Women's Health and Education Center (WHEC)

Medical Disorders and Pregnancy

List of Articles

  • Chronic Kidney Disease and Pregnancy
    Chronic kidney disease represents a heterogenous group of disorders characterized by alterations in the structure and function of the kidney. Its manifestations are largely dependent on the underlying cause and severity of the disease, but typically include decreased function, hypertension, and proteinuria, which can be severe. Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes, and these risks increase with the severity of the underlying renal dysfunction, degree of proteinuria, as well as the frequent coexistence of hypertension. The review discusses current management of pregnant patients with chronic kidney diseases, early diagnosis and postpartum management. Renal transplantation and pregnancy is also discussed. Avoidance of nephrotoxic and teratogenic medications is necessary, and renal dosing of commonly used medications must also be considered. Successful management of women with chronic kidney disease during pregnancy requires teamwork between primary care clinicians, midwives, specialists, and the patient. Frequent monitoring of simple clinical and biochemical features will guide timely expert intervention to achieve optimal pregnancy outcome and conservation of maternal renal function.

  • Sickle Cell Disease in Pregnancy
    Pregnancy complicated by sickle cell disease is high-risk for both mother and fetus. Surveillance helps manage problems such as vaso-occlusive crises and alloimmunization. Maternal problems can arise from chronic underlying organ dysfunction such as renal disease or pulmonary hypertension, from acute complications of sickle cell disease such as vaso-occlusive crises and acute chest syndrome, and/or from pregnancy-related complications. Fetal problems include alloimmunization, opioid exposure, growth restriction, preterm delivery, and stillbirth. Couples should be counseled that a pregnancy with sickle cell disease is high risk for both fetus and mother and be made aware of the increased risks of adverse pregnancy outcome. Risks of adverse fetal outcomes are reduced but not eliminated with fetal surveillance. This review provides recommendations, screening and clinical management during prenatal and puerperium of patients with sickle cell disease. Genetic screening can identify couples at risk for offspring with sickle cell disease and other hemoglobinopathies and allow them to make informed decisions regarding reproduction and prenatal diagnosis.

  • Inherited Thrombophilias in Pregnancy
    Identification of inherited thrombophilias has increased our understanding of one potential etiology for venous thromboembolism and of hypercoagulability in general. Over the past 10 years, some studies have suggested that inherited thrombophilia may be associated with preeclampsia and other adverse outcomes in pregnancy. There is limited evidence to guide screening for and management of these conditions in pregnancy. This document reviews common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy. The literature on fetal thrombophilia and its role in explaining some cases of perinatal stroke that lead, ultimately, to cerebral palsy are also discussed.

  • Psychiatric Disorders During Pregnancy
    This review focuses on the interrelationships between common psychiatric illnesses and the course of pregnancy, postpartum, and breastfeeding. Within the life cycle context, the impact of childbearing on existing disorders or vulnerabilities in the female patient is of primary interest, as well as episodes that are etiologically related to childbearing. Treatment considerations for psychiatric disorders during childbearing invoke special modifications of the risk-benefit decision-making process. Mental health is fundamental to health. For the pregnant woman, the capacity to function optimally, enjoy relationships, manage the pregnancy, and prepare for the infantís birth is critical. Perinatal health can be conceptualized within a model that integrates the complex social, psychological, behavioral, environmental, and biologic forces that shape pregnancy. Unipolar and bipolar mood disorders, which are common in pregnant and postpartum women, deserve the attention of obstetric providers. Procedures to identify those at risk should begin in pregnancy if not in the preconceptional period.

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