What if I have a chronic health condition?

Asthma. This is the most common respiratory problem in mothers-to-be and is usually controlled by inhalation of bronchodilator drugs and inhaled steroids. There seems to be little risk to the growing fetus from the medication although thrush, a condition often aggravated by pregnancy, can be a side-effect and sometimes labour can be brought on prematurely. Take care of your lifestyle because stress and tension as well as dust, pollen and pollution can cause breathlessness which may put a strain on your already hardworking heart.

Epilepsy. Research has found that pregnancy has a variable effect on the frequency and intensity of epileptic fits, with 50 percent of mothers with epilepsy unaffected, 40 percent slightly improved and 10 percent worse. During pregnancy drug treatment will be continued but this will need to be carefully monitored by a neurologist.

Diabetes mellitus. Diabetes is caused when the pancreas produces insufficient insulin to cope with glucose (sugar) levels in the body. Diabetes is likely to increase in severity as pregnancy hormones have an anti-insulin effect. Pregnancy can also lead to the development of gestational diabetes in those with an underlying tendency. The urine of all mothers-to-be is routinely screened for sugar and ketones, which are the usual indicators of diabetes. If you have a family history you should have a urine test before trying to conceive. Diabetes can cause fetal heart and respiratory abnormalities, can cause the baby to be very large and can cause complications for the mother ranging from chronic thrush to pre-eclampsia. If you have diabetes it’s important that you are in good control of your condition before conception and that blood sugar levels are monitored closely.

Heart disease. If you have a diagnosed heart condition then you will be given specialised medical advice but as a general rule it is advisable to avoid over-activity. Try to rest each afternoon for two hours and spend ten hours in bed at night. The majority of women with heart disease have easy spontaneous labours. During labour the additional strain on the heart is intermittent and less than that imposed upon the heart in the third trimester.

Kidney disease. This does not necessarily preclude having children, but a pregnant woman with kidney disease must be carefully monitored. The most common problem is recurrent urinary tract infection but as long as the kidneys remove waste effectively then pregnancy will be allowed to continue. If there is poor fetal growth then early induction will be recommended.

Sexually transmitted disease. If you suffer from herpes then it can pass to your baby if you have a primary infection at the time your membranes rupture or during labour. If you have no symptoms and are not shedding the virus from your cervix or vagina the risk that your baby will be infected is less than one per thousand. However, if herpes ulcers are present in primary infection just before labour commences you will probably be advised to have a Caesarean section to reduce the risk of your baby catching herpes as he descends the birth canal.

HIV/AIDS. The outlook for babies of mothers who are HIV-positive is more optimistic than it was a few years ago. The use of AZT may protect the fetus from infection and the baby will be regularly scanned to check growth. Doctors may recommend a Caesarean to protect the baby and will aim for minimal fetal trauma during labour to minimise the risk of maternal blood contamination. Although there is a risk that the baby will be born with HIV antibodies these are usually maternal antibodies that will disappear within 18 months.

German measles/rubella. Before conceiving, check with your doctor to see if you have antibodies to the German measles (rubella) virus. If you are not immune (this can be the case even if you have been vaccinated in the past) then you should be vaccinated. You should then wait at least three months before you try to conceive as the vaccine is live. If you come into contact with someone who has German measles tell your doctor immediately, who will arrange a blood test. If caught in the first three months of pregnancy it can cause malformations in your baby which include deafness, blindness and heart disease.