Let’s be real...there isn’t any such thing as a “perfect” pregnancy...even the more uneventful ones usually come with a handful of complaints that make some or all of those 9+ months a little, shall we say, challenging. 

Thankfully most of the issues you may experience are relatively minor (although it may not feel that way when you are in the midst of it!), and will quickly resolve once you birth your sweet little squish. It’s rare that anything more severe or potentially dangerous will arise during pregnancy, but there are a few complications that it’s important to be aware of so you can be prepared and proactive about your plans!

The good news? Your odds are really really good that you won’t have to worry about this stuff (most of the conditions listed below occur in less than 1% of pregnancies)...so don’t stress, mama! But we are all about being informed over here, so here’s what you should know:

Gestational Diabetes

Remember that weird sugary drink you had to chug in 5 minutes flat a few weeks ago? Well, that was to check for gestational diabetes. During pregnancy, the hormonal and bodily changes you go through can create a temporary insulin resistance, which can cause high blood sugar.

You probably won’t have any symptoms if you have gestational diabetes, and (you guessed it!) doctors aren’t sure why some women develop GD and some don’t -- though there are risk factors that increase the likelihood. GD may increase your risk of:

• Hypertension (fancy word for high blood pressure)
• Preeclampsia
• Unplanned Caesarean
• Type 2 diabetes later in life

GD can also cause complications for your baby, including:

• Excessive birth weight (which can mean increased risk of birth injury or unplanned Caesarean)
• Respiratory distress
• Low blood sugar shortly after birth
• Increased risk of obesity and type 2 diabetes later in life

The good news is that GD is easily manageable most of the time with lifestyle changes (eating healthy foods, moving your body, etc) and medications if indicated.

Group B Strep (GBS)

GBS is a bacteria that is naturally found in the digestive system and lower reproductive tracts of both men and women. Roughly 25% of women carry it, and typically it doesn’t pose any problems...you might never even know it’s there! However, it can be dangerous for babies due to their underdeveloped immune systems, so you will almost definitely be tested for it (via vaginal/rectal swab) around week 36 or 37 of pregnancy.

GBS status can change, so if you test negative at 36 weeks you might still be “colonized” when you give birth and if you test positive you may not actually be colonized when you give birth. However, the test is considered about 95% accurate in terms of predicting your GBS status at delivery if you have your baby within 5 weeks of doing the swab, and if you have a positive test your provider will assume you are GBS+ for birth.

If you’re positive, you probably won’t get any treatment for it until you actually go into labor, at which point you’ll be offered IV antibiotics to lower the risk of passing the bacteria to your baby as they come through the birth canal. The meds need to be given at least 4 hours before the actual birth and you may get more doses throughout labor if it’s a long one or if your waters break on the earlier side since that increases infection risk. If you’re planning a belly birth, you likely won’t need IV antibiotics, assuming you haven’t spontaneously gone into labor and your bag of waters is still intact. 

Mama Pro Tip → Depending on your provider and your personal wishes, you may choose to decline antibiotics in labor...if you do that, or if labor is speedy and you can’t receive your dose in time, they’ll monitor your babe for signs of infection for a few days post-birth. Check out Evidence-Based Birth for more info about GBS and treatment options. 

Preeclampsia / Eclampsia

Preeclampsia is a condition that is characterized by:

• high blood pressure
• protein in your urine
• blurry vision
• edema (swelling)

If it’s left unchecked or untreated it can develop into eclampsia, which is more rare but more serious and includes a risk of seizure or coma. It’s not clear what causes these conditions, although mamas who already had chronic high blood pressure before pregnancy are more susceptible. 

The best thing you can do is go to all your prenatal appointments so your provider can monitor your blood pressure and take action if it spikes! In some cases it can be managed by medications or other treatment protocols, and in others your doc may recommend you birth your baby early via induction or caesarean. You can also monitor your own health at home between visits; if you have swelling in your face or limbs, you get lightheaded, or you have vision problems, call your provider right away.

Mama Pro Tip → Swelling in pregnancy is super common and not always a cause for concern. A good way to check for edema that requires medical attention: poke your fingertip into your leg or wherever the swelling is and watch the spot you put pressure on. If it bounces back and regains normal tissue color, you’re probably ok. If the indentation remains or takes a while to go away, you should get a medical opinion. 

HELLP

HELLP is pretty uncommon, and most often occurs in conjunction with preeclampsia or eclampsia (although, just like with those disorders, experts aren’t sure what causes it). The acronym stands for:

• H → Hemolysis (your red blood cells break down too soon)
• EL → Elevated liver enzymes (your liver isn’t processing toxins in your body properly)
• LP → Low platelet count (lowers your body’s ability to make blood clots, which means hemorrhage risk)

It most often occurs in the third trimester of pregnancy and includes symptoms like:

• Abdominal pain or tenderness
• Vomiting
• Headaches
• Blurry vision
• Nosebleeds
• Rapid weight gain or swelling
• Seizures  

Physical markers for HELLP are tough to catch because they’re also potential common ailments of a normal, healthy pregnancy! Better be safe than sorry...if you feel like something isn’t right or you’re experiencing any of these symptoms, tell your provider so they can check you for high blood pressure or an enlarged liver, do blood tests, or perform an ultrasound.

HELLP is rare but the complications from it can be really dangerous, including liver or kidney failure and stroke. The main “treatment” for it is to deliver your baby, even if it will be born prematurely when you’re diagnosed, since most of the time symptoms will resolve once you aren’t pregnant anymore.

Placental abruption

Normally in pregnancy, your placenta stays adhered to your uterine wall until after your baby is born, and then you deliver your placenta shortly afterwards. Placental abruption is when the placenta separates (or begins to separate) from the uterus during pregnancy. It’s most common in the third trimester and can cause deprivation of oxygen and nutrients to baby if left untreated (which in turn can lead to restricted fetal growth, premature delivery, and stillbirth).

Risk factors for PA include:

• Abdominal trauma
• Premature rupture of membranes (also called PROM, which means your bag of waters breaks before week 37 of pregnancy)
• Use of cigarettes, cocaine, or alcohol during pregnancy
• Placenta previa (when your placenta covers all or part of your cervix)
• High blood pressure
• A short umbilical cord
• Carrying multiples
• Previous belly birth or termination of pregnancy

If you have PA you might experience vaginal bleeding, abdominal pain, frequent contractions, or back pain. Treatment will depend on how severe the abruption is and can be anything from bed rest (at home or in hospital) to delivering your baby via vaginal or belly birth.

Cholestasis

Cholestasis is another pregnancy complication that mystifies doctors as to what causes it (noticing a trend here?), but it is a result of excess bile buildup in the liver. Basically:

• Your liver makes bile, which helps break down fats during digestion
• Your gallbladder is a little pouch that stores the bile and pushes it into your intestines as needed
• Pregnancy hormones affect how the gallbladder works, and bile flow may slow or stop
• Bile builds up in your liver and gets into your bloodstream

Symptoms of cholestasis include:

• Yellowing of skin, eyes, and mucous membranes (also called jaundice)
• Severe itching (also called pruritus), most often on the palms of the hands and soles of the feet → this is the most common symptom
• Abdominal pain
• Light color of poop

Depending on a number of factors, your provider may prescribe meds to help lower your bile levels and relieve the itching, or they may recommend delivering your baby early (probably around week 37 of pregnancy, though your medical history and symptoms may dictate an earlier delivery), since high bile levels may cause serious complications for the fetus as well as vitamin K deficiency in mama.

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As always, remember that while all of us at AMMA are brilliant and passionate about all things motherhood, none of us are medical professionals! So use this as a jumping-off point for your own research and heed the wisdom of your care provider :)