Pregnancy is often portrayed as a time of joy and happiness, which many people can relate to. As doctors, it is difficult to ignore the health risks and fears that can arise after a positive pregnancy test for some of our vulnerable patients.
Pregnancy carries both short-term and long-term health risks, especially in the US. We have the worst pregnancy-related problem among the developed world, resulting in nearly 700 deaths each year across the country. This health burden is disproportionately distributed, falling most heavily on women of color and low-income women—in fact, black women are three times more likely to die than white women from pregnancy-related complications.
What makes pregnancy difficult from a health perspective?
Pregnancy is like a constant experiment that taxes the body’s systems and creates unique risks. It changes the way the heart, lungs, and kidneys work. It also improves the immune system, and changes the metabolism through the actions of different organs. It increases blood flow throughout the body. The results are great for anyone who already has high blood pressure, diabetes, or other diseases. In addition, pregnancy can also exacerbate existing psychological problems such as depression and anxiety, which often exacerbate symptoms.
There are two types of diseases in pregnancy:
- Preeclampsia. This causes high blood pressure and damage to other organs, such as the kidneys, liver, and brain. Pregnancy itself puts extra stress on the heart and blood vessels. Having a pregnancy affected by preeclampsia more than triples a person’s lifetime risk of developing cardiovascular disease such as stroke or heart disease, according to the Preeclampsia Foundation. The main risk factors for preeclampsia are being younger than 18 or older than 40, an autoimmune disease (such as lupus), existing high blood pressure, or preeclampsia during pregnancy.
- Heavy bleeding after birth (postpartum bleeding). Although some factors put people at greater risk, bleeding can occur with any birth, even after an uncomplicated pregnancy.
In most cases, pregnancy can go well even if a person is healthy. However, having a pre-existing condition such as heart disease or diabetes increases the risk of complications and death. Since middle age is more common, pre-existing heart disease complicates many pregnancies. Rarely needed, large multidisciplinary teams are now required to care for pregnant patients with heart problems or other illnesses.
Most pregnancies are unplanned
About half of all pregnancies in the United States are unplanned. Sometimes this means that pregnancy is wanted in the future; some that pregnancy is not wanted.
Why do so many unplanned pregnancies happen? Nine (9) out of ten (10) sexually active women who are not trying to conceive report using birth control. It is true that not all types of birth control are effective. Within one year of use, 13 percent of those who rely on condoms alone—and 23 percent of those who rely on public birth control methods—will become pregnant.
Unplanned pregnancies occur even when people use the most effective birth control methods. With proper use (which is difficult to achieve), at least one in 100 women who take birth control pills for a year will become pregnant. With regular use, seven out of every 100 will become pregnant. More than 13 million US women use birth control, such as tubal ligation, as a permanent method of birth control. Taking into account the failure rate of about one in 100, studies show that more than 65,000 pregnancies can occur every year after this procedure.
Health is also dependent. Certain diseases or medications, such as drugs used to treat epilepsy, can also increase the risk of infertility. Health also determines whether people can use more effective birth control methods.
Limiting health decisions and lifestyle choices
Pregnancy, childbirth, and parenting change the course of many lives—parents, siblings, and families—even when people choose this path. From June 2022, when a Dobbs The Supreme Court’s ruling has ended the universal right to abortion, with nearly 14 states banning or severely restricting the ability to choose a person during pregnancy. Even before Dobbsabout 10% of abortion seekers in the US had to leave the state.
Studies have shown that women who have abortions but are not allowed to have abortions often have health problems during pregnancy and experience economic hardship or poverty years later. State restrictions on abortion care will especially affect black and low-income women, who are at the highest risk of complications or death related to childbirth. Ultimately, laws that restrict or restrict comprehensive health care that includes abortion care put all pregnant women at risk – medically, economically, and socially.
Like pregnancy itself, the decision to remain pregnant is a personal one. And as with medical care, patients and doctors should freely consider all medical options to help guide decisions, including termination of pregnancy. Although abortion care is more restricted today than it has been since 1973, options exist and remain an important part of maternal care.
The tool of choice
Reproductive Technology, 21st edition, Managing Contraception LLC. More information is available on the Managing Contraception website.