Medical Complications in Pregnancy

Medical complications and intercurrent disease have long presented challenges to obstetricians and other medical providers caring for pregnant women. Contemporary medical practice and treatments have only added to these challenges. Advances in disease management mean that patients with some conditions (e.g., cystic fibrosis) whose life expectancies in the past would have precluded pregnancy are now living to reproductive age. Furthermore, treatments to restore fertility allow the barrier of age, as well as anatomic and genetic barriers, to be surmounted. All of these advances emphasize the need for careful and considered collaboration between clinicians caring for women of reproductive age who are not pregnant and those who care for them during pregnancy. This review discusses pregnancy planning and counseling, principles of teratogenesis, physiologic changes in pregnancy, cardiovascular disease, diabetes mellitus, thyroid disease, thrombophilia, asthma, infectious diseases, renal disease, autoimmune diseases, cancer, neurologic diseases, substance use, intrahepatic cholestasis, and pregnancy-specific conditions. Tables list elements of preconception care and counseling, the Food and Drug Administration drug classification system for pregnancy, selected drugs with suspected or known teratogenic potential, and physiologic changes of pregnancy. This review contains 15 tables and 83 references. Key Words: Headache, maternal mortality, obstetric medicine, pregnancy, pulmonary embolism