Dr. Keith Eddleman is the Director of Obstetrics and a senior member of the Division of Maternal-Fetal Medicine at The Mt. Sinai Medical Center. He also co-authored the books Pregnancy for Dummies and The Pregnancy Bible with Dr. Joanne Stone.
Welcome to your Pea in the Podcast. I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey as someone’s mom.
This week, we’ll talk about some of the problems you may face during your pregnancy.
“In severe, severe cases women can have a stroke.”
“I was sick pretty much the whole time, barfing.”
And the ugly…
“My ankles were as big around as my calves.”
We’re talking about pregnancy complications. You’ll want to know what’s normal and what’s not. Stick around.
Ah, pregnancy – a time to luxuriate in your divine feminine mystique…that’s what that is, right? You are fertility, you are abundance, you are Mother Earth and you’re glowing.
Wait, is that a glow or is that a sheen of perspiration from the sheer effort it takes to get your giant self from one place to the next?
Pregnancy can be hard, starting sometimes from the moment it occurs, before you even know you’re having a baby.
“Really the fatigue in the first trimester can sometimes be more debilitating than anything else.”
That was this mom’s biggest bugaboo.
“Fatigue is like the unsung hardest part of pregnancy.”
Oh, and pregnancy hurts!
“The sciatic pain and the pulling and stretching of the ligaments under your uterus.”
That’s called round ligament pain. Oh, and you may be glowing but you’ll also probably wake up one morning with cankles
“I had the worst swollen ankles. I mean, my ankles were as big around as my calves.”
And don’t forget that soft, round, generous, life-giving belly, the pride of any self- respecting fertility goddess
“My belly stuck out so big I couldn’t drive my car because I couldn’t reach the pedals.”
Oh, and that outie that used to be an inny?
“I know some people try and tape over their belly button, or put a quarter over it or whatever because they think it’s gross but I didn’t care. I thought it was cute.”
Yeah, pregnancy can be a rough ride right from the get-go, when about 70% of you will feel quite ill.
“Nausea and vomiting, not really a lot you can do. Every wives’ tale, every trick, every medication, I mean in severe cases there are medications that we can use to try to alleviate some of the nausea and vomiting.”
That’s Dr. Keith Eddleman, he wrote Pregnancy for Dummies and he’s a maternal-fetal specialist at Mt. Sinai in New York City. He says morning sickness or all day sickness is probably hormones and will likely pass with the first trimester but it will stick with some of you the whole time. There is also horrifying heartburn to make life interesting during the first trimester. That was my first symptom, along with exhaustion. There’s constipation and dizziness, mood swings, congestion, yeah you’ll have the sniffles probably, and yippee, infections.
“It’s very common to get urinary tract infections.”
A more troublesome pregnancy complication though is bleeding.
“1 in 5 women have some bleeding in the first trimester, so it’s very common.”
That sends many pregnant women into a panic, and understandably so.
“It does increase the risk of miscarriage, but there is nothing you can do about it in the first trimester, generally. So it’s really a wait and see, a watch and wait scenario.”
Some women do bleed during the first trimester and do continue to bleed off and on during their pregnancies. Dr. Eddleman says make sure you tell your doctor about this.
“People can have bleeding throughout pregnancy and still have a normal outcome, but if they have bleeding we need to look at it and address it and see where it’s coming from.”
Because bleeding could indicate a pregnancy complication that needs a lot of medical management.
“There are different causes for bleeding and they have different implications, like if the bleeding is due to what we call a placenta previa, where the placenta is covering the opening to the womb or the cervix, then obviously that’s different than bleeding that happens just in the early first trimester when the embryo is implanting.”
As your pregnancy progresses you’re likely to feel all kinds of discomfort. You’ll pee a lot during the first trimester because of hormones and during the last trimester because there’s a baby on your bladder. Your back will hurt; sometimes it will hurt quite a bit. Your breasts will hurt, of course. You may get hemorrhoids or headaches, muscle cramps, carpal tunnel and really annoying restless legs when you are trying to sleep, already! My hips hurt me to the point of fighting back tears on more than one occasion, and Dr. Eddleman says joint pain is very common.
“Number one is physically you’re carrying more weight and it puts a stress on your joints and your bones. Then secondly the progesterone that circulates to support the pregnancy that is made by the placenta actually softens some of the ligaments and joints. Part of that is to help the birth canal to be able to accommodate the baby as it fits through but it is not specific in that it can affect other joints too, so that you can have joint aches and pains.”
So much fun! Then of course there’s that highly attractive swelling so many pregnant women struggle with.
“The most common form is swelling in the legs and ankles.”
It could be particular problems for moms when it’s hot out, but it can also point to a more serious pregnancy complication.
“Well it’s a concern whenever it’s associated with high blood pressure and protein in your urine. Those are things that your doctor or your midwife will check on at each prenatal visit.”
So swelling may warrant a call to your doctor.
“If you all the sudden notice that you’re swelling, you didn’t have that before, then you should let your doctor know and then they’re probably going say let’s have you come in, let’s check your blood pressure and let’s check the protein in your urine. If it’s fine they’re going to say I think this is just pregnancy swelling. Put your ankles up as much as you can.”
If it’s not fine, you may be dealing with preeclampsia.
“It’s a condition that’s unique to pregnancy and the only treatment for preeclampsia really is delivery.”
Preeclampsia is very serious.
“Preeclampsia can lead to something called eclampsia, which is a seizure. It’s a seizure that can occur during a pregnancy because of the blood pressure. In severe, severe cases women can have a stroke. If the blood pressure gets so high and it’s not treated appropriately and delivery is not achieved, then they can have a stroke.”
So who’s at risk for preeclampsia?
“People who’ve had a previous history of it, people who have underlying blood pressure problems before they get pregnant. In other words if you have hypertension before you get pregnant then you’re at a higher risk for developing preeclampsia while you’re pregnant.”
If you find yourself with pregnancy-induced hypertension, which is high blood pressure that you didn’t have before you were pregnant, but you don’t have protein in your urine, you’re also at greater risk for developing preeclampsia. So you want to pay special attention to that.
If swelling is a very common pregnancy complication, how do you know when to worry?
“A sudden increase in the swelling that they have, sudden weight gain, severe headache that doesn’t go away with Tylenol, seeing double vision or seeing blurry vision. Things that are vision that’s not normal, that’s changed quickly. Having pain in the upper part of their abdomen. Severe, severe, severe indigestion and what we call epigastric pain.”
Dr. Eddleman says this can be so serious, even borderline test results are cause for concern.
“If you have somebody who comes in with mildly elevated blood pressures and borderline protein in the urine, then you’re not going to say come back in 3 weeks, you’re going to say come back to my office in 3 days or 2 days and let me check your blood pressure again.”
So if the only treatment for preeclampsia is delivery, well, that can be a problem for your baby, right?
“You know, if the preeclampsia occurs at 26 weeks and the mother has to be delivered at 26 and a half weeks, then the risk to the baby is not the preeclampsia, but it’s the fact that it had to be delivered prematurely. But at term, really the risks to the baby are not that significant, unless it’s long-standing. If it’s long-standing then the hypertension, the high blood pressure can lead to a chronic decrease in the amount of blood that’s flowing to the uterus and so the baby can suffer from growth. In other words, the growth can be impaired because of the preeclampsia if it’s long-standing.”
So I know you’re all asking yourself, is there anything I can do to avoid getting preeclampsia?
“Nope. Million-dollar question but no there’s not. There have been many things that have tried, high calcium supplements, other vitamin supplements, there are some people in Europe that advocate high doses of Omega 3 fatty acids or the fish oils which are the popular thing now to reduce cardiac risk in non-pregnant individuals. But really the jury’s still out. In America we’ve studied it but there’s no definitive data to show that they prevent preeclampsia.”
Oh, and a multiple pregnancy, well that puts you firmly in the preeclampsia risk zone.
“Twins have a 2-fold increase in the risk. Triplets have a 3 to 4-fold risk. Quadruplets if you make it long enough, you’re going to get it.”
This increased risk in a pregnancy with multiples also holds true for another pregnancy complication, gestational diabetes. About 4% of you will get that.
“It’s more common in obese women. It’s more common in women who have a strong family history of diabetes. It’s more common if you’ve had it before. In other words, if this is your second pregnancy and you had it with your first, it’s more likely that you’re going to have it then somebody who’s having a first pregnancy.”
And it’s more common among women who’ve been diagnosed with Polycystic Ovarian Syndrome, that’s a common endocrine disorder among women and it’s often linked with insulin resistance. One of those women is Christine Noria, so GD was on her radar.
“Oh yes, I mean having PCOS you kind of know, I have insulin issues and so yeah I kind of knew that I was at risk.”
She knew there was also little she could do to avoid it.
“Although eating a healthy diet is certainly a good thing while you’re pregnant, having sugar is not going to cause gestational diabetes. How much weight I gained is not going to cause gestational diabetes. But at the same time I was going to the gym and I was walking and I was trying to be careful about those sorts of things.”
Dr. Eddleman says Christine is right, there isn’t a lot you can do to avoid GD.
“The family history you can’t change and a prior history of diabetes you can’t change, so those types of things sort of in the cards.”
He says all of you, though, will be tested for the disorder.
“The routine screen is done around 26 to 28 weeks and you give women this really disgustingly sweet syrup to drink, it’s sort of like a cola or an orange cola but it’s really 50 grams of glucose, 50 grams of pure sugar. Then you check their blood sugar an hour afterward.”
If your blood sugar level is high after the one-hour test you get to go back and have some more of that delicious glucose drink, my favorite was orange.
“If the screen comes up positive then they need to have a diagnostic test. The diagnostic test is a 3-hour test and if that test is positive then they meet the criteria for the diagnosis of gestational diabetes.”
Christine, as she said, fully expected that diagnosis, but when she got it, she says she freaked out.
“Oh my gosh, I’m going to hurt my baby. My baby is going to die. Just because there are so many scary things out there that sometimes you feel like oh, ignorance is bliss. I don’t want to know.”
She went home and started researching gestational diabetes and that didn’t really help her at all.
“I’m reading this book and it’s saying things like full-term death and stillbirth and other things and I’m thinking I don’t know if I can handle this.”
She says by the time her husband got home she was really beside herself, and he had to talk her down.
“You’re going to manage it. You can do it. This happens to women everyday. You’re just going to have to follow the guidelines from your doctor. Take insulin if you have to. Keep exercising. He’s like you’re a good mom, you’re already a good mom. You’re doing the best you can so don’t go overboard.”
But the risks of GD to a baby are serious.
“One of the risks of children with gestational diabetes especially in boys is that their lungs don’t mature or develop fully as early as other babies that don’t have that complication. So that was part of my concern that he would not have mature lung development even though they were going to induce me at 39 weeks.”
And babies of moms with gestational diabetes do tend to be big, or “macrosomic.” That’s generally considered to be more than 9 pounds, and a big baby that can’t go to term with immature lung development, well that can be a problem, obviously.
Christine also worried that her baby would have low blood sugar, but her OB also reminded her of another concern for moms with GD.
“Sometimes babies whose mothers who have gestational diabetes, they just die. I was like ‘thanks’ because that’s really what every pregnant woman wants to hear. Your baby at the very end could just die. So there was that in the back of my head.”
This is a very rare complication of gestational diabetes, but Christine resolved to manage her diabetes, and that’s what she did.
“I had to watch my carb intake. I had to test my blood sugar 4 times a day. Fasting, after breakfast, after lunch, after dinner. She gave me the guidelines for what the range was that I should be in and I went home and I did it.”
Dr. Eddleman says your OB will also get more involved after a diagnosis of GD.
“We look at finger sticks, we look at their sugars, we see them more frequently, we check the growth of the baby, we tend not to let them go much past 40 weeks if they haven’t gone into labor spontaneously then we’ll encourage them to induce labor at that point.”
Christine admits following a gestational diabetes diet is not always easy.
“I think I spent pretty much the first month and a half on the diet eating sandwiches for lunch and dinner. But my kitchen scale became a very good friend of mine.”
Eating away from home can require some fancy footwork.
“I had to figure out what fast-food I could eat. It basically boiled down to 3 times the meat and twice the cheese on a roll at Subway and I had to go stop some place else to get milk because they don’t sell milk at Subway. Just kind of dealing with the everyday stuff you have to do and remembering all of the diet stuff on top of it. I did the best I could with the information that I had. Fortunately, it was enough that I didn’t have to go on insulin.”
In the end though, Christine’s discipline paid off. Diego is a gestational diabetes success story. It can be controlled. He was born and remains perfectly healthy.
And his size…
“He was 7 pounds 2 ounces and he was 20 inches long. He’s average. He was completely an average sized baby.”
Like with preeclampsia, when your baby’s born you’re all better, just like that. The folks at the hospital started offering Christine food.
“Immediately they were like ‘anything you want’, I was like ‘give me some sugar, I’m fine.’”
If you’re struggling with a pregnancy complication or the restrictions that go along with it, Christine has some advice for you.
“You can do anything for a finite amount of time. Like, I know this is going to end, it’s not like it’s something that I have to deal with for the rest of my life.”
Remember, even with your Fred Flintstone feet and your stretch mark-lined belly of and that odd waddle while you walk, you are beautiful.
We hope you’ve enjoyed this Pea in the Podcast: Pregnancy Complications. Please visit our website, peainthepodcast.com, for more information about our experts, to find links and transcripts, and to register to receive tailored week-by-week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie, thanks for listening.
A Special Thank You To…
Christine in Indiana who graciously shared with us her pregnancy journey with gestational diabetes for this podcast.