In this section you will learn about the importance of medical conditions.
Some women will have pre-existing medical conditions such as diabetes or epilepsy and some mental health concerns. These women will be seen regularly for follow up in the GP practice and there are many opportunities to discuss pregnancy intentions with them during review of their condition or medication. Supporting women with information to encourage them to discuss their plans at their routine follow up appointment is a role for all.
For other women they may have had a health concern during a previous pregnancy and assessing prior to conception and making arrangements to review once pregnant is essential to reduce pregnancy related complications.
The maternal death audit found that 2/3 maternal deaths occurred in those with preexisting physical or mental health conditions and were potentially avoidable. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK
Recommendations for specific conditions include continuing effective contraception until assessment has taken place and:
Diabetes:
- If there is a family history arrange a blood test before pregnancy to exclude undiagnosed diabetes
- If the woman is diabetic aim to optimize blood glucose levels and medication
- The diabetic may be seen in a pre-conception diabetic clinic if available
- Provide information about importance of good diabetes control to reduce pregnancy risks and affect on the developing foetus.
Epilepsy:
- Do not stop medication unless directed to by specialist
- Medication may need to be amended prior to pregnancy to reduce any risks to foetal development.
Cardiac disease/chronic hypertension/renal/rheumatological condition:
- Refer to appropriate specialist before conception to assess risk of pregnancy to the condition and to amend, commence relevant medication during pregnancy as required
Venous thromboembolism (blood clot):
- Arrange a specialist review before conception to decide if ‘blood thinning’ injections are recommended during the pregnancy.
