Chronic Illness and Pregnancy: Managing Risks for Mother and Child

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• Obstetric Complications from Maternal Disease
• Acute Maternal Complications and Premature Delivery
• Disease Transmission to the Baby
• Genetic Conditions and Inheritance Risks
• Parenthood with Physical Disability
• Mental Health and Cognitive Challenges in Parenthood
• The Critical Role of Pre-Pregnancy Planning

Obstetric Complications from Maternal Disease

Chronic medical conditions can directly cause serious obstetric complications during pregnancy. Dr. Marc Dommergues, MD, explains that autoimmune disorders like antiphospholipid syndrome are strongly associated with adverse outcomes. These include preeclampsia, placental abruption, and delivering small for gestational age babies.

These complications arise because maternal diseases can affect placental development and function. Proper disease management before and during pregnancy is essential to minimize these risks.

Acute Maternal Complications and Premature Delivery

Acute medical emergencies in the mother can force doctors to deliver babies prematurely, potentially harming the infant. Dr. Marc Dommergues, MD, addresses a common sentiment among mothers who say they're "ready to die for my baby." He emphasizes that this approach is counterproductive.

When a mother's life is at risk from conditions like acute heart failure, medical teams must often induce labor or perform cesarean sections very early. This necessary intervention to save the mother's life can result in significant neonatal complications from extreme prematurity.

Disease Transmission to the Baby

Maternal diseases can transmit to infants through several mechanisms, requiring careful management. Infectious diseases like HIV can transmit from mother to baby if the viral load isn't well controlled. Fortunately, modern antiretroviral therapy has dramatically reduced this transmission risk.

Antibody-mediated transmission represents another pathway, occurring in conditions like myasthenia gravis or thyroid disorders. In these cases, maternal antibodies cross the placenta and can affect the newborn, though these effects are often temporary.

Genetic Conditions and Inheritance Risks

Genetic disorders present unique challenges in pregnancy due to inheritance patterns and variable expression. Dr. Marc Dommergues, MD, uses Marfan syndrome as an example—an autosomal dominant condition with a 50% transmission risk to offspring.

Dr. Marc Dommergues, MD, explains a critical concept: genetic conditions show variable expression. One family member with Marfan syndrome might die at age 30 while another with the same mutation lives to 80. This variability makes genetic counseling complex, as carrying a disease gene doesn't guarantee a specific outcome.

Parenthood with Physical Disability

Physical disabilities require special consideration for practical parenting challenges beyond the pregnancy itself. Dr. Marc Dommergues, MD, notes that severe motor disabilities raise questions about providing routine infant care like changing and feeding. However, he emphasizes that severity doesn't necessarily predict parenting success.

Anticipation through training and environmental modifications can address many challenges. Interestingly, Dr. Marc Dommergues, MD, observes that parenting difficulties with physical disabilities often relate to subtle factors beyond the disability itself, noting that parenting is challenging even without disabilities.

Mental Health and Cognitive Challenges in Parenthood

Mental health conditions and cognitive disabilities present particularly complex parenting considerations. Severe mental illness or intellectual disability creates extremely complicated situations that are difficult to discuss before pregnancy. These conditions require specialized support systems.

However, Dr. Marc Dommergues, MD, offers hope for women with treatable psychiatric disorders. With proper organization and treatment beforehand, pregnancy outcomes can be extremely positive, highlighting the importance of pre-pregnancy mental healthcare.

The Critical Role of Pre-Pregnancy Planning

Preconception counseling and planning emerge as the unifying theme for managing chronic disease in pregnancy. Dr. Dommergues's insights throughout the discussion with Dr. Anton Titov, MD, consistently return to the value of anticipation. Whether addressing genetic risks, physical limitations, or mental health concerns, advanced planning dramatically improves outcomes.

This comprehensive approach allows healthcare teams to address transmission risks, implement environmental modifications, optimize medication regimens, and establish support systems long before conception occurs. This proactive strategy represents the gold standard in caring for women with chronic conditions who wish to become parents.

Full Transcript

Dr. Marc Dommergues, MD: Some medical diseases may induce obstetric complications. This is very well known. For example, the antiphospholipid syndrome is associated with obstetrical complications, such as preeclampsia, small for gestational age babies, and placental abruption.

There is also something which is less well known, or it is well known, but mothers don't think about it. If there's an acute complication in a mother, for example, acute heart failure, this may force the doctors to perform a premature delivery of a baby, which in turn may harm the baby.

Some mothers tell us, "I'm ready to die for my baby." I tell them that it's not a good idea, because if during the pregnancy you are going to be at risk of dying, we will have to either induce labor or perform a cesarean section very early. This may, in turn, harm the baby.

So this is the other issue—obstetrical complications related directly or indirectly to the disease.

Then there's the question of the disease that the mother may transmit to her child. It may be transmitted by very different routes. For example, it may be a transmission of infection if a mother is affected by HIV and the viral load is not well controlled. Then a risk exists of transmitting HIV to the baby.

Of course, now mother-to-baby HIV transmission risk is easy to control with antiretroviral drugs.

Another example: antibodies may be transferred from the mother to the baby. This can happen with myasthenia gravis or thyroid disorders.

Then there's the risk of genetic transmission. If a future mother has Marfan syndrome, which is an inheritable condition, there is a 50% risk of transmission of the gene for Marfan syndrome. She can pass this gene on to her baby.

The problem with a lot of inherited diseases with an autosomal dominant fashion of transmission is they have variable expression. One affected person in the family may have died at 30, and another person may die at 80 with the same gene of the same disease.

So knowing that you're carrying the gene for a disease doesn't mean that this or that is going to happen to you with 100% certainty. And this is a problem.

There's also a difficult question, which is the question of parenthood. A disease may interact with parenthood in different ways. For example, if you have a severe motor disability, the question is, "How am I going to be able to provide routine care to a baby?" This includes changing the baby or feeding the baby, etc.

Then it's very important to anticipate this and to anticipate this by training and by improving the environment. There are plenty of things that can be done.

Funny enough, our feeling is that parenthood difficulties with persons with a motor disability are not directly related to the severity of the disability, but probably to some other more subtle problems. It could be difficult to raise a child if you have no disability at all.

The last point is when parents have a mental disability. Parenthood with patients with mental retardation is something extremely complicated. It is extremely difficult to discuss beforehand.

When people have a severe mental illness, pregnancy may also be very difficult to discuss beforehand. On the other hand, if a woman has a straightforward and treatable psychiatric disorder, everything can be organized beforehand. Then usually, the outcome of pregnancy is extremely good.

So this is the impact of the disease on pregnancy.