Pregnancy is often portrayed as a time of elation and joy, emotions many people can indeed feel. However, as physicians, it’s hard to ignore the health risks and fears that can arise after a positive pregnancy test for some of our most vulnerable patients.
Simply being pregnant carries significant short- and long-term health risks, especially in the US. We have the highest rate of serious pregnancy-related complications among developed countries, resulting in approximately 700 deaths per year nationally. This health burden is unevenly distributed and falls hardest on women of color and low-income women — in fact, black women are three times more likely than white women to die from pregnancy-related complications.
What makes pregnancy a challenge from a health perspective?
Pregnancy acts as a constant stress test that strains body systems and poses unique health risks. It changes how the heart, lungs and kidneys function. It also alters the immune system and alters metabolism through effects on various organs. It increases blood flow throughout the body. The impact is greater for anyone who already has high blood pressure, diabetes or other health conditions. In addition, pregnancy can also exacerbate existing mental health disorders, such as depression and anxiety, often exacerbating symptoms.
Two health problems unique to pregnancy are:
- Preeclampsia. This causes high blood pressure and possible damage to other organs, such as the kidneys, liver and brain. Pregnancy alone puts additional stress on the heart and blood vessels. According to the Preeclampsia Foundation, having a pregnancy from preeclampsia more than triples the lifetime risk of cardiovascular disease such as stroke or heart attack. The biggest risk factors for developing preeclampsia are being younger than 18 or older than 40, autoimmune disease (such as lupus), existing high blood pressure, or preeclampsia during a previous pregnancy.
- Excessive bleeding after birth (postpartum bleeding). While certain factors put people at higher risk, bleeding can occur with any birth, even after uncomplicated pregnancies.
Most of the time, pregnancy can be safely navigated even if a person has health problems. Still, having an existing condition such as heart disease or diabetes increases the risk of complications and death. With pregnancies becoming more common later in life, pre-existing heart disease complicates 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 concerns.
Many pregnancies are unintended
Nearly half of all pregnancies in the United States are unintended. In some cases, this means that a pregnancy is desired at a later date; in others that a pregnancy is not desired.
Why do so many unintended pregnancies happen? Nine out of 10 sexually active women who are not trying to conceive use some form of contraception. Of course, not all types of birth control are very effective. In a year of use, 13 out of 100 people who rely on condoms alone — and up to 23 out of 100 who rely on fertility awareness methods — will get pregnant.
Unwanted pregnancies happen even when people use highly effective contraceptives. With perfect use (which is very difficult to achieve), less than one in 100 women who take birth control pills for a year will get pregnant. With normal use, seven out of 100 become pregnant. More than 13 million American women use surgical sterilization, such as tubal ligation, as a permanent form of birth control. Given the failure rate of nearly one in 100, research suggests that more than 65,000 unintended pregnancies may occur each year following these procedures.
Health factors also play a role. Certain medical conditions or medications, such as those used to treat epilepsy, can also increase your risk of birth control failure. Health conditions also determine whether people can use some of the more effective forms of birth control.
A narrowing of healthcare choices and life choices
Pregnancy, childbirth, and parenthood change the trajectory of many lives — parents, siblings, and the rest of the family — even when people choose this path. Since June 2022, when the Dobbs A Supreme Court decision overturned a national constitutional right to abortion, at least 14 states have banned or severely limited the ability to make choices after pregnancy. Even before Dobbsnearly 10% of people seeking abortion care in the US had to travel abroad.
Research shows that women who want an abortion but do not receive abortion care are more likely to have health problems during their pregnancy and to experience financial difficulties or poverty years later. State bans on abortion care will disproportionately impact black and low-income women, who are already at higher risk for complications or death related to childbirth. Ultimately, legislation that limits or prohibits comprehensive health care, including abortion care, puts all people capable of pregnancy at risk — medically, economically, and socially.
Like the pregnancy itself, the decision to stay pregnant is very personal. And as with all health care, patients and doctors should be free to consider all medical options to help make decisions, including terminating a pregnancy. While abortion care is more limited today than it has been since 1973, options are available and remain an essential part of maternal health care.
Contraceptive technology, 21st Edition, Managing Antiception LLC. More information is available on the Managing Antiception website.