Medical Diseases in Pregnancy: An Acute on Chronic Focus

In the last decade or so obstetric care has evolved and become more complex. This can be attributed to a combination of factors including rising obesity rates, maternal age and medical treatment advances. Clinicians are caring for more pregnant women with chronic medical disease in addition to any de novo presentations which may occur, emphasising the need for the general medicine body to feel confident and skilled in the management of medical problems before, during and after pregnancy. One of the difficulties faced by clinicians in the assessment and management of pregnant women is the differentiation between symptoms of a normal pregnancy vs symptoms of clinical significance which warrant further investigation, particularly in mothers with background medical disease. Careful consideration and knowledge of normal pregnancy physiology is required when assessing a pregnant women/birthing person to avoid closed thinking and adverse outcomes. Unfortunately, clinician inertia around the care of pregnant women is a common feature in maternal mortality reviews. The most recent maternal mortality report discusses common themes around cardiovascular disease in pregnancy, alongside management of acute and acute-on-chronic presentations in the context of common endocrine, gastrointestinal and neurological disease in pregnancy. This article discusses some of these themes and the management of common medical problems in pregnancy.