Pregnancy-related complications are high in the U.S., but doctors say women can help themselves
OKLAHOMA CITY, Okla. — Martha Garcia was a healthy 26-year-old when she became pregnant with a baby girl. It was her first pregnancy and she knew her body was undergoing major changes, but she worried even after the doctor said her swollen-like-a-football feet and exhaustion were normal.
Two weeks before her baby was due, Garcia found breathing so hard she felt like she was suffocating. In the emergency room, doctors found her blood pressure was through the roof, she was beginning to bleed and her baby had died, the victim of peripartum cardiomyopathy, a rare complication that results in heart failure and strikes healthy women late in pregnancy or within months after. It most often endangers the moms.
The battle had begun to save Garcia's life. The doctor handling the emergency was frank. Her blood pressure was so high she could have a seizure and she was bleeding uncontrollably. Garcia would be in intensive care and might need a heart transplant, if she survived. The baby she and husband Joseph had named Michelle was gone, but still had to be delivered.
Three years later, as she tells the story from her home in White Sands, N.M., Garcia cries. She was living a truth that's often ignored: Pregnancy can be dangerous. In fact, despite world-class medical care, maternal mortality is high in America compared to many industrialized countries. No single source tracks maternal complications, so the real number is unknown, but experts call it cause for concern. Sometimes, as happens with peripartum cardiomyopathy, a mom can do nothing more than get help when she's in trouble. But much of the time, moms can set the stage for a pregnancy that reduces the risk of complications.
Moving the needle
"The best way to have a healthy pregnancy is to be healthy when you get pregnant," says Dr. Janyne Althaus, a perinatologist at Johns Hopkins. "If you have health issues you have not maintained well, there's higher risk of having problems."
Women with known conditions, like seizure disorders or diabetes, should have them as well-controlled as possible from the beginning of the pregnancy, Althaus said. Any medical condition should prompt discussion with the obstetrician or perinatologist before pregnancy is attempted.
Pregnancy has potential complications even when nothing's already going wrong, Althaus said.
Something like peripartum cardiomyopathy can come unexpectedly, as can hemorrhaging at delivery and immediately after. "Pregnancy brings its own set of surprises and the healthiest women are at risk of some of the complications, including pre-eclampsia," a pregnancy-related hypertension that endangers mother or child, Althaus said.
"We've tried to see if we could predict those more likely to have surprise complications," she said. "We are not able to 100 percent. So knowing someone will surprise us, we try to have plans in place to deal with a crisis."
With all the diligence and effort, she said, "there's not enough data to show we've been able to shift the needle and decrease mortality." Some countries have a uniform reporting system; the United States doesn't. "If you want to solve a problem, you first have to know its scope," Althaus said.
An annual exam is a good time to discuss plans to have children, experts say. It's a chance to address potential challenges, whether they involve medications that aren't pregnancy-friendly, structural issues, maternal age or weight, among others.
"The best thing to do is optimize health and create a perfect environment for baby to grow," Althaus said.
"Obesity is the biggest challenge we're facing," said Dr. Flint Porter, director of Maternal-Fetal Medicine at Intermountain Medical Center in Murray. "We're losing the battle there."
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