Chronic health conditions and pregnancy

KEY POINTS

  • Women with chronic health conditions can and do have healthy pregnancies and healthy babies.

  • Chronic health conditions include asthma, autoimmune diseases, diabetes, high blood pressure, HIV, epilepsy and mental health conditions.

  • Work with your health care providers to manage chronic health conditions and treatments (including medicine) before, during and after pregnancy.

  • Don’t start or stop taking any prescription medicine before, during or after pregnancy without talking to your health care providers first.

  • Taking some medicines during pregnancy can cause serious problems, including premature birth, neonatal abstinence syndrome (NAS) and birth defects.

What is a chronic health condition?

A chronic health condition (also called chronic illness or chronic disease) is one that lasts for 1 year or more that needs ongoing medical care and that can limit a person’s usual activities and affect daily life. More and more women of childbearing age in this country have chronic health conditions. This is because risk factors that make people likely to have chronic conditions, like poor nutrition, limited physical activity, being overweight and smoking, are increasing.  

Women with chronic health conditions can and do have healthy pregnancies and healthy babies.

Your body does a great job taking care of your baby during pregnancy. If you have a chronic health condition, it may need some extra help from your health care providers to manage your condition and treatment (including prescription medicine) before, during and after pregnancy. There’s a lot you and your providers can do to keep your condition under control and keep your baby safe and healthy.

How can chronic health conditions affect pregnancy?

Chronic health conditions increase your risk for certain pregnancy complications. But careful treatment from health care providers can help you manage your condition to help you have a healthy pregnancy and a healthy baby.

Chronic health conditions can increase your risk for:

  • Infertility. This means you have trouble getting pregnant.
  • Premature birth. This is birth before 37 weeks of pregnancy. Babies born prematurely are more likely to have health problems than babies born on time.
  • Birth defects. These are health conditions that are present at birth that change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works.
  • Pregnancy loss, like miscarriage and stillbirth. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb.

What are examples of chronic health conditions?

Chronic health conditions include:

Autoimmune diseases. If you have an autoimmune disease, antibodies (cells in your body that fight off infections) attack healthy tissue by mistake. Autoimmune diseases include:

  • Ankylosing spondylitis. This is a type of arthritis that affects the spine (back bone). It causes inflammation (pain, redness, swelling) between your vertebrae (bones in the spine) and the joints between your spine and pelvis. It also may affect other joints. The pelvis connects the legs to the body.
  • Inflammatory bowel disease (also called IBD) includes Crohn’s disease and ulcerative colitis. IBD causes problems in the digestive tract, where your body breaks down food, take in nutrients and removes waste. 
  • Lupus (also called systemic lupus erythematosus or SLE). Lupus can damage the joints, skin, kidneys, heart, lungs and other body parts.
  • Multiple sclerosis (also called MS). MS attacks parts of the nerves in your brain and spinal cord.
  • Psoriasis. This is a skin disease that causes itchy or sore patches of thick, red skin. The patches usually appear on the elbows, knees, scalp, back, face, palms or feet. But they can show up on other body parts, too. Some people with psoriasis get a form of arthritis called psoriatic arthritis that causes pain, stiffness and swelling of the joints.
  • Rheumatoid arthritis (also called RA). RA attacks the lining of the joints throughout the body.
  • Scleroderma. This is a group of diseases that affects connective tissue in your body. Connective tissue is tissue that supports your skin and internal organs, like your kidneys, lungs and heart.

Chronic pain. This is pain that can last for weeks, months or even years. It may be caused by an injury, infection or another condition. Sometimes the cause is unknown.

Conditions that affect the blood, blood vessels, heart and lungs. These include:

  • Asthma. This is a lung disease that causes your airways to tighten up, making it hard for you to breathe.
  • Heart disease (also called cardiovascular disease). This includes conditions that affect the heart muscle or involve narrowed or blocked blood vessels that can lead to a heart attack or stroke.
  • High blood pressure (also called hypertension). Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. If the pressure in your arteries becomes too high, you have high blood pressure. High blood pressure can put extra stress on your heart and kidneys. This can lead to heart disease, kidney disease and stroke.
  • HIV. HIV stands for human immunodeficiency virus. HIV is a virus that attacks the body’s immune system. HIV is the virus that causes AIDS (acquired immune deficiency syndrome).
  • Obesity. If you’re obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30.0 or higher. BMI is a measure of body fat based on your height and weight. To find out your BMI, go to www.cdc.gov/bmi.

Conditions that affect hormones (chemicals made by the body). These include:

  • Diabetes. Diabetes is when your body has too much sugar (called glucose) in your blood. When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas (an organ behind your stomach) makes a hormone called insulin that helps your body keep the right amount of glucose in your blood. When you have diabetes, your body doesn’t make enough insulin or can’t use insulin well, so you end up with too much sugar in your blood. Diabetes can damage organs in your body, including blood vessels, nerves, eyes and kidneys. If you have diabetes before pregnancy, it’s called preexisting diabetes. Gestational diabetes is a kind of diabetes some women get during pregnancy.
  • Thyroid conditions. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food. If it makes too little or too much of these hormones, you can have health problems.

Mental health conditions. These conditions affect how you feel, think and act. They can interfere with your daily life. Depression (also called depressive disorder, major depression or clinical depression) is an example of a mental health condition. Depression causes feelings of sadness and a loss of interest in things you like to do. It’s a medical condition that needs treatment to get better.

What kinds of health care providers do you need to treat a chronic health condition before, during and after pregnancy?

To best manage your condition during pregnancy, you need a team of health care providers who work together to give you the best all-around care. Your team is led by:

  • Your prenatal care provider
  • The provider who treats your chronic health condition

Your team also may include other providers who help you manage your condition before, during and after pregnancy. And it can include your baby’s health care provider, especially as you get closer to your baby’s birth.

Before you try to get pregnant, make sure each provider knows about your pregnancy plans and the other providers you see. All your providers work together with you to help you get ready for pregnancy and stay healthy during pregnancy. For example, if you have depression, your prenatal care provider should know who treats you for depression and what your treatment is. And your mental health provider should know who you see for prenatal care.  Share their contact information so you and your providers can connect easily.

All of your providers work together to make sure any treatment you get (including medicine) is safe for you and your baby before, during and after pregnancy. Don’t start or stop taking any medicine without talking to each of your providers about its effect on pregnancy. Starting, stopping or changing medicines may cause serious health problems.

Your provider team includes:

Your prenatal care provider who takes care of you during pregnancy and delivers your baby. For example:

  • An obstetrician (also called OB). An OB is a doctor who has education and training to take care of pregnant women and deliver babies.
  • A family practice doctor (also called a family physician). This is a doctor who can take care of every member of your family. This doctor can take care of you before, during and after pregnancy.
  • A maternal-fetal medicine (also called MFM) specialist. This is an OB with education and training to take care of women who have high-risk pregnancies.
  • A certified nurse-midwife (also called CNM). This is a nurse with education and training to take care of women of all ages, including pregnant women.
  • A family nurse practitioner (also called FNP) or a women’s health nurse practitioner (also called WHNP). A FNP is a nurse with education and training to take care of every member of your family. A WHNP is a nurse with education and training to take care of women of all ages, including pregnant women.

Doctors who treat your specific condition. For example:

  • A cardiologist treats and helps prevent diseases of the heart and blood vessels.
  • An endocrinologist treats gland or hormone problems, like diabetes or thyroid conditions.
  • A gastroenterologist treats conditions that affect the digestive system, like IBD.
  • An infectious disease specialist treats infections, like HIV or Zika virus.
  • A neurologist treats brain, spine or nerve problems, like epilepsy.
  • A psychiatrist treats people with emotional or mental health problems, like depression.
  • A pulmonologist treats lung conditions, like asthma.
  • A rheumatologist treats autoimmune diseases and diseases that affect the bones, joints, muscles, ligaments and tendons.

Other kinds of providers, like:

  • Mental health professionals, including psychiatric nurse practitioners, psychologists, social workers, therapists and counselors
  • A doula. A doula is a trained professional who provides information and physical and emotional care and support to women before, during and after childbirth, including continuous support through labor and birth.  
  • A lactation consultant. This person has special training to help women breastfeed.
  • A diabetes educator. This is someone with special training to help people with diabetes control their blood sugar.
  • A registered dietitian. This is a licensed health care professional who helps people eat healthy foods to help them live a healthy life.

How can medicine you take for your condition affect your pregnancy?

Many women take medicines during pregnancy to control a chronic health condition. About 9 in 10 women (90 percent) take some type of medicine during pregnancy. And 7 in 10 women (70 percent) take at least one prescription medicine during pregnancy. But some medicines during pregnancy may increase your risk of serious complications, including:

  • Premature birth
  • Birth defects
  • Neonatal abstinence syndrome (also called NAS). NAS is a group of conditions caused when a baby withdraws from certain drugs he’s exposed to in the womb before birth. NAS most often is caused by drugs called opioids. Prescription opioids are used to treat pain.
  • Developmental disabilities in your baby. These are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.
  • Miscarriage, stillbirth and infant death

The medicine you take during pregnancy depends on:

  • Your chronic health condition and any other conditions you have
  • How much medicine you take
  • When you take the medicine during pregnancy
  • Other medicines you may take

If the medicine you take for your condition may be harmful to your baby, you may be able to change to one that’s safer. But some medicines may be critical to your own health, even if they may affect your baby. You and your providers can weigh the benefits and risks of medicine you take to give you the healthiest possible pregnancy.

When your provider gives you a prescription for medicine, he tells you exactly how much to take (called the dose), how often to take it and how long to take it. When you take any prescription medicine:

  • Take it exactly as your provider says to take it.
  • Don’t take it with alcohol or other drugs.
  • Don’t take someone else’s prescription medicine.

If have questions or concerns about your medicine, talk to your health care providers.

What can you do before pregnancy to get ready to manage your condition during pregnancy?

Plan ahead so you’re as healthy as you can be before you get pregnant. Your health care providers can help you get your condition under control and make changes in your life to get ready for pregnancy. Here’s what you can do:

Get your provider team set. Make sure all the providers know about other providers on your team and how to contact them. They all need to know about your condition and that you’re planning to get pregnant.

Get a preconception checkup. This is a medical checkup you get with your prenatal care provider before pregnancy to help make sure you’re healthy when you get pregnant. Go for this checkup before you start trying to get pregnant. At the checkup, ask your provider about taking folic acid to help prevent birth defects of the brain and spine called neural tube defects. Your provider can make sure your vaccinations are up to date to help protect you from infections that can cause problems during pregnancy.

Talk to your providers about when to get pregnant. They can help you think about the best time to get pregnant and help you choose birth control until you’re ready for pregnancy. This can help prevent unplanned pregnancies or pregnancy during times when your condition may cause problems for you and your baby. For example, if you have an autoimmune disease like IBD, you have periods of remission (few or no symptoms) and flares (many or intense symptoms). It’s best not to get pregnant when your disease is flaring, when you’ve started a new treatment or when you’re taking certain medicines. Using birth control and planning for your pregnancy can help reduce your risk of complications.

Work with your providers to get your condition under control. For example, if you have preexisting diabetes, work to get it under control 3 to 6 months before pregnancy. Monitor your blood sugar, take your diabetes medicine, eat healthy foods and be active every day.

Talk to your providers to make sure your treatment is safe for you and your baby when you do get pregnant. Working with your provider team, you can make decisions about treatment, including prescription medicines. Don’t start or stop taking any prescription medicine without talking to your providers first.

Be sure any provider who prescribes you medicine knows that you’re trying to get pregnant. And make sure your prenatal provider knows everything you take. This includes prescription medicines, over-the-counter medicines, supplements and herbal products. You may use over-the-counter (also called OTC) medicine, like pain relievers and cold medicine, to treat common conditions like a headache or a stuffy nose. Over-the-counter means you can buy the medicine without a prescription from a health care provider. But not all OTC medicines are safe to use during pregnancy. This goes for supplements and herbal products, too. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in the foods you eat. For example, you may take a vitamin supplement to help you get more vitamin B or C. Or you may take an iron or calcium supplement.

How can you manage a chronic health condition during pregnancy?

Once you’re pregnant, it’s important to monitor your pregnancy and your condition closely. Here’s what you can do:

Get early and regular prenatal care. This is medical care you get during pregnancy. At each visit, your prenatal care provider checks on you and your growing baby. Call your provider and go for your first prenatal care checkup as soon as you know you’re pregnant. And go to all of your prenatal care checkups, even if you’re feeling fine.

At each prenatal visit, talk to your provider about your condition, your treatment plan and keeping your other providers up to date on your prenatal care. Because you have a chronic health condition, you may need extra prenatal checkups throughout pregnancy. Your provider may ask you to monitor your health at home in between visits. For example, if you have high blood pressure, you may need to take your own blood pressure every day.

At your first prenatal checkup, your provider gives you a physical exam and checks your overall health. She also talks to you about prenatal tests. These are medical tests you get during pregnancy to help your provider find out how you and your baby are doing. Because you have a chronic health condition, you may need extra prenatal tests.

Tell your prenatal care provider about any medicine you take, even if it’s prescribed by another provider. Be sure any provider who prescribes you medicine knows that you’re pregnant. Don’t start or stop taking any prescription medicine during pregnancy without talking to your providers first. Stopping your medicine suddenly may cause severe problems. For example, if you have an autoimmune disease, you may find your condition gets better during pregnancy. But if you stop taking your medicine, your condition may flare up and harm your baby.

Get regular treatment for your condition. Keep seeing all the providers who treat your condition. Don’t stop going to checkups because you’re going to prenatal care checkups, too. Remember that your providers are all part of your team, and each one plays an important part of your care during pregnancy.

Make a postpartum care plan. This is a plan that helps you prepare for your medical care after giving birth. Your provider can tell you when to schedule your first postpartum care checkup. This is a medical checkup you get after having a baby to make sure you’re recovering well from labor and birth. Make your plan at one of your prenatal care checkups. Your plan includes making choices about birth control and breastfeeding making sure you get treatment for any complications you may have had during pregnancy.

Plan for breastfeeding. Ask your providers about how your health condition affects breastfeeding. Breast milk is the best food for babies in the first year of life. It helps babies grow and develop. Most women with chronic health conditions can breastfeed. But some conditions and some medicines you take for a condition may make breastfeeding unsafe for your baby. Talk to your provider to decide about breastfeeding.

If you’re not planning to breastfeed, ask your provider about feeding your baby donor breast milk or formula. Donor milk is breast milk that a woman donates to a milk bank. A milk bank receives and stores donated breast milk, tests it to make sure it’s safe and sends it to families of babies who need it. Donor breast milk is prescribed by your baby’s health care provider. It has all the benefits of your own breast milk. Formula is a milk product you can feed your baby instead of breast milk.

How can you manage a chronic health condition after you give birth?

Even after your baby is born, your health—especially treatment for your condition—is super important. The best thing you can do for yourself and your baby is to take care of your health. Here’s what you can do:

Go to your postpartum checkups, even if you’re feeling fine. This is important because new moms are at risk of serious and sometimes life-threatening health complications in the days and weeks after giving birth. Too many new moms have or even die from health problems that may be prevented by getting postpartum care.

At your checkups, your provider gives you a physical exam and checks on your chronic health condition. Talk to your provider about any problems you had during pregnancy, labor and birth that can affect your health after pregnancy. You may be able to prevent problems in future pregnancies, even if you’re not thinking about having another baby now. For example, if you have a premature birth in one pregnancy, you’re at increased risk of giving birth early again in another pregnancy. Even if you don’t plan to have more children, ask your provider if any problems you had during pregnancy may affect your health now or in the future.

Tell your provider if you’re worried about any discomforts after birth. Your body changes a lot after you give birth. Some changes are physical, like your breasts getting full of milk, and others are emotional, like feeing extra stress. Many of these discomforts and body changes are normal. But if you’re worried about how you feel, tell your provider. Don’t take any medicine to treat a discomfort without talking to your provider first. 

Learn the warning signs health problems after birth. These include chest pain, trouble breathing, heavy bleeding, severe headache and extreme pain. Getting treatment quickly may save your life. Life-threatening conditions that can happen after birth include infections, blood clots, postpartum depression (also called PPD) and postpartum hemorrhage (also called PPH). Chronic health conditions may increase your risk of some of these conditions. For example, if you have depression or another mental health condition, you may be more likely to have PPD. If you’re obese, you’re at increased risk of having blood clots or PPH.

Get regular treatment for your condition. Keep seeing all the providers who treat your condition. Don’t stop going to checkups because you’re no longer pregnant and you’re going to postpartum care checkups. Keep up with all your providers on your health care team.   

If you’re breastfeeding, keep your breast milk safe for your baby. You can pass medicine to your baby through breast milk. So ask your provider if your medicine is safe to take during breastfeeding. If it’s not, ask about feeding your baby donor milk or formula. And don’t smoke, drink alcohol or use harmful drugs. All of these can make your breast milk harmful to your baby.

Use birth control until you’re ready to get pregnant again. For most women, it’s best to wait at least 18 months between giving birth and getting pregnant again. This much time gives your body time to fully recover from your last pregnancy before it’s ready for your next pregnancy. You and your provider team can work together to manage your condition so you’re healthy when you’re ready for your next pregnancy.

More information

Last reviewed: March, 2019

See also: Prescription medicine during pregnancy, Preconception checkup, Prenatal care checkups, Your postpartum checkups