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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Zika Virus: What You Need to Know

Posted by Brigham and Women's Hospital March 1, 2016

The CDC recommends that women who are pregnant or trying to become pregnant should not travel to countries where Zika virus transmission is occurring.

The CDC recommends that women who are pregnant or trying to become pregnant should not travel to countries where Zika virus transmission is occurring.

Dr. Paul Sax, Clinical Director, Division of Infectious Diseases at Brigham and Women’s Hospital, provides important information about Zika virus – symptoms, how it’s spread, its link to microcephaly, advice for pregnant women, and tips for prevention.

Can you tell us about the Zika virus, including its symptoms and how it is spread?

Zika virus is a tropical infection spread by mosquitoes. It has been known since the 1940s, but it only recently entered the Western Hemisphere. The largest outbreak so far has been in Brazil, but it has now been observed throughout much of South and Central America and the Caribbean. When symptomatic, the illness tends to be mild, with some people noting fever, headache, rash, joint aches, and red eyes. Eighty percent of people have no symptoms at all.

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Preeclampsia: Pregnancy Complication Raises Heart Disease Risk

Posted by Brigham and Women's Hospital February 14, 2013

Preeclampsia in expectant mothers leads to high blood pressure.

Today’s post is written by Dr. Ellen Seely, Director of Clinical Research, Endocrinology, Diabetes and Hypertension Division at Brigham and Women’s Hospital (BWH).

Recently, the serious nature of preeclampsia, a complication of pregnancy, was highlighted on the popular TV series, Downton Abbey. During an episode that aired in January 2013, Lady Sybil Crawley suffered complications from the condition before delivery and after giving birth. In expectant mothers, preeclampsia results in high blood pressure and increased levels of protein in the urine. In some severe cases, preeclampsia can lead to eclampsia (seizures) and an increased risk of death.

Doctors have known about eclampsia for many centuries though its direct causes are unknown. The only cure for a mother-to-be remains delivery of her baby. In some serious cases, an early delivery, at times requiring Cesarean section, may be recommended, despite the health risks of a premature birth for the baby.

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