Cause of pregnancy risk: Factors such as maternal age, obesity, structural alterations of the reproductive system, difficulty in becoming pregnant, drug use (even so-called recreational) are some of the factors that can negatively affect the evolution of pregnancy and maternal-fetal health.
The prenatal screening is particularly important before the existence of certain risk factors because it determines the risk before the woman becomes pregnant and promote the care needed to come to fruition without unbalancing and aggravate the condition or state of maternal health.
FACTORS CONSIDERED AS CAUSES OF RISKY PREGNANCY
1. MOTHER’S AGE
Among the causes of pregnancy risk are the extremes of maternal age – an early pregnancy or a late pregnancy – increase the risks of maternal and fetal disease and mortality. In adolescents there is an increased risk of pre-eclampsia / eclampsia , restriction of fetal growth and malnutrition.
In women 35 years of age or older , there is a higher risk of hypertension, gestational diabetes and weight gain than recommended during pregnancy. Chromosomal changes in the fetus are also more common in older women.
Women who have diabetes before pregnancy should program their pregnancy only and only when their blood glucose values are controlled. Diabetes increases the risk of congenital malformations of the baby (cardiac and neural tube defects).
3. TOBACCO, ALCOHOL AND DRUG USE
The consumption of additive substances is associated to several risk pathologies such as:
- Tobacco : infertility of the couple, risk of miscarriage, reduced ability to deliver oxygen to the baby, low birth weight, preterm labor (or preterm birth), difficulty breathing in the baby.
- Alcohol : decreased fertility (low sperm count and mobility), increased risk of miscarriage, restriction of intrauterine growth.
- Drugs : in addition to the negative effects on the mother’s health and fetal development, there is an emphasis on the withdrawal symptoms of the newborn that requires specific treatment after birth.
4. EXPOSURE TO TOXIC AGENTS
Any substance, agent or environmental factor capable of causing negative effects on the development of the fetus should be evaluated before and during pregnancy.
Among these substances, certain drugs that are prohibited in pregnancy stand out. In addition to these, any medication should be prescribed by the doctor accompanying the pregnant woman after assessing the pros and cons. Self-medication is absolutely prohibited in pregnancy.
In addition to the drugs, infectious agents ( cytomegalovirus , listeria , rubella virus , toxoplasmosis , varicella virus , among others), increase the risk of infection of the baby and can have serious consequences in fetal development.
5 PREVIOUS OBSTETRIC HISTORY
Possible endocrine disorders, uterine abnormalities, abortion, infertility, postpartum haemorrhage / manual placental deferral, previous cesarean section , preeclampsia / eclampsia , fetus / neonatal death, prolonged or difficult labor are situations that are among the causes of pregnancies and require close monitoring of the woman before and during pregnancy.
6. PERSONAL HISTORY
The personal history also allows to identify possible causes of the pregnancy risk. Women with asthma, depression, hypertension, diabetes, epilepsy, rheumatoid arthritis, heart disease, chronic kidney disease, thyroid pathology should be accompanied by an obstetrician even before they become pregnant.
Maternal health problems prior to pregnancy can affect the health status of the mother throughout pregnancy, fetal development and the way pregnancy ends. The health / illness will be monitored continuously and regularly in consultation, with periodicity appropriate to each case to be defined by the obstetrician.
7. SPECIFIC CONDITIONS OF THE CURRENT PREGNANCY
Some events of pregnancy may require tightening the vigilance of pregnancy because they may be the source of complications such as low birth weight, preterm birth and even maternal mortality, namely:
- Bleeding in the early stage of pregnancy , before 20 weeks;
- Bleeding in late pregnancy after 20 weeks;
- Anemia ;
- Prolonged pregnancy ≥ 42 weeks;
- Hypertension developed during pregnancy;
- Premature rupture of the membranes (risk of preterm birth);
- Hydramnios (abnormally increased volume of amniotic fluid),
- Rh isoimmunization;
- Pelvic presentation of the baby;
- Intrauterine growth retardation (risk of fetal distress).
High blood pressure in pregnancy is at the origin of a complication called preeclampsia . It is an important cause of fetal growth restriction, perinatal mortality, and preterm delivery .
In rare cases, pre-eclampsia worsens and the pregnant woman may experience convulsions. It is then eclampsia .
9. PREGNANCY OF TWINS
Pregnancy from twins is considered a risk pregnancy causes because the woman’s body has to make an additional effort to nurture and support the development of more than one baby.
In this sense, the number of consultations or examinations will be individualized and defined by the obstetrician according to the evolution of gestation and the health of the mother and her babies.
10. PROFESSIONAL ACTIVITY
Certain occupational activities are considered to be hazardous, such as those involving exposure to chemical agents (lead, mercury and its derivatives, carbon monoxide, etc.), physical (ionizing radiation, high pressure atmospheres) and biological (risk of toxoplasmosis and rubella in nonimmune women).
Other indications are important as preventive measures :
- Rest the number of hours required per day;
- Do not work in environments with a risk of shock or vibration;
- Do not move loads weighing more than 10 kilograms;
- Do not stand for more than 4 straight hours;
- Do not work in noisy environments;
- Do not work in extreme temperatures (very hot or very cold).
PRE-CONCEPTION RISK ASSESSMENT
The correct evaluation of all the factors that involve the life of the woman and the couple before pregnancy is a fundamental step in diagnosing the factors for a pregnancy risk and, thus, starting the route to differentiated healthcare a set of measures and clinical actions that help to control eventual damages.
The parameters to be evaluated include :
- Anti-tetanus vaccine in day;
- Rubella immunity test (if you are not immune you will need to be vaccinated and only after 3 months you can try to get pregnant);
- Toxoplasmosis immunity test ;
- Weight and height assessment (BMI);
- Assessment of blood pressure;
- Performing a general physical examination;
- Performing a complete gynecological exam with colpocitology (if the previous one was performed more than 3 years after two negative annual tests).
RECOMMENDATIONS IN CASE OF RISK ASSESSMENT
In the preconception consultation you can recommend :
- The recording of the menstruation calendar to determine the fertile period ;
- Taking folic acid (0.4 mg / day) and potassium iodide (150-200 mcg / day) starting at least 2 months before the interruption of contraception;
- Prescription screening for the father: screening for syphilis, HIV infection and hepatitis B;
- Indications about healthy eating ;
- Physical exercise and rest;
- Abstinence from tobacco, alcohol and drugs;
- Definition of the monitoring of risk situations in collaboration with other health services where the woman is already accompanied;
- Inform the couple about the potential risks of pregnancy according to the chronic illness in question.