High-risk Pregnancy Care: When Is It Needed?

Posted by Brigham and Women's Hospital September 9, 2016

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Chelsea received specialized high-risk pregnancy care at BWH when she was diagnosed with a failing heart valve during her pregnancy with her daughter Aria.

Contributor: Louise Wilkins, Haug, MD, PhD, Division Director of Maternal-Fetal Medicine at Brigham and Women’s Hospital and a Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

When 29-year-old Chelsea was in the second trimester of her pregnancy with her daughter Aria, she began experiencing dizziness and shortness-of-breath. An echocardiogram revealed that one of her heart valves had deteriorated.

Chelsea was referred to the Cardiovascular Disease and Pregnancy Program at Brigham and Women’s Hospital (BWH), where a team including high risk pregnancy (maternal-fetal medicine) specialists, cardiologists, and cardiac surgeons worked together to develop a specialized plan for her care. This included delivering her baby in a hybrid operating suite at BWH to enable the team to quickly respond with a range of treatments for Chelsea’s heart condition if needed during the delivery. Chelsea delivered a healthy baby girl and had successful valve replacement surgery at BWH the following week.

Who is at Risk for Pregnancy Complications?

Women with heart disease like Chelsea, are one of several groups that may benefit from high risk pregnancy care. Thesegroups include women with other pre-existing medical conditions, women who develop complications during pregnancy, women at risk for premature birth, and women of advanced maternal age (35 years of age or older). Maternal-fetal medicine specialists provide individualized care before, during, and after pregnancy for women who are considered high risk.

“Our goal is to ensure a healthy pregnancy and safe delivery for each mother and baby through careful planning, medical expertise, and team-based care,” said Dr. Wilkins-Haug.

Consultation and planning before pregnancy (pre-conception planning) is very important for women with pre-existing medical conditions, such as diabetes, heart disease, lupus, and psychiatric illnesses. High-risk pregnancy specialists often work closely with other specialists (such as cardiologists, rheumatologists, gastroenterologists, and psychiatrists) to make adjustments to a woman’s medications prior to and during pregnancy. They also recommend key nutritional supplementation and lifestyle changes to help reduce risks during pregnancy.

During high-risk pregnancy, there may be concerns about how the baby is developing. In addition to closely monitoring the mother’s condition, high-risk pregnancy specialists track the baby’s development and may provide treatment to support the baby’s developing systems. In some cases, they may be able to correct certain conditions before the baby is born.

How Pregnancy Complications Affect Long-term Health

Conditions that develop during pregnancy also can place the mother at long-term risk for health complications. Up to 60 percent of women who have gestational diabetes end up with Type 2 diabetes, and women who experience preeclampsia (a condition characterized by high blood pressure) have a higher risk of developing cardiovascular disease throughout their lifetime. High-risk pregnancy specialists help women after delivery and work with their primary care physicians with the goal of improving their health for many years after pregnancy.

Learn more about high-risk pregnancy care in this video with Dr. Wilkins-Haug.

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-Jessica F.

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Defying the Odds: Heart Patient Welcomes New Baby

Posted by Brigham and Women's Hospital April 10, 2014

Ali Barton with her newborn son, Ethan.

When Ali Barton, 31, was about 18 weeks pregnant, she began experiencing “bizarre” swelling in her legs, sudden weight fluctuation, and intense nausea after just a few bites of food. Her local care team at the time attributed these symptoms to her pregnancy, but a few weeks later, Ali went to her community emergency department, worried that she may have a virus.

Following an echocardiogram, she was immediately transferred to Brigham and Women’s Hospital (BWH), where a team of high-risk obstetricians and heart failure specialists were intensely focused on her care. Ali previously had been diagnosed with endomyocardial fibrosis, a rare disease that causes a thickening of the walls of the heart, resulting in difficulty pumping and fluid retention.

Ali’s physicians at BWH had never seen a case of endomyocardial fibrosis in a pregnant woman, and with no experience to go on, they were deeply concerned for the health of both Ali and her unborn baby.

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