Exploring 10 Pregnancy Complications, Risk Factors, and Prevention
Understanding common pregnancy complications and management can help improve public health efforts to reduce maternal mortality rates.
Source: Getty Images
- Across the United States, there are 32.9 maternal deaths per 100,000 live births. This astronomically high maternal mortality rate is more significant in the US than in other similarly developed nations. Although systemic, systematic, and social implications contribute to high maternal death rates, understanding pregnancy complications, risk factors, and prevention strategies may help providers manage and track complications early, minimizing maternal deaths.
According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), a subset of the National Institutes of Health (NIH), multiple pregnancy complications can be detrimental to pregnant individuals and their children, including the following:
- High blood pressure
- Gestational diabetes
- Infections
- Pre-eclampsia
- Preterm labor
- Depression and anxiety
- Pregnancy loss or miscarriage
- Stillbirth
- Persistent nausea and vomiting
- Iron deficient anemia
High Blood pressure
High blood pressure, or hypertension, is caused by arterial narrowing, making it difficult for the blood to travel from the heart to the appropriate organs. In pregnant individuals, hypertension can prevent blood from reaching the placenta, which provides nutrients and oxygen to the fetus.
Although having high blood pressure can complicate a pregnancy, pregnancy can also trigger a type of high blood pressure called gestational hypertension. The condition begins in the second half of pregnancy and resolves after delivery.
Unlike pre-eclampsia, which is also characterized by high blood pressure, gestational hypertension does not come with other symptoms like proteinuria, heart complications, or kidney problems.
Gestational hypertension is only diagnosed in patients with a systolic blood pressure of 140 mm Hg and higher or diastolic blood pressure of 90 mm Hg and greater if a patient’s blood pressure was normal before pregnancy.
The condition is closely monitored to ensure that signs of pre-eclampsia are not developing. Patients may also be advised to adjust their diet, manage weight, or engage in physical activity to control blood pressure.
Pre-Eclampsia
Pre-eclampsia is a systemic condition characterized by high blood pressure. Like gestational hypertension, this condition often develops in the second half of pregnancy. In addition to high blood pressure, pre-eclampsia can cause swelling, headaches, visual changes, weight gain, nausea, and breathing complications.
Left unmanaged, the condition can cause low platelet counts, liver and kidney complications, abdominal pain, and lung fluid.
Multiple risk factors can increase the risk of these conditions, including a first pregnancy, a history of pre-eclampsia, and existing medical conditions, such as high blood pressure, diabetes, kidney disease, systemic lupus erythematosus, geriatric pregnancy, multiple pregnancies, and obesity.
Gestational Diabetes
Again, while diabetes can complicate pregnancy and delivery, some pregnant women will develop diabetes when they are pregnant: gestational diabetes. Unlike other conditions, gestational diabetes is difficult to detect from patient presentation alone, so patients are tested as part of prenatal care.
Uncontrolled gestational diabetes can cause high blood pressure and pre-eclampsia, possibly forcing a cesarean delivery or cesarean section (C-section). While there is no cure, it can be managed with lifestyle changes and medications.
Infections
Multiple types of infections can cause pregnancy complications. For example, sexually transmitted infections (STIs) can be passed through the birth canal from a mother to an infant.
Other infections can also be transmitted from mother to child during pregnancy. Infections commonly lead to further complications, including pregnancy loss, ectopic pregnancy, preterm labor, premature birth, low birth weight, birth defects, stillbirths, newborn illnesses, newborn death, and other maternal health complications.
Pregnant individuals should be extremely cautious to avoid infections during pregnancy. Individuals planning a pregnancy should be screened for STIs and other illnesses. These screenings can help providers determine how to manage the condition. In addition, a healthcare provider may request titers to determine if a patient needs a vaccine booster.
Ectopic Pregnancy
Ectopic pregnancies occur when an embryo implants outside the uterus, commonly in the fallopian tubes. Approximately 1% of all pregnancies are ectopic; however, common risk factors include fertility treatments, tubal surgeries, pelvic inflammatory disease, uterine infections, and a history of ectopic pregnancies.
Preterm Labor
Another common pregnancy complication is preterm labor, labor before 37 weeks. A preterm birth significantly increases the risk of health problems for the infant, as multiple organs may not fully develop.
Infections, a shortened cervix, and a history of preterm birth can indicate a higher risk of preterm labor.
The NICHD notes, “Progesterone, a hormone produced naturally during pregnancy, may be used to help prevent preterm birth in certain women. A 2003 study led by NICHD researchers found that progesterone supplementation to women at high risk for preterm delivery due to a prior preterm birth reduces the risk of a subsequent preterm birth by one-third.”
Placental Complications
Multiple kinds of placental complications exist, including placental abruption and placenta previa. Abnormalities in placental attachment can be a dangerous pregnancy complication.
Placental abruption occurs when the placenta detaches from the uterine wall before delivery, which can cause bleeding and nutrient or oxygen depletion.
Meanwhile, placenta previa occurs when the placenta attaches to or covers the cervix.
Amniotic Fluid Complications
Amniotic fluid complications can be one of the most dangerous pregnancy issues. The amniotic sac is the liquid that surrounds the fetus. However, excess fluid can increase pressure, breaking the membrane and initiating preterm birth.
Multiple pregnancies and diabetes may contribute to the increased fluid; however, the condition may indicate other issues like congenital disabilities.
Anemia
Among these complications, anemia, a depletion of red blood cells, can be a concern for many patients. Iron-deficient anemia can happen to anyone; however, this condition is common during pregnancy because the body requires more iron.
Anxiety and Depression
Anxiety and depression are common concerns during and after pregnancy are very common. With hormonal changes and increased stress, peripartum and postpartum depression can be a considerable concern.
Risk Reduction Strategies
According to the Centers for Disease Control and Prevention (CDC), there are multiple ways to reduce the risk of pregnancy complications before, during, and after pregnancy.
Before pregnancy, following a healthy lifestyle, like eating healthy, maintaining a healthy weight, avoiding toxic substances, and engaging in physical activity, can limit risks once a patient is pregnant.
In addition, patients must see a licensed healthcare professional, like an OB/GYN or nurse practitioner, once they are pregnant for prenatal care to promote a healthy pregnancy.
Physicians should monitor patients and alter treatments or prenatal supplement recommendations based on each patient’s health condition.
Obstetric care should not be discontinued after the third trimester. Postpartum patients should follow up with their clinician to monitor recovery after delivery.
