Pregrovidal preparation

Unfortunately, a fairly large proportion of young women approach pregnancy already having one or more chronic diseases. Chronic or, in scientific terms, extragenital pathology are those diseases that a woman suffered from for quite a long time before pregnancy. Any chronic disease to one degree or another affects conception, the health of the unborn child and the course of pregnancy, and pregnancy, in turn, affects the course of the disease, because During pregnancy, the load on internal organs increases several times.

Often, it is during the period of bearing a child that many chronic diseases worsen and complications arise, therefore, a woman with a chronic disease must undergo special preparation for pregnancy.

Such preparation begins with a visit to the obstetrician-gynecologist and the doctor who monitors you for the disease. Usually this is a general practitioner, but there may also be an ENT doctor (as in the case of chronic tonsillitis), a cardiologist (for arterial hypertension and heart defects) or an endocrinologist (for diabetes mellitus). When planning a pregnancy, a specialist doctor determines the severity of chronic diseases, decides on their compatibility with pregnancy, prescribes and adjusts treatment so as not to harm the expectant mother and her baby.

Obstetricians are especially wary of women with cardiovascular diseases (arterial hypertension, heart defects), chronic diseases of the respiratory tract (pneumonia or bronchitis, bronchial asthma, etc.) and kidneys (chronic pyelonephritis), with endocrine diseases (diabetes mellitus, thyroid diseases ). First of all, an additional examination is carried out to find out whether pregnancy is fundamentally contraindicated for this pathology.

Doctors will be against pregnancy for the following diseases:

severe heart defects;
severe arterial hypertension;
malignant neoplasms;
lung diseases accompanied by severe respiratory failure;
chronic renal failure;
diabetes mellitus with complications;
severe thyroid disease, adrenal insufficiency;
liver cirrhosis

If, nevertheless, a woman with severe pathology decides to become pregnant, despite the possible risks, then she is recommended to be examined in a hospital. In this case, the need for hospitalization may be caused not so much by the clinical picture (the woman’s condition at the time of the examination), but by the possible risks of pregnancy complications.

In addition to such severe conditions, there are also temporary contraindications to pregnancy, after the elimination of which, pregnancy is quite possible. Thus, many effective and safe drugs that a woman used before pregnancy must be replaced with others 3 months before planning. This is due to the adverse effect of the drug on the formation of the fetus. If you are undergoing periodic course treatment, then this course must also be completed 3 months before conception.

Some examinations also serve as a temporary contraindication to pregnancy . It is better to carry out all medical examinations of future parents related to x-rays 1-2 months before conception. X-rays are radiation that can affect actively dividing cells, in particular the genetic material of embryonic cells. This can negatively affect the development of the child, leading to developmental defects.

Pregnancy is also contraindicated during exacerbations of chronic diseases. This is due to the large drug load when treating an exacerbation, and to the fact that when pregnancy occurs, it may be difficult to achieve remission; this will require more time. The ideal option for conception is the presence of stable remission or compensation of the disease - that is, an inactive course of the disease that is safe for the pregnant woman and the fetus.

Diabetes

Diabetes mellitus leads to many complications of pregnancy: spontaneous abortion, the formation of congenital malformations, dysfunction of the placenta, chronic hypoxia and delayed fetal development, severe gestosis, and a high risk of developing diabetes mellitus in the child. Pregnancy will be contraindicated for those women who have severe forms of diabetes mellitus with complications: diabetic kidney damage (nephropathy), eye damage (retinopathy), and a transient hereditary form of this disease. Preparing for pregnancy, which is carried out together with an endocrinologist, will help minimize these risks. The main efforts should be aimed at achieving compensation of blood glucose levels. If compensation has not been achieved at the time of pregnancy, then the likelihood of congenital malformations among children of women with type I and type II diabetes is three times higher. This likelihood is significantly reduced by properly monitoring your sugar levels at least six months before conception.

Compensation is assessed based on the level of glycemia several times a day, as well as on the basis of long-term compensation indicators - glycated hemoglobin (HbA1C) and fructosamine. Pregnancy can be planned with normal levels of carbohydrate metabolism; conception can begin only when the glycated hemoglobin level decreases to 6.0% or lower. A diary of self-monitoring of blood glucose should be kept and reviewed with a doctor every 2 weeks.

It is also necessary to evaluate kidney function, for this they take several special urine tests, a biochemical blood test and consult a nephrologist (kidney specialist). An examination of the fundus by an ophthalmologist is necessary, because Diabetes mellitus often leads to changes in the retina of the eye. His task is to examine the vessels of the fundus and assess their condition. If any of them look unreliable, they are cauterized to avoid ruptures. A podiatrist should evaluate the condition of the foot, and a neurologist should assess the condition of the peripheral nerves of the limbs.

Finally, it is necessary to choose the right treatment. Thus, during pregnancy, tableted glucose-lowering drugs are contraindicated. It is necessary to switch to treatment with genetically engineered human insulin in advance.

Maternal thyroid dysfunction is a common cause of infertility and mental retardation in children, and the course of pregnancy and childbirth is accompanied by an increased incidence of complications. Examination of the thyroid gland in preparation for pregnancy includes an examination by an endocrinologist, ultrasound of the thyroid gland and testing of thyroid function through a blood test for thyroid-stimulating hormone (TSH) and thyroperoxidase antibodies (AT/TPO). The purpose of preparation is to select such a dose of medications so that the level of hormones corresponds to the norm. Only after reaching the norm is it possible to plan a pregnancy. During the dose selection period, hormone levels are monitored every 4-6 weeks.