Our hope for all of you is that your pregnancy is as smooth as possible and that every prenatal visit is quick and easy.
But the reality is that for many people, there are moments in pregnancy when you get some scary, or potentially scary, news. A test result that is slightly elevated, a measurement that isn’t quite what the doctor is looking for, something that feels not quite right. There is no easy or simple way to deal with these moments.
We wrote a book called The Unexpected to help you navigate complications that arise during and after pregnancy. In it, we lay out the data on complications like miscarriage, preeclampsia, premature birth, and more — and provide a road map for productive conversations with your provider. We hope no one needs to read it, but if you do, it’s here for you.
If you’re in the midst of a potential diagnosis right now, though, here are some next steps to consider.
Where do I start?
When navigating a new diagnosis, there is sometimes a temptation to immediately go all the way down the rabbit hole of the condition, to try to fully map out a plan for all possible circumstances. This is often virtually impossible and almost always unhelpful. From a practical standpoint, what makes sense is to focus on the immediate next steps.
Sometimes you aren’t even sure what the diagnosis might be at this point. That happens often: your doctor sees something that might mean something but might not. It’s a tough spot to be in as a patient, but unfortunately that is the reality in medicine — it often takes a while to get from suspicion to answer.
Some useful questions to ask your doctor at this stage might be (let’s call the condition “X”):
- Are you telling me that I/my baby has X or that there is a chance I/my baby has X?
- If only a chance, what do you think that chance is? This can be a specific percentage, or at least break it down into “less than 10%,” “10% to 50%,” “more than 50%” (or any other grouping you find helpful).
- What are we going to do to find out one way or the other? How long will it take? Might we not know until after birth?
- If I/my baby does have X, what does that mean for me/the baby? What is the likelihood it will be a serious issue for him/her? If you do not know the answer to this, which is okay, can I meet with other doctors/specialists to discuss what that means for after birth? Should I be doing that now or waiting until we know for sure?
In general, if you want to know something, you should ask. Your questions and concerns are key to shared decision-making with your doctor.
What if I’ve had a complicated pregnancy before?
Most pregnancy complications have a risk of recurrence that is higher than the baseline risk. If you take something like severe nausea, for example, the recurrence rate is probably around 50% (depending on how it is measured). For later-onset preeclampsia, the recurrence rate is around 16%. So your risks are higher than they would be if you hadn’t had the complication before. Does this mean that these things will happen for sure? No. A 16% recurrence risk means an 84% chance of no recurrence.
That said, in a second pregnancy, you will be better prepared. In some areas, this may help you lower your risk (i.e. low-dose aspirin reduces the risk of preeclampsia by about 20%). Even if you cannot lower your risk, you may be better able to access treatment (for example, for depression) if you know it might be coming. The awareness, the ability to know what you are facing, could make it easier.
At this stage, it’s valuable to gather some information about your previous pregnancy and ask your doctor these questions:
- What happened? Try to get a detailed understanding of your case — exactly what occurred and when, what tests were done, etc.
- Why did it happen to me? Not in the sense of “What did I do to deserve this?” but rather “Were there particular risk factors or events that made this more likely for me?”
- Is it going to happen to me again? What is the risk of recurrence in my particular case?
- What can be done to prevent it from happening again? Are there any evidence-based treatments, how well do they work, and are they likely to work for me?
These answers can go a long way toward making your future conversations as productive as possible.
Is stress bad for my baby?
During pregnancy, there is often some worry about stress causing harm to your baby. And going through a stressful experience, like a diagnosis, can bring up additional fears.
This seems to be overblown. Based on the data we have, it is plausible that major life stress — like the death of a close family member — may have a small negative impact. One study in Sweden found a 0.39% increase in the risk of low birth weight after the death of a relative. That’s an increase of 1 per 250 births. With such a large sample, it is significant, but that number is small. Similarly, the authors find that prescription medications for ADHD, both in childhood and adulthood, are increased when there is a death of a close relative. For ADHD prescriptions at ages 9 to 11, the increase is 1 in 150 children.
However, there’s nothing to indicate that a bad day at work or even a stressful period of time, such as that surrounding a diagnosis, would have enormous implications.
If you’re feeling a lot of stress, first of all, we are so sorry. Telling yourself to “just relax” rarely helps, so we encourage you to seek help if you can. This is true whether pregnant or not, but leaning on other people can alleviate your stress some, even if not completely. You may find support in a perinatal mental health professional, who specializes in issues like this.
The bottom line
- You may not have all the answers all at once. Focus on immediate next steps and ask your doctor direct questions to help you guide future decisions.
- Previous pregnancy complications, such as preeclampsia or severe nausea, increase the risk of recurrence but do not guarantee it.
- Significant life stress may have small effects on outcomes like birth weight or childhood ADHD risk. Seek support through loved ones or a perinatal mental health professional if you are struggling.
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