Medical Risk Assessment

The preconception period is the ideal time to assess and counsel the prospective pregnant woman regarding medical disorders or risks she may encounter during the pregnancy. Of medical problems that have substantial impact on the fetus, hypertensive disorders and diabetes are among the most common.

Hypertension may have many effects on the pregnancy depending on the degree of abnormality. Fetal effects range from none to increased miscarriage, IUGR, abruptio placentae, and fetal death. Underlying blood pressure disorders should be treated appropriately before pregnancy. Some hypertensive, reproductive-age women are treated with angio-tensin-converting enzyme (ACE) inhibitors. This class of therapeutics can cause significant risk to the developing fetus. These medications should be stopped and alternate medications started if needed. Women with preexisting hypertension should be referred for concurrent care with a physician experienced in managing hypertension in pregnancy.

Diabetes can also have many effects on the developing fetus. The preconception control of the maternal metabolism, reflected as normal blood glucose values before and after meals and normal hemoglobin A1c, has been shown to decrease the incidence of diabetes-associated embryopathy to almost that of a nondiabetic pregnant woman (Mills et al., 1988). Women with preexisting diabetes should be referred for specialized care if pregnancy is contemplated.

Less attention is directed to emotional and psychiatric disorders. Pregnancy may be a stressor that precipitates an acute event or worsens ongoing anxiety or depression. This is more likely in the postpartum period.

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