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The First Trimester of Pregnancy: Complications Health Article
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Prenatal care is especially important in the third trimester because the types of complications that can arise at this time are more easily managed if detected early. Gestational DiabetesGestational diabetes occurs because the hormonal changes of pregnancy make it more difficult for your body to effectively use insulin. When insulin cannot do its job of lowering blood sugar to normal levels, the result is abnormally high glucose (blood sugar) levels. Most women have no symptoms. While this condition is usually not dangerous for the mother, it poses several problems for the fetus. Specifically, macrosomia (excessive growth) of the fetus can increase the likelihood of cesarean delivery and the risk of birth injuries. When glucose levels are well controlled, macrosomia is less likely. At the beginning of the third trimester, all pregnant women should get tested for gestational diabetes. During this test (the so-called one-hour glucose test) a woman drinks a glucose-laden fluid, and her blood sugar level is tested one hour later. If it is abnormal (above 130 or 140mg/dL based on which of two accepted standards is used), a three-hour oral glucose tolerance test (OGTT) is done to confirm the diagnosis. Prior to this test, a woman follows a carbohydrate diet for three days and then fasts overnight (eight hours). She then takes 100 mg of oral glucose. Her glucose levels are measured before she drinks the glucose solution, and then at one, two, and three hours afterwards. The diagnosis of gestational diabetes can be made if two or more values are elevated. Normal plasma glucose levels are 95 or 105 (fasting), 180 or 190 (one hour after glucose solution), 155 or 165 (after two hours), and 140 or 145 (after three hours). This confirmatory test is often negative. If the test is abnormal, dietary changes, exercise, and possibly insulin (Humulin N, Humulin R) will be needed to bring the glucose levels into normal range. The good news is that gestational diabetes usually resolves during the postpartum period, but there is up to a 50% chance of developing diabetes later in life which can be decreased through lifestyle modifications like diet and weight control. It is also important to note that gestational diabetes will often complicate future pregnancies requiring careful attention to diet, weight control, and usually an early one hour glucose tolerance test. In the event that high glucose levels continue for six weeks after postpartum, the patient will be diagnosed with underlying diabetes mellitus. PreeclampsiaPreeclampsia is a condition characterized by high blood pressure, protein in the urine, and swelling of the hands and face that occurs after 20 weeks of pregnancy. It occurs in about 10 to 15% of pregnancies and is more common with the first pregnancy, in teenagers, and in women over 35. While it can occur in the late second trimester, preeclampsia is much more common in the third trimester, near term. Preeclampsia can lead to eclampsia (seizures), kidney failure, and rarely death in the mother and fetus.
Signs and Symptoms
Many women have no symptoms at first. Others have headaches, vision changes, and upper abdominal pain. These signs may suggest severe preeclampsia. The first sign that your doctor usually sees is high blood pressure during a routine prenatal visit. Protein may be detected in your urine, and you may have gained excessive weight. Sometimes your hands and face are swollen, but this is frequently absent in mild disease. Blood tests, such as liver and kidney function tests and blood clotting tests, may confirm the diagnosis and can detect severe disease.
TreatmentHow your doctor treats preeclampsia depends on its severity and how far along in the pregnancy you are, but delivery is the ultimate treatment.
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