Professor Leonie Callaway Obstetric and general physician and director of research , women ’ s and newborn services , Royal Brisbane and Women ’ s Hospital ; executive director , women , children and families stream , Metro North Hospital and Health Service District ; professor of medicine , The University of Queensland .

First published online on 21 July 2023

INTRODUCTION

THE scope of medical disorders

in pregnancy is vast and clearly beyond that of a short article providing practical guidance to GPs . For a perspective on the scope of this topic , the curriculum of the Society of Obstetric Medicine of Australia and New Zealand guides physicians who wish to develop expertise in this area . 1

This How to Treat focuses on a series of practical issues that confront GPs on a regular basis and aims to ensure GPs can confidently manage common issues , are aware of the common pitfalls , and have confidence in seeking specialist support .

MEDICAL CONDITIONS PRE- DATING PREGNANCY

THERE is an increasingly diverse range

of women with pre-existing medical disorders who are wishing to become pregnant . There are a range of demographic drivers that have led to this .

Women are older when they consider having children , which is associated with age-related phenomena such as increased rates of hypertension , glucose intolerance or diabetes , cardiovascular disease and cancer . Women who were born with congenital anomalies , had childhood illnesses , or have had serious adult illness are likely to have benefited from major advances in medical care , and are more likely to be in a position to consider having a baby at all . Examples of this include the increasing numbers of women with congenital heart disease , cystic fibrosis and autoimmune disease who present for pregnancy care .

In general , medicine has become less paternalistic , and more focused on women ’ s autonomy , thus enabling women to make decisions about the risks they are willing to take to have babies . Another significant driver is that women have more access to fertility services , which increases the number of women who are conceiving in the context of chronic disease .

PRECONCEPTION CARE

IDEALLY , all women with medical

disorders before pregnancy require preconception care . There is a clear evidence base for this , particularly in relation to pre-existing diabetes . 2

Preconception care for women with medical disorders that predate pregnancy needs to focus on several issues .

Don ’ t forget the basics

In all the complexity of women

planning conception in the context of pre-existing medical disorders , it is easy to forget routine pregnancy planning . These women need the usual preconception care that is required for all women . Ensure they are fully vaccinated , that cervical screening tests are up to date and they are advised regarding folic acid and iodine supplementation for at least three months before pregnancy . Consider healthy lifestyle ( nutrition , smoking , alcohol , physical activity , drugs ), ensure screening

blood tests are undertaken , that the risk of sexually transmitted diseases and need for viral serology has been considered . Other issues that are important include avoidance of occupational exposure to toxic chemicals , avoidance of environmental hazards , diabetes and hypertension screening , anaemia screening , early identification and support for domestic violence , mental health screening , oral health review and a review of all prescription and non-prescription drugs . 3

Health assessment

Carefully consider the medical disorder

. As a general principle , before conception it is ideal for a medical disorder to be stable and well managed . Perform a risk – benefit assessment about drug use during pregnancy ; some medications need to be ceased or changed before conception . Should there be any concern about this , seek specialist physician or specialist obstetric