While pregnancy is often portrayed as a time of excitement and happiness, many people can actually feel the emotions. However, as doctors, it is difficult to ignore the health risks and fears that some of our most vulnerable patients face in the wake of a positive pregnancy test.
Simply being pregnant poses significant short- and long-term risks to health, especially in the US. We have one of the highest rates of serious pregnancy complications in the developed world, resulting in approximately 700 deaths per year nationally. This health burden is unequally distributed, falling hardest on women of color and low-income women — in fact, black women are three times as likely to die from pregnancy-related complications as white women.
What makes pregnancy challenging from a health perspective?
Pregnancy serves as a continual stress test that taxes body systems and poses unique health risks. It changes how the heart, lungs, and kidneys work. It also alters the immune system, and alters metabolism through effects on various organs. It increases the flow of blood throughout the body. The effect is greater for people who already have high blood pressure, diabetes or other health conditions. Additionally, pregnancy can also exacerbate existing mental health disorders such as depression and anxiety, often exacerbating symptoms.
Two health issues unique to pregnancy are:
- Preeclampsia. This leads to high blood pressure and potential damage to other organs such as the kidneys, liver and brain. Pregnancy alone puts extra strain on the heart and blood vessels. According to the Preeclampsia Foundation, being affected by preeclampsia in pregnancy more than triples the lifetime risk of heart disease such as stroke or heart attack. The biggest risk factors for developing preeclampsia are being younger than 18 or older than 40, having an autoimmune disease (such as lupus), existing high blood pressure, or preeclampsia in a prior pregnancy.
- Excessive bleeding after birth (postpartum haemorrhage). While certain factors put people at higher risk, bleeding can occur with any birth, even in those who carry pregnancies without gestosis.
Often, pregnancy can be safely navigated regardless of a person’s health conditions. Yet having an existing condition such as heart disease or diabetes increases the risk of complications and death. Now that later pregnancies are more common, existing heart disease is complicating more pregnancies. Once rarely needed, large multidisciplinary teams of health professionals are now often required to care for pregnant people with complex cardiac needs or other health conditions.
multiple pregnancies are unexpected
About half of all pregnancies in the United States are unintended. In some cases it means that there is a desire for future pregnancies; In others that pregnancy is not desired.
Why are there so many unwanted pregnancies? Nine out of 10 sexually active women who are not trying to become pregnant report using some form of birth control. Of course, not all types of birth control are highly effective. In one year of use, up to 13 out of 100 people who rely on condoms alone — and up to 23 out of 100 who rely on fertility awareness methods — will become pregnant.
Unintended pregnancies happen even when people use very effective contraceptives. With perfect use (which is very difficult to achieve), less than one in 100 women who take birth control pills for one year will become pregnant. With typical use, seven out of 100 will become pregnant. More than 13 million American women use surgical sterilization, such as tubal ligation, as a permanent form of birth control. Given a failure rate of approximately one in 100, research suggests that as many as 65,000 unintended pregnancies may occur annually following these procedures.
Health factor too. Certain medical conditions or medications, such as those used to treat epilepsy, may also increase the risk of contraceptive failure. Health conditions also determine whether people can use some of the more effective forms of birth control.
contraction of health care options and life choices
Pregnancy, childbirth, and parenting change the trajectories of many lives — parents, siblings, and extended family — even when people choose this path. from June 2022, when dobbs After the Supreme Court decision overturned a national constitutional right to abortion, at least 14 states have banned or severely restricted the ability to choose once pregnant. even before dobbsAbout 10% of people seeking abortion care in the US had to travel out of state.
Research shows that women who seek an abortion but are denied access to abortion care are more likely to have health problems during pregnancy and experience financial difficulties or live in poverty afterward. State restrictions on abortion care would disproportionately affect black and low-income women, who are already at higher risk of childbirth-related complications or death. Ultimately, legislation that limits or restricts comprehensive health care that includes abortion care puts everyone capable of pregnancy at risk medically, economically, and socially.
Like pregnancy itself, the decision to stay pregnant is a very personal one. And as is the case with all health care, patients and physicians should be able to independently consider all medical options to help them make decisions, including whether to terminate a pregnancy. Although abortion care is more restricted today than it was in 1973, options are available and remain an important part of maternal health care.
contraceptive technique21st ed., Managing Contraception LLC. More information is available on the Managing Contraception website.