Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations

Cardiovascular considerations receive substantial attention, as pregnancy-induced changes in blood volume and cardiac output place women with existing heart disease at heightened risk for maternal decompensation and adverse fetal outcomes. The chapter systematically reviews chronic medical conditions affecting pregnant patients, including sustained hypertension, respiratory disorders such as asthma and tuberculosis, and various hematologic conditions ranging from iron-deficiency anemia to hemoglobinopathies like thalassemia and sickle cell disease, each requiring specialized monitoring and intervention strategies. Autoimmune disorders including systemic lupus erythematosus, multiple sclerosis, and rheumatoid arthritis are examined for their disease-modifying effects during pregnancy and implications for pharmacologic management. Infectious disease complications are thoroughly covered, emphasizing vertical transmission pathways and teratogenic risks associated with cytomegalovirus, herpes simplex virus, group B streptococcus, toxoplasmosis, and human immunodeficiency virus. The chapter concludes by addressing vulnerable pregnant populations whose circumstances create additional physiological and psychosocial challenges, including adolescent pregnancy with its developmental implications, advanced maternal age with associated chromosomal risks, obesity-related metabolic complications, and substance use disorders with particular emphasis on the neurological consequences of fetal alcohol spectrum disorder and the neonatal complications of abstinence syndrome. Throughout, the chapter integrates evidence-based nursing assessment, risk stratification, and individualized care planning to optimize maternal-fetal outcomes across diverse clinical presentations.