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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Preventing Preterm Birth

Posted by Brigham and Women's Hospital August 18, 2016

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Medical and surgical treatment approaches can help prevent or delay preterm birth.

Contributor: Thomas McElrath, MD, PhD, Director of the Preterm Birth Clinic in the Division of Maternal-Fetal Medicine at Brigham and Women’s Hospital (BWH) and Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

There are a number of effective treatment approaches that can help prevent or delay preterm birth depending on a mother’s condition.

“Medications and, in some cases, surgery can be used to minimize risks associated with preterm delivery,” says Dr. McElrath.

One in nine babies in the United States is born prematurely (before 37 weeks of pregnancy). These babies have a higher risk of short- and long-term complications, and the risk increases the earlier the delivery.

To provide additional support to the cervix and help prevent preterm labor, specialists sometimes use a soft flexible ring (pessary) or a stitch (cerclage) at the cervical opening. Other approaches include the use of progesterone, a hormone, to prolong pregnancy.

In addition to a history of preterm delivery, other risk factors for preterm birth include prior cervical surgery, reproductive tract or uterine anomalies, multiple gestation pregnancy (twins, triplets, or more), low or high maternal age, and high blood pressure.

“Preconception planning and specialized care are key for women at high risk for preterm birth,” says Dr. McElrath. “A multidisciplinary team dedicated to evaluating, treating, and monitoring these patients will be able to ensure the best possible outcomes for babies and their families.”

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-Jessica F.

 

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Preterm Birth and Brain Development: A New Frontier of Newborn Care

Posted by Brigham and Women's Hospital October 29, 2015

One in nine babies in the U.S. is born prematurely.

One in nine babies in the United States is born prematurely. Thanks to innovations in medical care, more than 90 percent of these babies survive. However, nearly half of preterm infants may be at risk for learning problems later in life. Dr. Terrie Inder, Chair of the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital (BWH), is working to overcome this challenge.

Dr. Inder, who is dual-trained in pediatric neurology and neonatology, is expanding BWH research programs to study newborn brain development. One area of her research is the use of brain imaging to predict the likelihood of future learning problems. In 25 percent of preterm babies, Dr. Inder explains, brain imaging mirrors that of full-term babies, indicating a low risk for the development of learning problems. However, in about 20 percent of preterm babies, researchers see changes in brain imaging that suggest an increased risk for learning problems later in life. Based on these findings, additional therapy and support services may be recommended to positively influence brain development.

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What’s a NICU Mom Thankful For?

Posted by Brigham and Women's Hospital October 16, 2014

The boys celebrate their first birthday with NICU nurses Kathy Moran (left) and Mary Ellen Musynski.

The breadth of medical expertise and advanced technology available in a Level 3 neonatal intensive care unit (NICU) is invaluable for treating and monitoring babies born with dangerous medical conditions. But helping these babies and their parents involves much more than providing state-of-the-art medical care.

Karyn, a North Shore mother of triplets born at Brigham and Women’s Hospital (BWH), is well aware of the scope of care provided in a NICU. She’s thankful for all the people who helped take care of her triplet sons – and her – while the boys recovered in the BWH Neonatal Intensive Care Unit in the fall of 2012. That includes people she saw nearly every day and people she never saw at all.

Her boys Tyler, Caleb, and Nathan were born at 27 weeks that fall. As expected with any child born that early, they all had issues with lung development, breathing, and feeding.

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Study Shows Smoking Bans Benefit Kids

Posted by Brigham and Women's Hospital July 17, 2014

Passive smoking is linked to premature births, birth defects, asthma, and lung infections.

We know that smoking cigarettes is bad for adults, but a 2014 intercontinental study demonstrates how beneficial public smoking bans are for children.

Nearly half of the world’s children are regularly exposed to second-hand smoke. Passive smoking is linked to premature births, birth defects, asthma, and lung infections. Studies also have suggested that being exposed to second hand smoke during childhood may have long-term health implications, contributing to the development of chronic diseases, like heart disease and diabetes, in later life.

Laws that prohibit smoking in public places, such as bars, restaurants, and workplaces, are proven to protect adults from the health threats associated with passive smoking. In the first comprehensive study to look at how anti-smoking laws are affecting the health of children, researchers from Brigham and Women’s Hospital, Harvard Medical School, the University of Edinburgh, Maastricht University, and Hasselt University found that the introduction of new laws that ban smoking in public places in North America and Europe has been followed by a decrease in rates of premature births and hospital visits for asthma attacks in children. These findings were published in March 2014 in The Lancet.

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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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Sneaking Mom Inside the Incubator

Posted by Blog Administrator March 12, 2012

Baby in NICU

Mom’s voice may decrease complications in premature infants.

There’s a difference between surviving and thriving, and it turns out that a mother’s touch – or at least her sounds – can make the difference between one and the other.

According to new research from Brigham and Women’s Hospital (BWH), babies born extremely prematurely (26-32 weeks gestation) have fewer heart and respiratory complications when they are able to hear their own mother’s voice and heartbeat played through a soundtrack into their incubator.

It’s important to note that the research does not address survival rates. The technology and clinical expertise of leading Neonatal Intensive Care Units (NICUs), such as the Brigham and Women’s Hospital NICU, are already highly successful at saving the lives of premature infants. The problem is that because they are underdeveloped, preterm infants experience high rates of lung and heart complications, including apnea (a pause in breathing that lasts longer than 20 seconds ) and bradycardia (periods of significantly slow heart rate).

Like a mother’s womb, NICU incubators regulate temperature and humidity. And highly skilled nurses and care givers ensure that the premature babies receive adequate nutrients, oxygen, and attention. But researcher Amir Lahav, director of the Neonatal Research Lab at BWH, thought something else was missing – the simulation of the maternal sounds that a baby would hear in the womb.

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