Disorders of Pregnancy

Disorders of Pregnancy

In the course of its research on healthy pregnancy, the NICHD has made great progress in understanding features of disorders that may occur during pregnancy. Work is ongoing to find ways to treat and prevent these disorders to help women have healthy pregnancies and healthy babies.
Gestational Diabetes Mellitus (GDM)
GDM is a specific type of diabetes that only pregnant women get. To support the fetus as it grows, the mother's body makes hormones. In some women, these hormones work against their bodies, making them less able to make the insulin needed to get energy from body cells. Without this insulin, the level of sugar in the mother's blood starts to build up, which, if left untreated, can cause health problems for both mother and fetus.
Researchers estimate that GDM occurs in nearly 7 percent of all pregnancies. Unlike some other disorders that occur during pregnancy, GDM is often treatable. GDM treatment plans should be designed by a health care provider to address a woman's specific health needs. In general, many GDM treatment plans include: following a healthy meal plan as outlined by a health care provider; getting regular, moderate physical activity; maintaining a healthy weight gain; and measuring and recording blood sugar levels. Some women also need to take insulin or other medications to maintain a healthy pregnancy.
Even though it usually goes away after the baby is born, GDM can affect the health of both mother and baby later in life. For instance, women who have GDM during pregnancy have a 40 percent greater chance of developing type 2 diabetes later in life. And, babies born to mothers with GDM are at greater risk than babies born to other mothers of developing type 2 diabetes or being obese (extremely overweight) later in life.Because babies born to mothers with GDM tend to be larger than average, GDM can also affect the way a baby is delivered. In some cases, the safest way to deliver a baby from a mother with GDM is by surgery, called cesarean section; but, cesarean section delivery carries its own risks.
The NICHD supports a great deal of research on GDM, its risk factors, and its treatments. One study, supported by the NICHD through the Maternal-Fetal Medicine Unit (MFMU) Network, is examining the benefits of counseling and dietary management in treating mild GDM. Other clinical trials on GDM are also underway.
The NICHD offers Are you at risk for gestational diabetes? a brochure that outlines the risk factors for GDM and summarizes recommendations from American College of Obstetricians and Gynecologists about testing for GDM. In addition, Managing Gestational Diabetes: Your Guide to a Healthy Pregnancy provides general information and guidelines for keeping yourself healthy if you have GDM.
The American Academy of Family Physicians also provides more detailed patient information about GDM.
Preeclampsia and Eclampsia
Preeclampsia (pree-ee-KLAMP-see-uh) describes an abnormal increase in a woman's blood pressure after the 20th week of pregnancy. Preeclampsia is often associated with swelling in the face and hands. (A woman's feet might swell, too, but swollen feet are common during healthy pregnancies; swollen feet do not always mean there is a problem.) This dangerous condition occurs in 3 percent to 4 percent of all pregnancies and is the leading cause of maternal and fetal death in the United States.Eclampsia (ee-KLAMP-see-uh) is a more severe form of preeclampsia that can lead to seizures and coma. Estimates place the number of women affected by eclampsia at one in 200 women who have preeclampsia. Eclampsia can be fatal if it's not treated quickly.High blood pressure is one possible sign of preeclampsia. Having abnormal levels of protein in the urine is also part of preeclampsia. If you are pregnant and your blood pressure normally runs high, or is suddenly high, your health care provider may ask for frequent urine samples throughout your pregnancy, to test your urine for protein as a sign of preeclampsia.The only definite cure for preeclampsia is delivering the fetus. But, preeclampsia can occur early in pregnancy, which may mean delivery is not the best option. If so, your health care provider may develop a plan with you to try and safely prolong your pregnancy to allow the fetus to develop more, while closely monitoring you for signs that the fetus should be delivered, even prematurely, if necessary. In this case, the decision of whether or not to deliver can be very difficult; it requires that the mother be watched very closely, often in the hospital, as a precaution. If you have questions about preeclampsia, please talk to your health care provider.Currently, there is no definite way to predict which pregnant women will develop preeclampsia. Recent findings from an NICHD-supported study found that abnormal levels of two molecules in the blood may predict the development of preeclampsia, but further research is needed. To read more about this finding, read the news release about preeclampsia.The National Heart, Lung, and Blood Institute (NHLBI), is collaborating with the NICHD MFMU Network to conduct a study and a clinical trial called CAPPS: Combined Antioxidant Preeclampsia Prediction Studies. The CAPPS clinical trial will evaluate whether vitamin C and E supplements can prevent some of the problems associated with preeclampsia. The observational study portion of CAPPS will collect samples and data to help identify predictors of preeclampsia, as well as markers that may improve understanding of the mechanisms that underlie this condition.In addition, NICHD-supported researchers have found that women who were highly insulin resistant during the early months of pregnancy were more likely to develop preeclampsia later in pregnancy than were women who were not insulin resistant. Further studies will look at ways of reducing insulin resistance in early pregnancy as one possible way of preventing preeclampsia.