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Medical Disorders and Pregnancy

• Editor's Note
• List of Articles

List of Articles

• Renal Disorders and Pregnancy
  Among the various physiologic alterations that occur in normal pregnancy, few are as striking as those affecting the urinary tract. Changes in the urinary tract during normal pregnancy are so marked that norms in the nonpregnant cannot be used for obstetric management. Awareness of all alterations is essential if kidney problems in pregnancy are to be suspected or detected and then handled correctly. Most women with mild to moderate renal disease tolerate pregnancy well and have a successful obstetric outcome without adverse effect on the natural history of the underlying renal lesion. Crucial determinants are renal functional status at conception, the presence or absence of hypertension, and the type of renal disease.
  
  
• Cardiovascular Diseases and Pregnancy
  The current guidelines to manage cardiovascular diseases affecting pregnancy, and preconception counseling are discussed. The new guidelines for antibiotic prophylaxis for infective endocarditis are also discussed. There is some controversy over the optimal approaches to clinical assessment and treatment of women with cardiac diseases. Management hinges on the severity of cardiac diseases, gestational age and evaluation of relative risks. Additional guidelines on the basis of consensus and expert opinion also are presented. Without accurate diagnosis and appropriate care, heart disease in pregnancy can be a significant cause of maternal mortality and morbidity.
  
  
• Thyroid Disease in Pregnancy
  Thyroid disease is the second most common endocrine disease affecting women of reproductive age; obstetricians often care for patients who have been previously diagnosed with alterations in thyroid gland function. In addition both hyperthyroidism and hypothyroidism may initially manifest during pregnancy. The interactions between pregnancy and the thyroid gland are fascinating from at least three aspects: pregnancy induces increased thyroid-binding globulin, intimate relationship between maternal and fetal thyroid function, and a number of related abnormal pregnancy and thyroid conditions that at least appear to interact. The purpose of this document is to review the thyroid-related patho-physiologic changes created by pregnancy, and the maternal-fetal impact of thyroid disease.
  
  
• Seizure Disorders and Pregnancy
  Roughly one out of every 100 pregnancies occurs in a woman with epilepsy. These pregnancies present a unique challenge to obstetricians and neurologists due to the interrelationship of the effects of epilepsy and pregnancy, the variable effects of anti-convulsant medications on mother and fetus, and the changes in pharmacokinetics of these medications during pregnancy. The obstetricians and neurologist should work together prior to conception and throughout the patient's pregnancy to determine the safest and most effective medical therapy. Furthermore, the pediatrician selected by the patient to care for her baby should be included in pre-pregnancy discussions to address the potential increase in congenital malformations, the potential for neonatal sedation with certain medications, and questions concerning breast-feeding. The purpose of this document is to provide the current information on this issue and to offer practical advice on managing patients.
  
  

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