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6 questions to ask your ob-gyn about pregnancy when you have a chronic health condition
Here’s how to talk to your provider about the extra help you might need while you’re expecting.
It’s not so unusual to have a chronic health condition and be pregnant at the same time. After all, more and more women of childbearing age in the U.S. have chronic conditions, according to the March of Dimes.
What exactly is a chronic condition? It’s a health issue you’ve had for at least a year that you are being treated for. This can be diabetes, high blood pressure, an abnormal heartbeat, depression, an autoimmune disorder such as rheumatoid arthritis, or other problems.
If you have a chronic health condition, you may wonder about the best way to manage it during your pregnancy. The first important thing to know: With a good team of providers and the right kind of care, you can stay on the path to a healthy pregnancy.
To get the care you need, it helps to be prepared. One way is to have a list of questions to ask your ob-gyn. These questions and their answers will help you know what to expect during your pregnancy.
1. Should I see an obstetrician who specializes in high-risk pregnancies?
Talk to your ob-gyn about the level of care you may need. You may love your doctor, but it’s okay to ask if you should be referred to a specialist.
A high-risk obstetrician is someone who sees patients with preexisting health conditions or other factors that may make their pregnancy more complicated, such as carrying twins. The specialist can set up a plan of action for you.
“We can counsel [patients] on what type of complications they could encounter and what we need to monitor for,” says Marc R. Parrish, D.O. He’s an ob-gyn and maternal and fetal medicine specialist at the University of Kansas Health System.
Sometimes it can be helpful to consult a high-risk ob-gyn just to get a second opinion. You can still continue to see your ob-gyn.
You can also take a team approach, as suggested by the March of Dimes. That’s when your routine prenatal care is handled by your regular ob-gyn, but you also keep seeing the doctor who treats your chronic condition. Your team may include other specialists who can help you manage your chronic condition during pregnancy.
2. How often will I need to be seen?
Your pregnancy will likely need to be watched more closely than one that is not high risk, says Dr. Parrish. That might mean an appointment with your doctor every four weeks for the first 20 weeks. During the second trimester, you might see your provider twice a month. After week 27 or 28, you might go in once a week until you deliver, explains Dr. Parrish.
The reason? Your doctor will want to keep an eye on your baby’s growth and your health. For example, if you have lupus (an autoimmune disorder), you’re at risk for high blood pressure, says the Centers for Disease Control and Prevention. That can increase your chances of developing preeclampsia, a high blood pressure disorder that can happen during pregnancy. High blood pressure might also increase your chances of having a smaller baby or giving birth before 37 weeks.
3. Will I need extra ultrasounds and tests?
Along with the extra visits come extra tests. That could include more ultrasounds, sometimes once every four weeks. You might also get a fetal echocardiogram to look at the baby’s heart. Some chronic conditions, such as lupus, can raise the possibility that your baby will be born with a heart defect, according to the American College of Rheumatology (ACR).
Then at around 28 to 32 weeks, your provider will give you a weekly non-stress test combined with an ultrasound, says Dr. Parrish. That means you will have a fetal monitor strapped around your belly to check the baby’s heartbeat. All of these tests are ways to check how well you and your baby are doing.
4. Can I continue to take my medications during pregnancy?
Your doctor will review your medications to make sure they’re safe to take while you’re expecting. They will also discuss the risks and benefits of continuing medication. The bottom line: Most of the time, you need these medications to stay healthy and keep your baby healthy. But it’s important to find the safest options.
For example, you might take an antidepressant for depression. The risk to the baby when taking antidepressants during pregnancy is low, according to the Mayo Clinic. But some antidepressants are linked to certain birth defects. So, your provider may recommend that you switch to a different medication.
The same is true if you have high blood pressure and autoimmune disorders such as rheumatoid arthritis. Hydroxychloroquine is safe for you and your baby, but methotrexate or biologics aren’t, says the ACR.
5. What can I do to make sure I have a healthy pregnancy?
Every pregnant woman should eat a diet rich in whole grains, fruits and vegetables. They also need to exercise. But you might want to ask your provider detailed questions depending on what type of condition you have.
If you have an abnormal heartbeat, for instance, some activities may be off limits. Ask your provider for a list of the types of activities that are safe for you. Be sure to find out how often you can do them.
Do you have diabetes? In that case, it’s important to watch your blood sugar levels. Your doctor will work with you on your diet or even recommend a nutritionist to discuss a healthy eating plan. You’ll probably be asked to monitor your blood sugar levels and send readings to your doctor regularly. That way, you are working together to meet your goals.
6. Will I have to get induced or require a C-section?
Your doctor may not know the answer yet and will monitor you along the way. Based on your condition, you may ask if they think you’ll go to full term, which is between 39 and 40 weeks. With some chronic health conditions, you might need to have your baby earlier, via induced labor or a planned C-section (cesarean delivery).
Once you have your care team in place, you’ve taken an important step towards a healthy pregnancy. Your team will support you along the way and do everything they can to help you stay well. They’ll be watching you closely — and rooting for you and your baby.
Additional sources:
Chronic disease and pregnancy: March of Dimes
Provider team: March of Dimes
Lupus: Centers for Disease Control and Prevention
Heart defects: American College of Rheumatology
Antidepressants: Mayo Clinic
Heart problems and exercise: Cleveland Clinic
Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.
