Chapter 26: Concurrent Disorders During Pregnancy

Diabetes during pregnancy encompasses three distinct presentations: Type 1 and Type 2 Diabetes Mellitus in patients with established disease, and gestational diabetes mellitus developing specifically in pregnancy due to the diabetogenic effect of placental hormones including human placental lactogen, estrogen, and progesterone that increase maternal insulin resistance to redirect nutrients toward fetal development. Maternal complications of hyperglycemia include ketoacidosis, polyhydramnios, and preeclampsia, while fetal consequences include macrosomia resulting from excessive fetal insulin secretion that promotes growth beyond normal parameters, necessitating careful glycemic control through dietary modification, physical activity, and insulin therapy to prevent neonatal hypoglycemia, hypocalcemia, and respiratory distress syndrome. Cardiovascular disorders present unique challenges because pregnancy increases cardiac output and blood volume substantially, potentially precipitating decompensation in women with rheumatic heart disease, mitral valve prolapse, or structural defects including atrial septal defects and Tetralogy of Fallot, with management guided by New York Heart Association functional classification and vigilant prevention of fluid overload during labor's hemodynamic stress. Hematologic disorders including iron deficiency anemia, folic acid deficiency with associated neural tube defect risk, and sickle cell disease require specialized intervention, with sickle cell disease patients needing aggressive hydration and oxygenation to avert vaso-occlusive crises and placental infarction. Autoimmune conditions such as systemic lupus erythematosus and antiphospholipid syndrome present significant risks for thromboembolism and recurrent pregnancy loss. The chapter concludes by addressing infectious disease management, particularly TORCH pathogens—toxoplasmosis, rubella, cytomegalovirus, and herpes simplex—alongside parvovirus B19 and tuberculosis, with specific emphasis on Group B Streptococcus screening protocols and HIV management incorporating antiretroviral therapy and cesarean delivery to minimize vertical transmission risk to the neonate.