimized by taking steps to reduce anxiety and stress, resting, avoiding strenuous activity and heat, taking iron supplements to prevent anemia (decreased ability of the blood to carry oxygen), and by becoming aware of the signs of heart failure (which include breathing difficulties, tiredness, and coughing fits).

The strain of pregnancy can also cause heart problems such as heart murmurs, arrhythmias, and high blood pressure to develop even when such problems were not previously apparent. Heart murmurs and arrhythmias are complications of pregnancy which do not generally require treatment. However, high blood pressure needs to be taken seriously because it may indicate the onset of pre-eclampsia, a condition requiring immediate medical attention. Your doctor will test for blood pressure problems as a routine part of your prenatal care, and will generally be able to diagnose and safely treat any problems that emerge so that they do not overly complicate your pregnancy.

Paralysis

Paralyzed pregnant women face the same normal array of pregnancy complications as do other women. However, the likelihood that these complications will occur is higher in paralyzed women than in other women. Possible complications include:

  • Urinary Tract Infections. These infections are common in women who have indwelling catheters and women who are not able to regularly empty their bladders. Paralyzed pregnant women need to monitor their urine for cloudiness or blood, and to report any pain they may experience upon urination. To be safe, doctors will often routinely check paralyzed pregnant women's urine for bacteria even in the absence of symptoms.
  • Anemia. This common complication in which blood cells fail to carry enough oxygen can increase the likelihood of bedsores and pressure ulcers. To avoid these issues, pregnant paralyzed women should make sure their red blood cell levels are monitored. They may also choose to take iron supplements to provide their body with the raw material necessary to make more blood cells.
  • Medications. Paralyzed women may need to stop taking some medicines, and start taking others as a result of their pregnancy. For instance, medicines that are commonly prescribed to paralyzed patients to help treat muscular elasticity may not be safe for the developing fetus. Pregnancy increases the tendency of blood to clot. Under some conditions a paralyzed pregnant woman's doctor may prescribe an anticoagulation drug like Heparin to address clotting problems. Each woman's needs and experience will be different. Talk to your doctor immediately once you suspect you are pregnant so that he or she can adjust your medicines appropriately.
  • Hospitalization. Some paralyzed pregnant women require bed rest or hospitalization in the later stages of their pregnancy as maneuvering becomes more difficult.
  • Complications During Delivery. Spinal cord injured women may require a cesarean section and/or assistance with breathing during their labor and delivery. It is possible, however, that only forceps or vacuum assisted delivery will be necessary. Each paralyzed woman's experience and needs will be different. Your doctor will be able to size up your needs and offer assistance with the birth process as is required.

In general, if you are paralyzed, you will need to work with your doctors to determine the best course of action to ensure a successful pregnancy. Although your experience will likely be somewhat different from that of a woman who is not paralyzed, your pregnancy can be successful and exciting.

Obesity

Obesity is a label applied to people who are grossly overweight in proportion to their height and sex. Though the term is frequently used informally, it also has a technical meaning, describing people who have a Body Mass Index (or BMI) of 30 or greater. The BMI is a measure of a person's body fat percentage. It is computed by considering the ratio of a person's weight to that person's height, and is adjusted for variation between the sexes. A normal weight person has a BMI between 18.5 and 24.9, while moderately overweight people have a BMI between 25 and 29.9. You can calculate your own BMI using the calculator program available here.

Obesity, and overweight in general, are associated with numerous serious health problems. Thus, obesity is a health issue for all overweight people, not just for pregnant women. However, obesity is specifically associated with rather serious pregnancy complications. For example, women with a BMI greater than 29 are at increased risk for infertility, gestational diabetes, pre-eclampsia, and stillbirth. Obesity in the mother also affects the baby; babies of obese women are at an increased risk for neural tube defects, birth trauma, and even death.

The best plan of action for an obese woman is to try to lose weight before becoming pregnant. If an obese woman becomes pregnant, experts suggest that they limit their weight gain to 15 lbs or less unless otherwise instructed by a doctor.

It is not considered safe to lose weight while pregnant. Efforts to diet may result in the fetus not getting enough of the balanced nutrients it needs to grow properly. Also, weight loss attempts during pregnancy can elevate levels of a chemical called ketone, which is known to be toxic to developing fetuses.

Reader Comments

Parapalegic since Dec.20th, 2007 - Armesia - Apr 9th 2013

The pregnancy went pretty normal so dont worry but this last trimester its been excruciating pain especailly my hips and my back btw my due June14th hope this helps a little

-Armesia-

worried - kim - Sep 8th 2010

i am a pregnant young lady in her early 20's with rheumatic heart disease. the only prob i have is that i might not be able to keep the baby but would like to. i dont no what to do.(sad)

- - Feb 17th 2009
i have a friend that has less than 5 years to live .she has just found out thatshe could become paralysis,because of medical reason and that she would unable to have any more children.