Caring for High-Risk Pregnancies: An Expert Perspective on Chronic Conditions
Published Feb 4, 2026
Pregnancy and the postpartum period are times of profound physical and emotional change. For individuals managing chronic health conditions, these changes can feel especially daunting. To better understand how chronic conditions affect pregnancy — and how patients can be supported before, during and after delivery — Sydney M. Thayer, M.D., a maternal-fetal medicine subspecialist who cares for patients with high-risk pregnancies, offers some perspective.
Meet the Expert: Sydney M. Thayer, M.D.
Dr. Sydney Thayer is a MFM subspecialist who provides care for pregnancies impacted by maternal and/or fetal complications. While she practices the full spectrum of high-risk obstetrics, her expertise lies in caring for patients with chronic health conditions such as diabetes, heart disease, high blood pressure, obesity and thyroid disorders.
At the core of Dr. Thayer’s clinical philosophy is patient-centered care. She believes strongly in ensuring patients fully understand their diagnoses and treatment options in a way that is accessible and empowering. By prioritizing clear communication, agency, and autonomy, she helps patients navigate the difficult — and often highly complex — decisions that can arise during pregnancy and the postpartum period.
Chronic Conditions and Reproductive Health
In recent years, there has been a notable increase in chronic health conditions among people of reproductive age. Conditions such as diabetes, obesity and cardiovascular disease are becoming more common, with rates of chronic hypertension alone increasing by an estimated 67%–87%.
Pregnancy is often described as a “stress test” for the body. During this time, the body undergoes dramatic changes, including increased blood volume, higher energy demands, rapid hormonal shifts and physical expansion. These changes can place significant strain on pre-existing health conditions, making chronic disease management more challenging — particularly for endocrine disorders like diabetes and thyroid disease.
The postpartum period can be equally, if not more, demanding. Conditions such as preeclampsia, postpartum hemorrhage, breastfeeding challenges and postpartum depression may arise, adding further complexity to chronic disease management. Together, pregnancy and the postpartum period represent a critical window for identifying, managing and addressing long-term health risks.
Gestational Diabetes and Cardiovascular Disease: A Closer Look
Gestational diabetes mellitus and cardiovascular disease are two leading contributors to maternal morbidity and mortality.
Gestational diabetes develops because of hormonal changes driven by the placenta, which reduce maternal insulin sensitivity and disrupt normal blood sugar regulation. Cardiovascular disease — including chronic hypertension and heart disease — often stems from long-standing strain on the heart and blood vessels related to factors such as obesity, high cholesterol and inherited risk.
Both GDM and CVD significantly increase the risk of hypertensive disorders of pregnancy, including preeclampsia. Importantly, these conditions also are associated with long-term health consequences: individuals affected during pregnancy have an approximately ninefold increased lifetime risk of worsening cardiovascular disease, including heart attacks and strokes.
For the fetus and newborn, these conditions can contribute to growth abnormalities (both larger and smaller than average), stillbirth, birth trauma such as shoulder dystocia, neonatal intensive care unit admission, abnormal blood sugar levels and jaundice.
Best Practices for Postpartum Management
The postpartum period is a crucial time to address health conditions encountered during pregnancy, as they often have long-term implications.
For individuals who experienced gestational diabetes, the risk of developing prediabetes or Type 2 diabetes is significant — estimated at 50%-70% within 20 years, with many cases diagnosed within five years of delivery. Current recommendations include performing a glucose tolerance test between four and 12 weeks postpartum, though emerging evidence suggests testing in the immediate postpartum period (around two days after delivery) also may be appropriate. If diabetes is not diagnosed, ongoing surveillance with a hemoglobin A1c every three years is recommended.
For those with cardiovascular disease or hypertensive disorders, close blood pressure monitoring is essential. This may include a combination of in-person visits and home blood pressure monitoring, when available. For patients on antihypertensive medications, careful dose adjustments are recommended to maintain systolic blood pressure at or below 150 mmHg and diastolic blood pressure at or below 100 mmHg.
Breastfeeding also can offer important health benefits. It has been linked to improved blood sugar control, reduced risk of developing Type 2 diabetes, improved cholesterol profiles and positive effects on blood vessel health. Additionally, clinicians should discuss appropriate pregnancy spacing, review contraception options and ensure patients establish care with a primary care provider within three to six months after delivery.
Reassurance and Advice for Patients
For patients with chronic health conditions who feel anxious about the postpartum period, Dr. Thayer emphasizes an important message: healthy and safe pregnancies are absolutely possible.
Managing a chronic condition during pregnancy and postpartum often involves frequent appointments, ongoing monitoring and medication adjustments — all of which can feel overwhelming. Strong partnership between the patient and their health care team is essential. Using evidence-based guidelines, maintaining regular communication, and building trust can significantly reduce complications and improve outcomes.
Equally important is addressing barriers to care. Challenges such as insurance limitations, transportation difficulties or socioeconomic stressors can impact health outcomes if left unaddressed. Dr. Thayer encourages patients to openly share these concerns with their health care teams so that care plans can be adapted to meet the patients’ needs.
With the right support, education, and collaboration, patients with chronic conditions can navigate pregnancy and the postpartum period with confidence — and lay the foundation for long-term health.