In contrast to these perinatal morbidities, obesiy is linked with several maternal complications. As discussed in Chapter 48 (p. 939), these include preeclampsia, gestational diabetes, labor abnormalities, cesarean delivery, and operative complications (American College of Obstetricians and Gynecologists, 2015b). Obesity also appears to be associated with a range of structural fetal anomalies (Stothard, 2009).
Conditioned pregnant women usually can continue to exercise throughout gestation (American College of Obstetricians and Gynecologists, 2017d). As discussed in Chapter 9 (p. 170), no data suggest that exercise is harmful during pregnancy. One caveat is that as pregnancy progresses, balance problems and joint relaxation may predispose to orthopedic injury. A woman is advised not to exercise to exhaustion, and she should augment heat dissipation and fluid replacement. Further avoidances include prolonged supine position, activities requiring good balance, and extreme weather conditions.
Pregnancy can exacerbate interpersonal problems and is a time of elevated risk from an abusive partner. According to the American College of Obstetricians and Gynecologists (2012), approximately 324,000 pregnant women are abused each year. As discussed in Chapter 47 (p. 925), intimate partner violence has been associated with greater risk for several pregnancy-related complications, including hypertension, vaginal bleeding, hyperemesis, preterm delivery, and low-birthweight neonates (Silverman, 2006). Because domestic violence can escalate during pregnancy, even to the point of homicide, the preconceptional period provides an ideal time for screening and if indicated, intervention (Cheng, 2010). s detailed in Chapter 9 (p. 162), the American College of Obstetricians and Gynecologists (2012) provides recommendations and resources for screening both pregnant and nonpregnant women for domestic violence.
Certain laboratory tests may help assess the risk for and prevent some pregnancy complications. hese include basic tests that are usually performed during prenatal care and are enumerated in Chapter 9. More speciic tests may assist evaluation of women with certain chronic medical diseases. Examples of some chronic diseases that ideally would be assessed before conception are highlighted in Table 8-4. With several of these, optimizing maternal condition before conception will improve pregnancy outcomes. Cox and coworkers (1e992) reviewed pregnancy outcomes in 1075 high-risk women who received such evaluation. hey reported that the 240 women with hypertension, asthma, or renal, thyroid, or cardiac disease had better outcomes compared with the outcomes from their prior pregnancies.
TABLE 8-4. Selected Preconceptional
Methyl mercury: Avoid shark, swordfish, king mackerel, and tile fish. Ingest no more than 12 ounces or 2 servings of canned tuna and no more than 6 ounces of albacore per week.
Lead: Blood lead testing if a risk factor is identified; treat if indicated according to recommendations.
Calculate BMI yearly from Figure 48-1, p. 937
BMI .25 kglm2: Counsel on diet. Test for diabetes and metabolic syndrome if indicated. Consider weight 105s prior to conception.
BMI � 78.5 kglm2: Assess for eating disorder.
Counsel on cardiac risks during pregnancy; discuss situations in which pregnancy is contraindicated.
cardiac function. Discuss medication teratogenicity (warfarin, ACE inh'bitor, ARB) and, if possible, switch to less dangerous agent when conception planned. Ofer genetic counseling to those with congenital cardiac anomalies (Table 49-4, p. 953).