Complications of pregnancy

The following problems originate in the mother, however, they may have serious consequences for the fetus as well.

Gestational diabetes is when a woman, without a previous diagnosis of diabetes, develops high blood sugar levels during pregnancy.{{Cite web|url=https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications|title=Pregnancy complications |website=womenshealth.gov|access-date=2018-11-07|date=2016-12-14}} There are many non-modifiable and modifiable risk factors that lead to the development of this complication. Non-modifiable risk factors include a family history of diabetes, advanced maternal age, and ethnicity. Modifiable risk factors include maternal obesity.{{cite journal | vauthors = Lende M, Rijhsinghani A | title = Gestational Diabetes: Overview with Emphasis on Medical Management | journal = International Journal of Environmental Research and Public Health | volume = 17 | issue = 24 | pages = 9573 | date = December 2020 | pmid = 33371325 | pmc = 7767324 | doi = 10.3390/ijerph17249573 | doi-access = free }} There is an elevated demand for insulin during pregnancy which leads to increased insulin production from pancreatic beta cells. The elevated demand results from increased maternal calorie intake, weight gain, and increased prolactin and growth hormone production. Gestational diabetes increases the risk for further maternal and fetal complications such as the development of pre-eclampsia, the need for cesarean delivery, preterm delivery, polyhydramnios, macrosomia, shoulder dystocia, fetal hypoglycemia, hyperbilirubinemia, and admission into the neonatal intensive care unit. The increased risk is correlated with how well the gestational diabetes is controlled during pregnancy, with poor control associated with worsened outcomes. A multidisciplinary approach is used to treat gestational diabetes. It involves monitoring blood-glucose levels, nutritional and dietary modifications, lifestyle changes such as increasing physical activity, maternal weight management, and medication such as insulin.

Hyperemesis gravidarum is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is similar, although more severe than the common morning sickness.{{cite journal | vauthors = Summers A | title = Emergency management of hyperemesis gravidarum | journal = Emergency Nurse | volume = 20 | issue = 4 | pages = 24–28 | date = July 2012 | pmid = 22876404 | doi = 10.7748/en2012.07.20.4.24.c9206 }}{{cite journal | vauthors = Goodwin TM | title = Hyperemesis gravidarum | journal = Obstetrics and Gynecology Clinics of North America | volume = 35 | issue = 3 | pages = 401–17, viii | date = September 2008 | pmid = 18760227 | doi = 10.1016/j.ogc.2008.04.002 }} It is estimated to affect 0.3–3.6% of pregnant women and is the greatest contributor to hospitalizations under 20 weeks of gestation. Most often, nausea and vomiting symptoms during pregnancy are resolved in the first trimester; however, some continue to experience symptoms. Hyperemesis gravidarum is diagnosed by the following criteria: greater than 3 vomiting episodes per day, ketonuria, and weight loss of more than 3 kg or 5% of body weight. Several non-modifiable and modifiable risk factors predispose women to the development of this condition, such as a female fetus, psychiatric illness history, high or low BMI pre-pregnancy, young age, African American or Asian ethnicity, type I diabetes, multiple pregnancies, and a history of pregnancy affected by hyperemesis gravidarum. There are currently no known mechanisms for the cause of this condition. This complication can cause nutritional deficiency, low pregnancy weight gain, dehydration, and vitamin, electrolyte, and acid-based disturbances in the mother. It has been shown to cause low birth weight, small size for gestational age, preterm birth, and poor APGAR scores in the infant. Treatments for this condition focus on preventing harm to the fetus while improving symptoms and commonly include fluid replacement and consumption of small, frequent, bland meals. First-line treatments include ginger and acupuncture. Second-line treatments include vitamin B₆ +/- doxylamine, antihistamines, dopamine antagonists, and serotonin antagonists. Third-line treatments include corticosteroids, transdermal clonidine, and gabapentin. Treatments chosen are dependent on the severity of symptoms and response to therapies.{{cite journal | vauthors = Austin K, Wilson K, Saha S | title = Hyperemesis Gravidarum | journal = Nutrition in Clinical Practice | volume = 34 | issue = 2 | pages = 226–241 | date = April 2019 | pmid = 30334272 | doi = 10.1002/ncp.10205 | s2cid = 52987088 }}

Pelvic girdle pain (PGP) disorder is pain in the area between the posterior iliac crest and gluteal fold, beginning peri or postpartum caused by instability and limitation of mobility. It is associated with pubic symphysis pain and sometimes radiation of pain down the hips and thighs. For most pregnant individuals, PGP resolves within three months following delivery, but for some, it can last for years, resulting in a reduced tolerance for weight-bearing activities. PGP affects around 45% of individuals during pregnancy: 25% report serious pain, and 8% are severely disabled.{{cite journal | vauthors = Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI, Ostgaard HC | title = Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence | journal = European Spine Journal | volume = 13 | issue = 7 | pages = 575–589 | date = November 2004 | pmid = 15338362 | pmc = 3476662 | doi = 10.1007/s00586-003-0615-y }}{{cite journal | vauthors = Walters C, West S, A Nippita T | title = Pelvic girdle pain in pregnancy | journal = Australian Journal of General Practice | volume = 47 | issue = 7 | pages = 439–443 | date = July 2018 | pmid = 30114872 | doi = 10.31128/AJGP-01-18-4467 | s2cid = 52018638 | doi-access = free }} Risk factors for complication development include multiparity, increased BMI, physically strenuous work, smoking, distress, history of back and pelvic trauma, and previous history of pelvic and lower back pain. This syndrome results from a growing uterus during pregnancy that causes increased stress on the lumbar and pelvic regions of the mother, thereby resulting in postural changes and reduced lumbopelvic muscle strength, leading to pelvic instability and pain. It is unclear whether specific hormones in pregnancy are associated with complication development. PGP can result in poor quality of life, predisposition to chronic pain syndrome, extended leave from work, and psychosocial distress. Many treatment options are available based on symptom severity. Non-invasive treatment options include activity modification, pelvic support garments, analgesia with or without short periods of bed rest, and physiotherapy to increase the strength of gluteal and adductor muscles, reducing stress on the lumbar spine. Invasive surgical management is considered a last-line treatment if all other treatment modalities have failed and symptoms are severe.

{{Main|Hypertensive disease of pregnancy}}

Potential severe hypertensive states of pregnancy are mainly:

• Pre-eclampsia – gestational hypertension, proteinuria (>300 mg), and edema. Severe pre-eclampsia involves a BP over 160/110 (with additional signs). It affects 5–8% of pregnancies.{{cite book | vauthors = Villar J, Say L, Gulmezoglu AM, Meraldi M, Lindheimer MD, Betran AP, Piaggio G | chapter = Eclampsia and pre-eclampsia: a health problem for 2000 years. | title = Pre-eclampsia | veditors = Critchly H, MacLean A, Poston L, Walker J | location = London | publisher = RCOG Press | date = 2003 | pages = 189–207 }}
• Eclampsia – seizures in a pre-eclamptic patient, affecting around 1.4% of pregnancies.{{cite journal | vauthors = Abalos E, Cuesta C, Grosso AL, Chou D, Say L | title = Global and regional estimates of preeclampsia and eclampsia: a systematic review | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 170 | issue = 1 | pages = 1–7 | date = September 2013 | pmid = 23746796 | doi = 10.1016/j.ejogrb.2013.05.005 }}
• Gestational hypertension can develop after 20 weeks but has no other symptoms and may resolve itself, but it can develop into pre-eclampsia.{{cite web |title=High Blood Pressure in Pregnancy |url=https://medlineplus.gov/highbloodpressureinpregnancy.html |website=medlineplus.gov |access-date=28 September 2022}}
• HELLP syndrome – Hemolytic anemia, elevated liver enzymes and a low platelet count. Incidence is reported as 0.5–0.9% of all pregnancies.{{cite journal | vauthors = Haram K, Svendsen E, Abildgaard U | title = The HELLP syndrome: clinical issues and management. A Review | journal = BMC Pregnancy and Childbirth | volume = 9 | pages = 8 | date = February 2009 | pmid = 19245695 | pmc = 2654858 | doi = 10.1186/1471-2393-9-8 | url = http://www.biomedcentral.com/content/pdf/1471-2393-9-8.pdf | url-status = live | archive-url = https://web.archive.org/web/20111112031619/http://www.biomedcentral.com/content/pdf/1471-2393-9-8.pdf | archive-date = 2011-11-12 | doi-access = free }}
• Acute fatty liver of pregnancy is sometimes included in the pre-eclamptic spectrum. It occurs in approximately one in 7,000 to one in 15,000 pregnancies.{{cite journal | vauthors = Mjahed K, Charra B, Hamoudi D, Noun M, Barrou L | title = Acute fatty liver of pregnancy | journal = Archives of Gynecology and Obstetrics | volume = 274 | issue = 6 | pages = 349–353 | date = October 2006 | pmid = 16868757 | doi = 10.1007/s00404-006-0203-6 | s2cid = 24784165 }}{{cite journal | vauthors = Reyes H, Sandoval L, Wainstein A, Ribalta J, Donoso S, Smok G, Rosenberg H, Meneses M | display-authors = 6 | title = Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients | journal = Gut | volume = 35 | issue = 1 | pages = 101–106 | date = January 1994 | pmid = 8307428 | pmc = 1374642 | doi = 10.1136/gut.35.1.101 }}

Women who have chronic hypertension before their pregnancy are at increased risk of complications such as premature birth, low birthweight, or stillbirth.{{cite journal | vauthors = Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS | title = Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis | journal = Journal of the American Heart Association | volume = 10 | issue = 9 | pages = e018494 | date = May 2021 | pmid = 33870708 | pmc = 8200761 | doi = 10.1161/JAHA.120.018494 }} Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing cardiovascular disease compared to women with normal blood pressure who had no complications in pregnancy. Monitoring pregnant women's blood pressure can help prevent both complications and future cardiovascular diseases.{{Cite journal |date=2023-11-21 |title=Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure |url=https://evidence.nihr.ac.uk/alert/pregnancy-complications-increase-the-risk-of-heart-attacks-and-stroke-in-women-with-high-blood-pressure/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60660|s2cid=265356623 |url-access=subscription }}{{cite journal | vauthors = Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O'Reilly ÉJ | title = Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes | journal = Hypertension | volume = 80 | issue = 7 | pages = 1427–1438 | date = July 2023 | pmid = 37170819 | doi = 10.1161/HYPERTENSIONAHA.122.20628 | doi-access = free }}

Venous thromboembolism, consisting of deep vein thrombosis and pulmonary embolism, is a major risk factor for postpartum morbidity and mortality, especially in highly developed countries. A combination of pregnancy-exacerbated hypercoagulability and additional risk factors such as obesity and thrombophilias makes pregnant women vulnerable to thrombotic events{{Cite journal |last1=Sarkar |first1=Monika |last2=Brady |first2=Carla W. |last3=Fleckenstein |first3=Jaquelyn |last4=Forde |first4=Kimberly A. |last5=Khungar |first5=Vandana |last6=Molleston |first6=Jean P. |last7=Afshar |first7=Yalda |last8=Terrault |first8=Norah A. |date=January 2021 |title=Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases |url=https://journals.lww.com/10.1002/hep.31559 |journal=Hepatology |language=en |volume=73 |issue=1 |pages=318–365 |doi=10.1002/hep.31559 |pmid=32946672 |issn=0270-9139}} The prophylactic measures that include the usage of low molecular weight heparin can significantly reduce risks associated with surgery, particularly in high-risk patients. Awareness among healthcare givers and prompt response in early identification and management of venous thromboembolism during pregnancy and the postpartum period are both crucial for prompt response. Deep vein thrombosis, a form of venous thromboembolism, has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death in developed countries after bleeding.Venös tromboembolism (VTE) – Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008

• Caused by: Pregnancy-induced hypercoagulability as a physiological response in preparation for the potential bleeding during childbirth.
• Treatment: Prophylactic treatment, e.g., with low molecular weight heparin may be indicated when additional risk factors for deep vein thrombosis are present.

{{main|Anemia in pregnancy}}

Anemia is a globally recognized pregnancy complication and is a condition with a low hemoglobin level in one of the trimesters. Such physiological modifications are more pronounced among individuals who suffer from undernutrition as well as chronic diseases associated with hemoglobin rehoming, like sickle cell anemia. Prevention of anemia during pregnancy is complicated and is often treated by a team effort of dietary supplementation, iron therapy, and continuous assessment of mother and fetal indices in a multidisciplinary approach.{{Cite journal |last1=Taher |first1=Ali T. |last2=Iolascon |first2=Achille |last3=Matar |first3=Charbel F. |last4=Bou-Fakhredin |first4=Rayan |last5=de Franceschi |first5=Lucia |last6=Cappellini |first6=Maria Domenica |last7=Barcellini |first7=Wilma |last8=Russo |first8=Roberta |last9=Andolfo |first9=Immacolata |last10=Tyan |first10=Paul |last11=Gulbis |first11=Beatrice |last12=Aydinok |first12=Yesim |last13=Anagnou |first13=Nicholas P. |last14=Bencaiova |first14=Gabriela Amstad |last15=Tamary |first15=Hannah |date=August 2020 |title=Recommendations for Pregnancy in Rare Inherited Anemias |journal=HemaSphere |language=en-US |volume=4 |issue=4 |pages=e446 |doi=10.1097/HS9.0000000000000446 |pmid=32885142 |pmc=7437563 |issn=2572-9241}} As an additional measure, emphasis is placed on the astute determination of the respective triggering points, and the application of optimal prenatal care to better maternal and fetal outcome.

Levels of hemoglobin are lower in the third trimester. According to the United Nations (UN) estimates, approximately half of pregnant individuals develop anemia worldwide. Approximately half of pregnant women experience iron deficiency with or without anemia.{{cite journal |last1=Benson |first1=AE |last2=Shatzel |first2=JJ |last3=Ryan |first3=KS |last4=Hedges |first4=MA |last5=Martens |first5=K |last6=Aslan |first6=JE |last7=Lo |first7=JO |title=The incidence, complications, and treatment of iron deficiency in pregnancy |journal=European Journal of Haemotology |date=December 2022 |volume=109 |issue=6 |pages=633–642 |doi=10.1111/ejh.13870 |pmid=36153674 |pmc=9669178 }} Anemia prevalence during pregnancy differed from 18% in developed countries to 75% in South Asia; culminating to a global rate of 38% of pregnancies worldwide.{{cite book |vauthors=Wang S, An L, Cochran SD |chapter=Women |veditors=Detels R, McEwen J, Beaglehole R, Tanaka H |title=Oxford Textbook of Public Health |publisher=Oxford University Press |year=2002 |pages=1587–601 |edition=4th}}

Treatment varies due to the severity of the anaemia, and can be used by increasing iron-containing foods, oral iron tablets, or by the use of parenteral iron.

{{Main|Susceptibility and severity of infections in pregnancy}}Pregnancy is a critical period for the expectant mom to experience additional dangers associated with infections. Moreover, a mother and baby's health is exposed to danger when she is in this condition. The prenatal physiology complexity and immunity modulation inherently increase the risk of influenza, hepatitis E, and cytomegalovirus transmission.https://www.cell.com/immunity/pdf/S1074-7613(22)00184-4.pdf {{Bare URL PDF|date=August 2024}} Avoidance actions like vaccines and strict infectious control protocols can be given priority in the policies aimed at limiting the risk of transmission among high-risk populations. In addition, early diagnosis and management of maternal infections are among the main methods to prevent vertical transmission and fetal aberrations.{{Further | Neonatal infection}}

A pregnant woman is more susceptible to certain infections. This increased risk is caused by an increased immune tolerance in pregnancy to prevent an immune reaction against the fetus, as well as secondary to maternal physiological changes including a decrease in respiratory volumes and urinary stasis due to an enlarging uterus.{{cite journal | vauthors = Kourtis AP, Read JS, Jamieson DJ | title = Pregnancy and infection | journal = The New England Journal of Medicine | volume = 370 | issue = 23 | pages = 2211–2218 | date = June 2014 | pmid = 24897084 | pmc = 4459512 | doi = 10.1056/NEJMra1213566 }} Pregnant individuals are more severely affected by, for example, influenza, hepatitis E, herpes simplex and malaria. The evidence is more limited for coccidioidomycosis, measles, smallpox, and varicella. Mastitis, or inflammation of the breast, occurs in 20% of lactating individuals.{{cite journal | vauthors = Kaufmann R, Foxman B | title = Mastitis among lactating women: occurrence and risk factors | journal = Social Science & Medicine | volume = 33 | issue = 6 | pages = 701–705 | year = 1991 | pmid = 1957190 | doi = 10.1016/0277-9536(91)90024-7 | hdl-access = free | hdl = 2027.42/29639 }}

Some infections are vertically transmissible, meaning that they can affect the child as well.{{cite web |title=What infections can affect pregnancy? |url=https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/infections |website=NIH |date=27 April 2021 |access-date=March 6, 2023}}

Peripartum cardiomyopathy is a heart failure caused by a decrease in left ventricular ejection fraction (LVEF) to <45%, which occurs towards the end of pregnancy or a few months postpartum. Symptoms include shortness of breath in various positions and/or with exertion, fatigue, pedal edema, and chest tightness. Risk factors associated with the development of this complication include maternal age over 30 years, multi-gestational pregnancy, family history of cardiomyopathy, previous diagnosis of cardiomyopathy, pre-eclampsia, hypertension, and African ancestry. The pathogenesis of peripartum cardiomyopathy is not yet known, however, it is suggested that multifactorial potential causes could include autoimmune processes, viral myocarditis, nutritional deficiencies, and maximal cardiovascular changes, which increase cardiac preload. Peripartum cardiomyopathy can lead to many complications such as cardiopulmonary arrest, pulmonary edema, thromboembolisms, brain injury, and death. Treatment of this condition is very similar to treatment of non-gravid heart failure patients, however, the safety of the fetus must be prioritized. For example, for anticoagulation due to increased risk for thromboembolism, low molecular weight heparin, which is safe for use during pregnancy, is used instead of warfarin, which crosses the placenta.{{cite journal | vauthors = Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U | title = Peripartum Cardiomyopathy: JACC State-of-the-Art Review | journal = Journal of the American College of Cardiology | volume = 75 | issue = 2 | pages = 207–221 | date = January 2020 | pmid = 31948651 | doi = 10.1016/j.jacc.2019.11.014 | s2cid = 210701262 | doi-access = free }}

{{Main | Thyroid disease in women}}

Hypothyroidism (commonly caused by Hashimoto's disease) is an autoimmune disease that affects the thyroid by causing low thyroid hormone levels. Symptoms of hypothyroidism can include low energy, cold intolerance, muscle cramps, constipation, and memory and concentration problems.{{Cite web |title=Thyroid Disease & Pregnancy {{!}} NIDDK |url=https://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease |access-date=2022-03-12 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}} It is diagnosed by the presence of elevated levels of thyroid stimulation hormone or TSH. Patients with elevated TSH and decreased levels of free thyroxine or T4 are considered to have overt hypothyroidism. Those with elevated TSH and normal levels of free T4 are considered to have subclinical hypothyroidism.{{cite journal | vauthors = Sullivan SA | title = Hypothyroidism in Pregnancy | journal = Clinical Obstetrics and Gynecology | volume = 62 | issue = 2 | pages = 308–319 | date = June 2019 | pmid = 30985406 | doi = 10.1097/GRF.0000000000000432 | s2cid = 115198534 }} Risk factors for developing hypothyroidism during pregnancy include iodine deficiency, history of thyroid disease, visible goiter, hypothyroidism symptoms, family history of thyroid disease, history of type 1 diabetes or autoimmune conditions, and history of infertility or fetal loss. Various hormones during pregnancy affect the thyroid and increase thyroid hormone demand. For example, during pregnancy, there is increased urinary iodine excretion as well as increased thyroxine binding globulin and thyroid hormone degradation, which all increase thyroid hormone demands.{{cite journal | vauthors = Taylor PN, Lazarus JH | title = Hypothyroidism in Pregnancy | journal = Endocrinology and Metabolism Clinics of North America | volume = 48 | issue = 3 | pages = 547–556 | date = September 2019 | pmid = 31345522 | doi = 10.1016/j.ecl.2019.05.010 | series = Pregnancy and Endocrine Disorders | s2cid = 71053515 | url = https://orca.cardiff.ac.uk/id/eprint/129120/1/Hypothyroidism%20in%20Pregnancy%20submissionORCA.pdf }} This condition can have a profound effect on the mother and fetus during pregnancy. The infant may be seriously affected and have a variety of birth defects. Complications in the mother and fetus can include pre-eclampsia, anemia, miscarriage, low birth weight, stillbirth, congestive heart failure, impaired neurointellectual development, and, if severe, congenital iodine deficiency syndrome. This complication is treated by iodine supplementation, levothyroxine, which is a form of thyroid hormone replacement, and close monitoring of thyroid function.

Acute fatty liver of pregnancy (ALFP) is a rare but serious complication of pregnancy that can result in extensive morbidity or mortality to the mother and fetus. AFLP happens when fat builds up inside the liver. It is thought to be caused by build up of fat cells within the micro vesicular of live cells due to mitochondrial dysfunction in fat break down (fatty acid β-oxidation). This can prevent the liver from working functioning normally, however its exact mechanism is not clearly understood.{{Cite journal |last1=Liu |first1=Joy |last2=Ghaziani |first2=Tara T |last3=Wolf |first3=Jacqueline L |date=June 2017 |title=Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management |url=https://journals.lww.com/00000434-201706000-00011 |journal=American Journal of Gastroenterology |language=en |volume=112 |issue=6 |pages=838–846 |doi=10.1038/ajg.2017.54 |pmid=28291236 |issn=0002-9270|url-access=subscription }} Diagnosis is supported by abnormal ultrasound findings of the liver or microvascular fatty infiltration of biopsy of the liver. AFLP may cause symptoms of excessive fatigue, vomiting, stomach pain, or jaundice. Individuals may also have low blood sugar, trouble thinking clearly, or bleeding problems.

Summary of signs  and symptoms

•      Vomiting
•      Abdominal pain
•      Excessive thirst/urination
•      Encephalopathy

AFLP is a medical emergency and requires urgent delivery. Children of mothers with ALFP be at risk of low blood sugar, dilated cardiomyopathy, neuromyopathy and sudden infant death syndrome.{{Cite journal |last1=Nelson |first1=David B. |last2=Byrne |first2=John J. |last3=Cunningham |first3=F. Gary |date=March 2020 |title=Acute Fatty Liver of Pregnancy |url=https://journals.lww.com/10.1097/GRF.0000000000000494 |journal=Clinical Obstetrics & Gynecology |language=en |volume=63 |issue=1 |pages=152–164 |doi=10.1097/GRF.0000000000000494 |pmid=31725416 |issn=0009-9201|url-access=subscription }}{{Cite journal |last1=Nelson |first1=David B. |last2=Byrne |first2=John J. |last3=Cunningham |first3=F. Gary |date=March 2021 |title=Acute Fatty Liver of Pregnancy |url=https://journals.lww.com/10.1097/AOG.0000000000004289 |journal=Obstetrics & Gynecology |language=en |volume=137 |issue=3 |pages=535–546 |doi=10.1097/AOG.0000000000004289 |pmid=33543900 |issn=0029-7844|url-access=subscription }}

Swansea Criteria for the diagnosis of AFLP. The presence of ≥6 abnormal variables had positive predictive value of 85% and negative predictive value of 100 percent for finding microvascular steatosis:{{Cite journal |last1=Desai |first1=Anshuman |last2=McNair |first2=Jasmine |last3=Ebiai |first3=Ruona |last4=Bzowej |first4=Natalie |date=October 2024 |title=S4161 A Rare Case of Postpartum Acute Fatty Liver of Pregnancy |url=https://journals.lww.com/10.14309/01.ajg.0001046012.65455.9c |journal=American Journal of Gastroenterology |language=en |volume=119 |issue=10S |pages=S2688–S2689 |doi=10.14309/01.ajg.0001046012.65455.9c |issn=0002-9270|url-access=subscription }}

AFLP can lead to acute liver failure. Acute liver failure is a medical emergency and prompt recognition and treatment with dialysis, delivery and other supportive measures have showed to decrease risk of both maternal and fetal complications.{{Cite journal |last1=Paulina |first1=Banach |last2=Kuczkowska |first2=Justyna |last3=Areshchanka |first3=Yulia |last4=Banach |first4=Weronika |last5=Rzepka |first5=Jakub |last6=Kudliński |first6=Bartosz |last7=Rzepka |first7=Rafał |date=2025-03-17 |title=Acute Liver Failure During Early Pregnancy—Case Report and Review of Literature |journal=Journal of Clinical Medicine |language=en |volume=14 |issue=6 |pages=2028 |doi=10.3390/jcm14062028 |doi-access=free |issn=2077-0383 |pmc=11942626 |pmid=40142836}}

The following problems occur in the fetus or placenta, but may have serious consequences on the mother as well.

Ectopic pregnancy is implantation of the embryo outside the uterus. This form of complicated pregnancy, which is an implantation of a normally fertilized egg at any spot other than the uterus, involves operation failure, which can cause life-threatening conditions. However, the underlying reasons for this are not exactly known. This phenomenon is often accompanied by Pelvic inflammatory disease (PID), or salpingectomy (surgery).

• Caused by: Unknown, but risk factors include smoking, advanced maternal age, and prior surgery or trauma to the fallopian tubes.
• Risk factors include untreated pelvic inflammatory disease, likely due to fallopian tube scarring.{{cite journal | vauthors = Lemire F | title = [Not Available] | journal = Canadian Family Physician | volume = 67 | issue = 10 | pages = 791 | date = October 2021 | pmid = 34649907 | pmc = 8516186 | doi = 10.46747/cfp.6710791 | s2cid = 238861265 | doi-access = free }}
• Treatment: In most cases, keyhole surgery must be carried out to remove the fetus, along with the fallopian tube. If the pregnancy is very early, it may resolve on its own, or it can be treated with methotrexate, an abortifacient.{{Cite web|url=http://www.nhs.uk/conditions/ectopic-pregnancy/pages/treatment.aspx|title=Ectopic pregnancy – Treatment – NHS Choices|website=www.nhs.uk|access-date=2017-07-27}}

Miscarriage is the loss of a pregnancy before 20 weeks.{{Cite web|url=https://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html |title=Pregnancy complications |website=www.womenshealth.gov |access-date=2016-11-13 |url-status=live |archive-url=https://web.archive.org/web/20161114002619/https://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.html |archive-date=2016-11-14 }}{{cite book | vauthors = Dugas C, Slane VH | chapter = Miscarriage |date=2022 | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK532992/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30422585 |access-date=2022-09-12 }} In the UK, miscarriage is defined as the loss of a pregnancy during the first 23 weeks.{{cite web|url=http://www.nhs.uk/conditions/Miscarriage/Pages/Introduction.aspx|title=Miscarriage|website=NHS Choice|publisher=NHS|archive-url=https://web.archive.org/web/20170215140413/http://www.nhs.uk/conditions/Miscarriage/Pages/Introduction.aspx|archive-date=2017-02-15|url-status=live|access-date=2017-02-13}} Comprehensive support, consists of the consultation of the genomics as well as the provision of the medical or surgical operations required. The psychological relevance of family members, relatives, and friends to the bereaved ones is also crucial. The most effective tools that can be used to minimize the psychological implications of the mourners include autopsy and bereavement counseling.

Approximately 80% of pregnancy loss occurs in the first trimester, with a decrease in risk after 12 weeks of gestation. Some variables, such as the mother's being older or chromosomal abnormalities, possess a higher likelihood of causing multiple miscarriages.{{Cite journal |last1=du Fossé |first1=Nadia A |last2=van der Hoorn |first2=Marie-Louise P |last3=van Lith |first3=Jan M M |last4=le Cessie |first4=Saskia |last5=Lashley |first5=Eileen E L O |date=2020-05-02 |title=Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis |url=https://doi.org/10.1093/humupd/dmaa010 |access-date=2024-08-11 |journal=Human Reproduction Update |volume=26 |issue=5 |pages=650–669 |doi=10.1093/humupd/dmaa010 |pmc=7456349 |pmid=32358607}} Spontaneous abortions can be further categorized into complete, inevitable, missed, and threatened abortions:{{citation needed|date=September 2022}}

• Complete: Vaginal bleeding occurs followed by the complete passing of conception products through the cervix.  
• Inevitable: Vaginal bleeding occurs; the cervical os is closed indicating that conception products will pass soon.
• Missed: Vaginal bleeding occurs and some products of conception may have passed through the cervix; the cervical os is closed and ultrasound shows a nonviable fetus and remaining products of conception.
• Threatened: Vaginal bleeding occurs; the cervical os is closed and ultrasound shows a viable fetus.

Stillbirth is defined as fetal loss or death after 20 weeks of gestation. Early stillbirth is between 20 and 27 weeks gestation, while late stillbirth is between 28 and 36 weeks of gestation. A term stillbirth is when the fetus dies 37 weeks and above.{{cite journal | vauthors = Marufu TC, Ahankari A, Coleman T, Lewis S | title = Maternal smoking and the risk of still birth: systematic review and meta-analysis | journal = BMC Public Health | volume = 15 | issue = 1 | pages = 239 | date = March 2015 | pmid = 25885887 | pmc = 4372174 | doi = 10.1186/s12889-015-1552-5 | s2cid = 5241108 | doi-access = free }} This phenomenon can go beyond grief and can lead to worries about strange maternal feelings or postpartum treatment regarding complications of childbirth.{{Cite journal|url=https://www.obgyn.theclinics.com/article/S0889-8545(20)30035-8/abstract|title=Stillbirth - Obstetrics and Gynecology Clinics|date=2020 |pmid=32762929 |last1=Page |first1=J. M. |last2=Silver |first2=R. M. |journal=Obstetrics and Gynecology Clinics of North America |volume=47 |issue=3 |pages=439–451 |doi=10.1016/j.ogc.2020.04.008 |url-access=subscription }} Such parents would require more than empathy; generally, adequate medical programs should be considered for parents having such unbearable grief. Along with psychiatric help, counseling, and peer support, which should be useful in the process of assisting parents who have lost their children.

• Epidemiology: There are over 2 million stillbirths a year and there are about 6 stillbirths per 1000 births (0.6%){{cite journal | vauthors = Page JM, Silver RM | title = Evaluation of stillbirth | journal = Current Opinion in Obstetrics & Gynecology | volume = 30 | issue = 2 | pages = 130–135 | date = April 2018 | pmid = 29489503 | doi = 10.1097/GCO.0000000000000441 | s2cid = 3607787 }}
• Clinical presentation: Fetal behavioral changes like decreased movements or a loss in fetal sensation may indicate stillbirth, but the presentation can vary greatly.
• Risk factors: Maternal weight, age, and smoking, as well as pre-existing maternal diabetes or hypertension
• Treatment: If fetal passing occurs before labor, treatment options include induced labor or cesarean section. Otherwise, stillbirths can pass with a natural birth.

Placental abruption defined as the separation of the placenta from the uterus before delivery, is a major cause of third trimester vaginal bleeding and complicates about 1% of pregnancies.{{cite journal | vauthors = Oyelese Y, Ananth CV | title = Placental abruption | journal = Obstetrics and Gynecology | volume = 108 | issue = 4 | pages = 1005–1016 | date = October 2006 | pmid = 17012465 | doi = 10.1097/01.aog.0000239439.04364.9a | s2cid = 960903 }} Symptomatic presentations are variable: Some women can entirely ignore the symptoms, while others have mild bleeding or abdominal discomfort and pain. Hence, though symptom severity variance and precipitous placental separation are not relevant, they can still cause the diagnosis and clinical management to be complicated.

Several contributors may result in placental abruption. This includes: pre-existing maternal factors (e.g., smoking, hypertension, advanced age),{{cite journal | url=https://www.sciencedirect.com/science/article/pii/S0301211520304607 | doi=10.1016/j.ejogrb.2020.07.018 | title=Associations of maternal smoking and drinking with fetal growth and placental abruption | journal=European Journal of Obstetrics & Gynecology and Reproductive Biology | date=October 2020 | volume=253 | pages=95–102 | last1=Odendaal | first1=Hein | last2=Wright | first2=Colleen | last3=Schubert | first3=Pawel | last4=Boyd | first4=Theonia K. | last5=Roberts | first5=Drucilla J. | last6=Brink | first6=Lucy | last7=Nel | first7=Daan | last8=Groenewald | first8=Coen | pmid=32862031 | url-access=subscription }} as well as pregnancy-related factors such as [https://www.acog.org/womens-health/faqs/multiple-pregnancy#:~:text=A%20pregnancy%20with%20more%20than,and%20grow%20in%20the%20uterus. multiple pregnancies] or the presence of in-utero infections. Identifying risk factors beforehand to take steps and make quick reactions to minimize the likelihood of unfavorable outcomes for the mother or the fetus is essential. The therapy techniques for placental rupture are based on the fetal gestation age and the status of both the mother and the baby. Instant delivery should be medically warranted for full-term babies (36 weeks or more) and in case of distress. Milder cases with immature embryos are monitored closely, and any necessary intervention is done in time after careful observation.

Preventive measures, which include pre-conception counseling to deal with the modifiable risk factors, can significantly reduce incidents of placental abruption. Knowing the long-term impacts on the mother and the baby after giving birth is essential. Continuous research and evidence-based approaches help in providing management that works. Collaboration between healthcare providers and patients is the core of the outcomes of placenta abruption.

• Clinical Presentation: Varies widely from asymptomatic to vaginal bleeding and abdominal pain.
• Risk factors: Prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of membranes, intrauterine infections, and hydramnios.
• Treatment: Immediate delivery if the fetus is mature (36 weeks or older), or if a younger fetus or the mother is in distress. In less severe cases with immature fetuses, the situation may be monitored in the hospital, with treatment if necessary.

Placenta previa is a condition that occurs when the placenta fully or partially covers the cervix. Placenta previa can be further categorized into complete previa, partial previa, marginal previa, and low-lying placenta, depending on the degree to which the placenta covers the internal cervical os. Placenta previa is primarily diagnosed by ultrasound, either during a routine examination or following an episode of abnormal vaginal bleeding, often in the second trimester of pregnancy. Most placenta previa cases are diagnosed during the second trimester.{{citation needed|date=March 2023}}

Treatments are adapted according to their severity and the mother's state of health, from strict monitoring to cesarean section.

• Risk Factors: prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, maternal age.{{cite journal | vauthors = Oyelese Y, Smulian JC | title = Placenta previa, placenta accreta, and vasa previa | journal = Obstetrics and Gynecology | volume = 107 | issue = 4 | pages = 927–941 | date = April 2006 | pmid = 16582134 | doi = 10.1097/01.AOG.0000207559.15715.98 | s2cid = 22774083 }}

Placenta accreta is an abnormal adherence of the placenta to the uterine wall.{{cite journal | vauthors = Wortman AC, Alexander JM | title = Placenta accreta, increta, and percreta | journal = Obstetrics and Gynecology Clinics of North America | volume = 40 | issue = 1 | pages = 137–154 | date = March 2013 | pmid = 23466142 | doi = 10.1016/j.ogc.2012.12.002 | hdl = 11323/6264 | hdl-access = free }} Specifically, placenta accreta involves abnormal adherence of the placental trophoblast to the uterine myometrium.{{cite journal | vauthors = Silver RM, Branch DW | title = Placenta Accreta Spectrum | journal = The New England Journal of Medicine | volume = 378 | issue = 16 | pages = 1529–1536 | date = April 2018 | pmid = 29669225 | doi = 10.1056/NEJMcp1709324 | s2cid = 81685472 }}

Placenta accreta risk factors include placenta previa, abnormally elevated second-trimester AFP and free β-hCG levels, and advanced gestational parent age, specifically over the age of 35.{{cite journal | vauthors = Hung TH, Shau WY, Hsieh CC, Chiu TH, Hsu JJ, Hsieh TT | title = Risk factors for placenta accreta | journal = Obstetrics and Gynecology | volume = 93 | issue = 4 | pages = 545–550 | date = April 1999 | pmid = 10214831 | doi = 10.1016/S0029-7844(98)00460-8 }}{{Cite thesis |title=Risk Factors, Pattern and Outcome of Third Trimester Bleeding in a Tertiary Care Hospital |url=http://repository-tnmgrmu.ac.in/19279/ |publisher=Coimbatore Medical College, Coimbatore |date=May 2022 |degree=masters |language=en |first=M. |last=Anuselvi}} Furthermore, prior cesarean delivery is one of the most common risk factors for placenta accreta due to the presence of a uterine scar leading to abnormal decidualization of the placenta.{{Cite web |title=Placenta Accreta Spectrum |url=https://www.acog.org/en/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum |access-date=2022-09-16 |website=www.acog.org |language=en}}

Due to abnormal adherence of the placenta to the uterine wall, cesarean delivery is often indicated, as well as cesarean hysterectomy.

Umbilical cord prolapses is a rare and dangerous pregnancy complication that can result in significant adverse outcomes for the mother and fetus. Umbilical cord prolapse is defined by the displacement of the umbilical cord beyond the cervical os before the fetus during labor or delivery. The can lead to compression of the umbilical cord and result in low levels of oxygen being delivered to the fetus which can result in fetal morbidity and mortality.

Several risk factors for umbilical cord prolapse have been identified include maternal age greater than 35 years, multiple prior pregnancies, fetal presentations in which the fetal head is no oriented towards the mother's pelvis during delivery, pre0term labor (<37 weeks gestation), low birth weight, excess amniotic fluid, multiple gestation pregnancy and male sex of the newborn.{{Cite journal |last1=Ahmed |first1=Waleed Ali Sayed |last2=Hamdy |first2=Mostafa Ahmed |date=2018-08-21 |title=Optimal management of umbilical cord prolapse |journal=International Journal of Women's Health |language=English |volume=10 |pages=459–465 |doi=10.2147/IJWH.S130879 |doi-access=free |pmc=6109652 |pmid=30174462}}

Umbilical cord prolapse may result in either severe or complete sudden oxygen deprivation, or a gradual lack of oxygen, each causing distinct effects on the newborn. Umbilical cord prolapse is an obstetrical emergency that requires prompt delivery of the fetus. Caesarean section is the most common method, however a vaginal or assisted delivery may be considered if it can be performed more rapidly.

Several approaches can be used help relieve umbilical cord compression until a cesarean section is performed. These include administering short-acting tocolytic agents, placing the patient in the Trendelenburg or knee-chest position, elevating the buttocks, and filling the maternal bladder.{{Cite journal |last1=Wong |first1=Lo |last2=Kwan |first2=Angel Hoi Wan |last3=Lau |first3=So Ling |last4=Sin |first4=Wing To Angela |last5=Leung |first5=Tak Yeung |date=October 2021 |title=Umbilical cord prolapse: revisiting its definition and management |url=https://linkinghub.elsevier.com/retrieve/pii/S0002937821007444 |journal=American Journal of Obstetrics and Gynecology |language=en |volume=225 |issue=4 |pages=357–366 |doi=10.1016/j.ajog.2021.06.077|url-access=subscription }}

{{Main|Multiple birth}}

Multiple births may become monochorionic, sharing the same chorion, with resultant risk of twin-to-twin transfusion syndrome. Monochorionic multiples may even become monoamniotic, sharing the same amniotic sac, resulting in risk of umbilical cord compression and entanglement. In very rare cases, there may be conjoined twins, possibly impairing the function of internal organs.{{citation needed|date=March 2023}} Control of multiple pregnancies, such as special prenatal care and birth plans, can help in the control of placenta accreta.{{cite journal | url=https://www.sciencedirect.com/science/article/pii/S1521693420300973 | doi=10.1016/j.bpobgyn.2020.06.007 | pmid=32698993 | date=2021 | last1=Jauniaux | first1=E. | last2=Kingdom | first2=J. C. | last3=Silver | first3=R. M. | title=A comparison of recent guidelines in the diagnosis and management of placenta accreta spectrum disorders | journal=Best Practice & Research. Clinical Obstetrics & Gynaecology | volume=72 | pages=102–116 }} Moreover, early detection and response to the health problems arising from multiple pregnancies can help both the expectant parents and medical care providers deal with this particular aspect of reproductive health consciously.

{{Further|Vertically transmitted infection}}

{{Further|Neonatal infection}}

Since the embryo and fetus have little or no immune function, they depend on the immune function of their mother. Several pathogens can cross the placenta and cause (perinatal) infection. Often, microorganisms that produce minor illnesses in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy. Problems related to perinatal infection are not always directly noticeable.{{citation needed|date=March 2023}}

The term TORCH complex refers to a set of several different infections that may be caused by transplacental infection:

• T - Toxoplasmosis
• O - other infections (i.e., Parvovirus B19, Coxsackievirus, Chickenpox, Chlamydia, HIV, HTLV, syphilis, and Zika virus)
• R - Rubella
• C - Cytomegalovirus
• H - Herpes Simplex Virus (HSV)

Babies can also become infected by their mother during birth. During birth, babies are exposed to maternal blood and body fluids without the placental barrier intervening and to the maternal genital tract.{{Cite journal |last1=Kumar |first1=Manoj |last2=Saadaoui |first2=Marwa |last3=Al Khodor |first3=Souhaila |date=2022 |title=Infections and Pregnancy: Effects on Maternal and Child Health |journal=Frontiers in Cellular and Infection Microbiology |volume=12 |doi=10.3389/fcimb.2022.873253 |doi-access=free |pmid=35755838 |pmc=9217740 |issn=2235-2988}} Because of this, blood-borne microorganisms (hepatitis B, HIV), organisms associated with sexually transmitted disease (e.g., gonorrhoea and chlamydia), and normal fauna of the genito-urinary tract (e.g., Candida) are among those commonly seen in infection of newborns. Furthermore, vaccination, commitment to safe birth practices, and prenatal screening and treatment of infections are also strategic measures that can help reduce the risk of newborn infections.

Factors increasing the risk (to either the pregnant individual, the fetus/es, or both) of pregnancy complications beyond the normal level of risk may be present in the pregnant individual's medical profile either before they become pregnant or during the pregnancy.{{cite web|title=Health problems in pregnancy |url=https://www.nlm.nih.gov/medlineplus/healthproblemsinpregnancy.html |website=Medline Plus |publisher=US National Library of Medicine |url-status=live |archive-url= https://web.archive.org/web/20130813100208/http://www.nlm.nih.gov/medlineplus/healthproblemsinpregnancy.html |archive-date=2013-08-13 }} These pre-existing factors may related to the individual's genetics, physical or mental health, their environment and social issues, or a combination of those.{{cite web|last=Merck |title=Risk factors present before pregnancy |url=http://www.merckmanuals.com/home/womens_health_issues/pregnancy_at_high-risk/risk_factors_present_before_pregnancy.html |website=Merck Manual Home Health Handbook |publisher=Merck Sharp & Dohme |url-status=live |archive-url=https://web.archive.org/web/20130601003348/http://www.merckmanuals.com/home/womens_health_issues/pregnancy_at_high-risk/risk_factors_present_before_pregnancy.html |archive-date=2013-06-01 }}

Some common biological risk factors include:

• Age of either parent
• Adolescent parents: Young mothers are at an increased risk of developing certain complications, including preterm birth and low infant birth weight.{{cite journal | vauthors = Koniak-Griffin D, Turner-Pluta C | title = Health risks and psychosocial outcomes of early childbearing: a review of the literature | journal = The Journal of Perinatal & Neonatal Nursing | volume = 15 | issue = 2 | pages = 1–17 | date = September 2001 | pmid = 12095025 | doi = 10.1097/00005237-200109000-00002 | s2cid = 42701860 }}
• Older parents: As they age, both mothers and fathers are at an increased risk for complications in the fetus and during pregnancy and childbirth. Complications for those 45 or older include increased risk of primary Caesarean delivery (i.e. C-section).{{cite journal | vauthors = Bayrampour H, Heaman M | title = Advanced maternal age and the risk of cesarean birth: a systematic review | journal = Birth | volume = 37 | issue = 3 | pages = 219–226 | date = September 2010 | pmid = 20887538 | doi = 10.1111/j.1523-536X.2010.00409.x }}
• Height: Pregnancy in individuals whose height is less than 1.5 meters (5 feet) correlates with a higher incidence of preterm birth and underweight babies. Also, these individuals are more likely to have a small pelvis, which can result in such complications during childbirth as shoulder dystocia.
• Weight
• Low weight: Individuals whose pre-pregnancy weight is less than 45.5 kilograms (100 pounds) are more likely to have underweight babies.
• High weight: Obese individuals are more likely to have very large babies, potentially increasing difficulties in childbirth. Obesity also increases the chances of developing gestational diabetes, high blood pressure, preeclampsia, experiencing postterm pregnancy and requiring a cesarean delivery.
• Pre-existing disease in pregnancy, or an acquired disease: A disease and condition not necessarily directly caused by the pregnancy.
• Diabetes mellitus in pregnancy
• Lupus in pregnancy
• Thyroid disease in pregnancy
• Risks arising from previous pregnancies: Complications experienced during a previous pregnancy are more likely to recur.{{cite journal | vauthors = Brouwers L, van der Meiden-van Roest AJ, Savelkoul C, Vogelvang TE, Lely AT, Franx A, van Rijn BB | title = Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis | journal = BJOG | volume = 125 | issue = 13 | pages = 1642–1654 | date = December 2018 | pmid = 29978553 | pmc = 6283049 | doi = 10.1111/1471-0528.15394 }}{{cite journal | vauthors = Lamont K, Scott NW, Jones GT, Bhattacharya S | title = Risk of recurrent stillbirth: systematic review and meta-analysis | journal = BMJ | volume = 350 | pages = h3080 | date = June 2015 | pmid = 26109551 | doi = 10.1136/bmj.h3080 | hdl-access = free | doi-access = free | hdl = 2164/4642 }}
• Multiple pregnancies: Individuals who have had more than five previous pregnancies face increased risks of rapid labor and excessive bleeding after delivery.
• Multiple gestation (having more than one fetus in a single pregnancy): These individuals have an increased risk of mislocated placenta.

Some common environmental risk factors during pregnancy include:

• Exposure to environmental toxins
• Ionizing radiation{{cite journal | vauthors = Williams PM, Fletcher S | title = Health effects of prenatal radiation exposure | journal = American Family Physician | volume = 82 | issue = 5 | pages = 488–493 | date = September 2010 | pmid = 20822083 | s2cid = 22400308 }}
• Exposure to recreational drugs
• Alcohol: Use during pregnancy can cause fetal alcohol syndrome and fetal alcohol spectrum disorder.{{cite journal | vauthors = Denny CH, Acero CS, Naimi TS, Kim SY | title = Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18-44 Years - United States, 2015-2017 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 16 | pages = 365–368 | date = April 2019 | pmid = 31022164 | pmc = 6483284 | doi = 10.15585/mmwr.mm6816a1 }}
• Tobacco use: During pregnancy, causes twice the risk of premature rupture of membranes, placental abruption and placenta previa.{{cite web | work = Centers for Disease Control and Prevention | date = 2007 | url = https://www.cdc.gov/nccdphp/publications/factsheets/prevention/pdf/smoking.pdf | title = Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy | archive-url = https://web.archive.org/web/20110911020755/http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/smoking.pdf | archive-date=2011-09-11 }} Also, it increases the odds of the baby being born prematurely by 30%.{{cite web|url=https://www.cdc.gov/reproductivehealth/tobaccousepregnancy/index.htm |title=Substance Use During Pregnancy |access-date=2013-10-26 |url-status=live |archive-url=https://web.archive.org/web/20131029204538/http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/index.htm |archive-date=2013-10-29 | work = Centers for Disease Control and Prevention | date = 2009 }}
• Prenatal cocaine exposure: Associated with premature birth, birth defects and attention deficit disorder.
• Prenatal methamphetamine exposure: Can cause premature birth and congenital abnormalities.{{cite web |title=New Mother Fact Sheet: Methamphetamine Use During Pregnancy |url=http://www.ndmch.com |website=North Dakota Department of Health |access-date=7 October 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110910221317/http://www.ndmch.com/ |archive-date=2011-09-10 }} Other investigations have revealed short-term neonatal outcomes to include small deficits in infant neurobehavioral function and growth restriction when compared to control infants.{{cite journal | vauthors = Della Grotta S, LaGasse LL, Arria AM, Derauf C, Grant P, Smith LM, Shah R, Huestis M, Liu J, Lester BM | display-authors = 6 | title = Patterns of methamphetamine use during pregnancy: results from the Infant Development, Environment, and Lifestyle (IDEAL) Study | journal = Maternal and Child Health Journal | volume = 14 | issue = 4 | pages = 519–527 | date = July 2010 | pmid = 19565330 | pmc = 2895902 | doi = 10.1007/s10995-009-0491-0 }} Also, prenatal methamphetamine use is believed to have long-term effects in terms of brain development, which may last for many years.
• Cannabis: Possibly associated with adverse effects on the child later in life.
• Social and socioeconomic factors: Generally speaking, unmarried individuals and those in lower socioeconomic groups experience an increased level of risk in pregnancy, due at least in part to lack of access to appropriate prenatal care.{{Cite journal |last1=Grand-Guillaume-Perrenoud |first1=Jean Anthony |last2=Origlia |first2=Paola |last3=Cignacco |first3=Eva |date=2022-02-01 |title=Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review |journal=Midwifery |volume=105 |pages=103237 |doi=10.1016/j.midw.2021.103237 |pmid=34999509 |issn=0266-6138|doi-access=free }}
• Unintended pregnancy: Unintended pregnancies preclude preconception care and delay prenatal care. They preclude other preventive care, may disrupt life plans, and, on average, have worse health and psychological outcomes for the mother and, if birth occurs, the child.{{cite book|url=https://archive.org/details/bestintentionsun0000unse|title=The best intentions: unintended pregnancy and the well-being of children and families| vauthors = Eisenberg L, Brown SH |publisher=National Academy Press|year=1995|isbn=978-0-309-05230-6|location=Washington, D.C. |access-date=2011-09-03|url-access=registration}}{{cite web|url=http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=13|title=Family Planning - Healthy People 2020|archive-url=https://web.archive.org/web/20101228012908/http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=13|archive-date=2010-12-28|url-status=live|access-date=2011-08-18}}
• Exposure to pharmaceutical drugs: Certain anti-depressants may increase risks of preterm delivery.{{cite journal | vauthors = Gavin AR, Holzman C, Siefert K, Tian Y | title = Maternal depressive symptoms, depression, and psychiatric medication use in relation to risk of preterm delivery | journal = Women's Health Issues | volume = 19 | issue = 5 | pages = 325–334 | year = 2009 | pmid = 19733802 | pmc = 2839867 | doi = 10.1016/j.whi.2009.05.004 }}
• Stress
• An elevated level of stress during pregnancy leads to notorious pregnancy outcomes, including preterm birth, low birth weight, and mental health problems for the mother.
• Prolonged effects of chronic stressors such as discrimination, intimate partner violence, housing issues, and poverty lead to widespread maternal health issues and adverse pregnancy outcomes. {{Citation needed|date=May 2024}}
• Culture
• Cultural norms, convictions, and traditions connected to pregnancy and childbirth lead people to establish perceptions, habits, and treatment-seeking. Cultural determinants affect the assessment of prenatal care utilization, childbirth practice, dietary habits, and reproductive health beliefs, which are direct outcomes of pregnancy and health situations.{{Citation needed|date=May 2024}}

Some disorders and conditions can mean that pregnancy is considered high-risk (about 6-8% of pregnancies in the USA) and, in extreme cases, may be contraindicated. High-risk pregnancies are the main focus of doctors specialising in maternal-fetal medicine. Serious pre-existing disorders which can reduce a woman's physical ability to survive pregnancy include a range of congenital defects (that is, conditions with which the woman herself was born, for example, those of the heart or reproductive organs, some of which are listed above) and diseases acquired at any time during the woman's life.

{{Venous thromboembolism incidence during pregnancy and the postpartum period}}

Obstetric complications are those complications that develop during pregnancy. A woman may develop an infection, syndrome, or complication that is not unique to pregnancy and that may have existed before pregnancy. Pregnancy often is complicated by preexisting and concurrent conditions. Though these pre-existing and concurrent conditions may have a great impact on pregnancy, they are not included in the following list.

{{div col|style=text-align: left; line-height: 1.8;}}

• Chromosome abnormalities{{sfn|Leveno|2013|page = 38}}{{cite web|url=https://www.genome.gov/11508982/|title=Chromosome Abnormalities Fact Sheet|website=National Human Genome Research Institute (NHGRI)|access-date=14 May 2017}}
• Ectopic pregnancy{{sfn|Leveno|2013|page = 13}}{{cite journal | vauthors = Kirk E, Bottomley C, Bourne T | title = Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location | journal = Human Reproduction Update | volume = 20 | issue = 2 | pages = 250–261 | date = 1 March 2014 | pmid = 24101604 | doi = 10.1093/humupd/dmt047 | doi-access = }}
• Mendelian disorders{{sfn|Leveno|2013|page = 47}}
• Spontaneous abortion{{sfn|Leveno|2013|page = 2 }}{{cite web|url=https://www.nichd.nih.gov/health/topics/pregnancyloss/conditioninfo/Pages/default.aspx|title=Pregnancy Loss: Condition Information|website=www.nichd.nih.gov|access-date=14 May 2017}}
• Nonmedelian disorders{{sfn|Leveno|2013|page = 50}}
• Oligohydramnios{{sfn|Leveno|2013|page = 88}}
• Hydramnios{{sfn|Leveno|2013|page = 91 }}
• Abnormal labor and delivery{{sfn|Leveno|2013|page = 114}}
• Chorioamnionitis{{sfn|Leveno|2013|page = 130}}
• Shoulder dystocia{{sfn|Leveno|2013|page = 131}}
• Breech delivery{{cite journal | vauthors = Cluver C, Gyte GM, Sinclair M, Dowswell T, Hofmeyr GJ | title = Interventions for helping to turn term breech babies to head first presentation when using external cephalic version | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 2 | pages = CD000184 | date = February 2015 | pmid = 25674710 | doi = 10.1002/14651858.CD000184.pub4 | pmc = 10363414 | hdl-access = free | hdl = 10019.1/104301 }}
• Prior Cesarean delivery {{sfn|Leveno|2013|page = 147}}
• Uterine rupture {{sfn|Leveno|2013|page = 152}}{{cite web|url=http://reference.medscape.com/article/275854-overview|title=Uterine Rupture in Pregnancy: Overview, Rupture of the Unscarred Uterus, Previous Uterine Myomectomy and Uterine Rupture|website=reference.medscape.com|access-date=14 May 2017}}
• Hysterectomy after delivery{{sfn|Leveno|2013|page = 154}}
• Postpartum infection {{sfn|Leveno|2013|page = 161}}
• Postpartum depression
• Septic pelvic thrombosis {{sfn|Leveno|2013|page = 169}}
• Hypertension {{sfn|Leveno|2013|page = 171}}
• Preeclampsia{{sfn|Leveno|2013|page = 171 }}
• Eclampsia{{sfn|Leveno|2013|page = 180}}
• Placental abruption{{sfn|Leveno|2013|page =188}}
• Placenta previa{{sfn|Leveno|2013|page = }}
• Fetal-to-mother hemorrhage{{sfn|Leveno|2013|page = 218}}
• Rh disease{{cite journal | vauthors = Bowman JM, Chown B, Lewis M, Pollock JM | title = Rh isoimmunization during pregnancy: antenatal prophylaxis | journal = Canadian Medical Association Journal | volume = 118 | issue = 6 | pages = 623–627 | date = March 1978 | pmid = 77714 | pmc = 1818025 }}
• Amniotic fluid embolism {{sfn|Leveno|2013|page = }}
• Delayed delivery{{sfn|Leveno|2013|page =223}}
• Fetal death{{sfn|Leveno|2013|page =225}}
• Incontinence
• Preterm birth{{sfn|Leveno|2013|page= 232}}
• Neonatal infection{{sfn|Leveno|2013|page= }}
• Low birth-weight infant{{sfn|Leveno|2013|page= }}
• Premature rupture of membranes{{sfn|Leveno|2013|page= 236}}
• Incompetent cervix{{sfn|Leveno|2013|page= 241}}
• Posterm infant{{sfn|Leveno|2013|page=247}}
• Fetal growth restriction{{sfn|Leveno|2013|page=250}}
• Macrosomia{{sfn|Leveno|2013|page=252}}
• Twin pregnancy{{sfn|Leveno|2013|page=260-273}}
• Triplets and more{{sfn|Leveno|2013|page=274}}{{cite web|url=https://sogc.org/publications-resources/public-information-pamphlets.html?id=33|title=Public Education Pamphlets|website=sogc.org|access-date=15 May 2017|archive-url=https://web.archive.org/web/20180706163239/https://sogc.org/publications-resources/public-information-pamphlets.html?id=33|archive-date=6 July 2018|url-status=dead}}
• Seizures{{cite journal | vauthors = Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C | display-authors = 6 | title = Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society | journal = Neurology | volume = 73 | issue = 2 | pages = 126–132 | date = July 2009 | pmid = 19398682 | pmc = 3475195 | doi = 10.1212/WNL.0b013e3181a6b2f8 }}
• Gestational trophoblastic disease{{sfn|Leveno|2013|page=278}}
• Gestational diabetes{{sfn|Leveno|2013|page=}}
• Hyperemesis gravidarum
• Pelvic girdle pain
• HELLP syndrome
• Acute fatty liver of pregnancy
• Deep vein thrombosis
• Pregnancy-induced hypercoagulability
• Immune tolerance in pregnancy
• Mastitis
• Peripartum cardiomyopathy
• Vertically transmitted infection
• Postpartum bleeding
• Perineal tear
• Fetal alcohol spectrum disorder
• Thyroid disease in pregnancy
• Pruritic urticarial papules and plaques of pregnancy
• Intrahepatic cholestasis of pregnancy
• Gestational pemphigoid
• Prurigo gestationis
• Lupus
• Cephalopelvic disproportion
• Stillbirth
• Molar pregnancy
• Obstetric fistula
• Uterine incarceration
• Twin to Twin transfusion syndrome
• Gestational trophoblastic disease{{sfn|Leveno|2013|page = }}
• Antiphospholipid antibody syndrome{{sfn|Leveno|2013|page=335}}
• Hyperemesis gravidarum{{sfn|Leveno|2013|page = 349}}
• Acute fatty liver of pregnancy{{sfn|Leveno|2013|page =363 }}
• Gestational diabetes{{sfn|Leveno|2013|page = }}
• Hemoglobinopathies{{sfn|Leveno|2013|page =382 }}
• Postpartum thyroiditis{{sfn|Leveno|2013|page = 410 }}
• Postpartum depression{{sfn|Leveno|2013|page = 425}}
• Hyperpigmentation{{sfn|Leveno|2013|page = 435}}
• Hair growth changes{{sfn|Leveno|2013|page = }}
• Herpes gestationitis{{sfn|Leveno|2013|page =439 }}
• Pruritic urticarial papaules of pregnancy{{sfn|Leveno|2013|page = 439}}
• Abnormality of maternal pelvic organs{{cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/O99.7|title=ICD-10 Version:2016|publisher = International Statistical Classification of Diseases and Related Health Problems 10th Revision

|access-date=16 May 2017}}

• Postpartum acute renal failure
• Postpartum nephritis
• Haemorrhoids in pregnancy
• Obstetric embolism
• Pregnancy-related peripheral neuritis
• Obstetrical tetanus
• Unicornuate uterus
• Maternal death
• Arcuate uterus

{{div col end}}

• List of obstetric topics
• Dermatoses of pregnancy
• Thyroid disease in pregnancy
• Reproductive Health Supplies Coalition

{{Reflist}}

{{refbegin}}

• {{cite book | vauthors = Leveno K | title = Williams manual of pregnancy complications | publisher = McGraw-Hill Medical | location = New York | year = 2013 | isbn = 978-0071765626 }}

{{refend}}

• [https://www.who.int/news-room/fact-sheets/detail/maternal-mortality Maternal mortality], World Health Organization.

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|O|00||o|00}}-{{ICD10|O|48||o|30}}

| ICD9 = {{ICD9|630}}-{{ICD9|648}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D011248

}}

{{Women's health|state=collapsed}}

{{Pathology of pregnancy, childbirth and the puerperium}}

{{Disease groups}}

{{Authority control}}

*

Category:Women's health

sv:Graviditet#Möjliga komplikationer