High-risk pregnancies

If you have certain health conditions, your pregnancy may be considered high-risk. You will probably be monitored by a clinic that specializes in high‑risk pregnancies.

Hypertension during pregnancy

Some women start to have hypertension (high blood pressure) during pregnancy. They are considered more at-risk if they have already been treated for hypertension, have had hypertension during a previous pregnancy, or are expecting twins.

Treatment for hypertension during pregnancy may include resting at home, reducing activity, and sometimes taking medication to lower blood pressure.

If your blood pressure starts to rise, your urine will be tested for protein. If protein is found, that means you have preeclampsia, or hypertension with protein in the urine.

If you are diagnosed with preeclampsia, you may need to be hospitalized so that you and your baby can be monitored more closely. Depending on the status of your pregnancy and the severity of the condition, labour may also have to be induced. Giving birth is the only way to treat preeclampsia. Your medical team will determine the best time for you to give birth.

Gestational diabetes

Gestational diabetes (pregnancy diabetes) is due to an increase in the blood sugar level caused by the placenta, which produces hormones. Gestational diabetes is different from other types of diabetes. It carries no risk of birth defects. In fact, the most common consequence of gestational diabetes is having a bigger baby, which can make for a more difficult delivery for both mother and baby. The baby may also have hypoglycaemia and breathing problems at birth.

If you have gestational diabetes, the first step in treating it is to eat a balanced diet. You can meet with a nutritionist who will explain how to eat well. The diet of a woman with gestational diabetes is different from what is usually recommended for diabetics because pregnant women need more nutrients to help their baby grow. You will also be encouraged to exercise daily, for example, by taking a 30 minute walk.

If diet and exercise are not enough to control your blood sugar, you may be prescribed insulin. The treatment may sound complicated, but it’s not. Your medical team will help and guide you. You may also have to have one or more ultrasounds and additional tests done during your last few weeks of pregnancy to ensure your baby is doing well.

Twins

Did you just learn you are expecting twins, triplets, or quadruplets? They say having a baby changes your life forever, so what happens when you’re expecting more than one? You’ll need to make adjustments to plan for prenatal care, the birth, and after birth.

Identical twins share the same placenta

Non identical twins each have their own placenta

Illustration: Maurice Gervais

There are two types of twins: identical twins and fraternal twins. Identical twins come from the same egg and the same sperm. They have the same genetic makeup, are of the same sex, and usually share the same placenta. Fraternal twins come from separate eggs fertilized by different sperm. They develop side by side in the uterus, but have a different genetic makeup and may not be of the same sex.

Twin pregnancies are considered high-risk. So if you are pregnant with twins, you will have more medical check-ups and exams as part of your prenatal care. Care by an obstetrician will also be strongly recommended, as obstetricians specialize in this kind of pregnancy and delivery.

Here are the most common problems that occur with twin pregnancies:

  • Premature babies: The most common problem is pre-term labour, which can lead to the birth of premature babies. Premature babies have a higher risk of disease and mortality than full-term babies.
  • Twin-to-twin transfusion syndrome: In the case of identical twins, there may be abnormalities caused by an unequal distribution of placental blood to the two babies.
  • Second baby: When twins are born, the second baby has a higher risk of complications and accidents caused by the umbilical cord, or problems with the placenta, and the baby’s position.

Plan your delivery with your doctor and healthcare team. It is also important to decide where the birth will take place. Women who are expecting twins are advised to deliver in a hospital where specialized obstetric, paediatric, and anaesthesia services are available.

Your doctor will assess your situation and needs and discuss them with you. If the first baby is in a head-down position, which happens in two-thirds of cases, vaginal delivery is usually recommended, regardless of the second baby’s position. And in 40% of twin pregnancies, both babies are head down.

During your pregnancy, you and your family will prepare to welcome your newborns into your home. The best way to do so is probably to talk with other parents of twins who are willing to share their experience and tips with you. There are also associations of parents of twins in some areas of Québec. Contact your CLSC to learn about services and organizations in your area that can provide information and assistance.

Association de parents de jumeaux et de triplés de la région de Montréal
514-990-6165
www.apjtm.com (in French only)

Association des parents de jumeaux et plus de la région de Québec
418-210-3698
www.apjq.net (in French only)

Tips on preparing to bring your twins home

  • Have people offered to help during your recovery? Take them up on it, but be clear about your needs. Make a list of household chores and a schedule that you can adjust later as needed.
  • Feel free to ask for help in the weeks after your return home. If you don’t have any family or friends nearby, find out if there are any organizations in your area that can help.
  • When you cook, make extra portions and freeze some. Your friends and family can also help by bringing meals as gifts.
  • You don’t always need to buy two or three of everything. You can borrow furniture, strollers, and clothing, or buy used.