By Michaela Gibson Morris
Pregnancy is as old as the human race, but that doesn’t mean it’s without perils.
With the benefit of modern medical practice, most women and babies sail through the process. But some moms and babies need extra assistance to navigate gestation and arrive at the best possible outcome.
Not every complication is foreseeable, but there are known factors that put moms and babies at higher risk of complications, said Dr. Justin Brewer, a maternal fetal medicine specialist who joined the North Mississippi Medical Center Women’s Hospital staff in August.
Some risk factors can be identified before a woman gets pregnant.
Women who become pregnant after age 35 are at increased risk for chromosomal abnormalities in addition to having other health issues to manage.
“Because they’re older, they’re more likely to have other health issues,” such as high blood pressure and diabetes than younger moms, Brewer said.
Regardless of age, women with chronic medical conditions including lupus, asthma, seizures and blood clots also carry extra risks.
In some cases, their doctors may need to adjust the medications used to manage the conditions to reduce the risk of adverse impact on the baby. Especially with conditions like diabetes and high blood pressure, the moms may need to be monitored closely throughout the pregnancy.
Other risk factors include a history of problems during previous pregnancies, like developing pre-eclampsia, gestational diabetes, delivering preterm, or a personal or family history of birth defects.
Many of these moms-to-be can benefit from preconception counseling, where they better understand their risks and make adjustments where possible, Brewer said. In cases involving a family history of birth defects or inherited diseases, genetic counseling may be appropriate.
“We’re looking for ways to optimize the mother’s health before she attempts pregnancy,” Brewer said.
There are risk factors that arrive with pregnancy. Any pregnancy involving triplets or other multiples is automatically considered high risk because of the risk of preterm labor.
Women who develop pre-eclampsia – caused by an unsafe rise in blood pressure – also need to be monitored closely. Mothers are at risk for seizures and stroke if the high blood pressure can’t be controlled. The baby can become growth-restricted as well.
Women who are pregnant after 35 have options for screening after they get pregnant. There’s a range of tests available, Brewer said, including cell-free fetal DNA test.
“There’s no risk to the baby,” Brewer said, and it looks specifically for three chromosomal abnormalities including Down syndrome. The test, which is more limited than amniocentesis, is performed using a simple blood draw from the mother.
It’s important to know, so families and doctors can make plans for delivery.
“It can alter the timing and location of delivery,” Brewer said.
Down syndrome babies, for example, sometimes need additional support because their muscles have lower tone, Brewer said. It’s important for those moms to deliver at hospitals with pediatricians and neonatologists immediately available. They are also at an increased risk for heart defects, which may indicate a need for further screening and referral to a pediatric heart surgery center.
The role of a fetal maternal specialist is to back up obstetricians, providing in-depth screening and management when needed, Brewer said. Most of the moms that come to see Brewer will return to their regular doctor for care and delivery.
“I don’t deliver babies,” said Brewer, but when conditions like gestational diabetes and pre-eclampsia are threatening the health of mom and baby, he helps make the decisions about when to deliver.
Women who needed more consultation than was available from their obstetrician previously had to travel to Memphis, Jackson or Birmingham.
“Now we will be able to keep more expectant mothers here so they can continue to use their own ob-gyn,” said Ellen Friloux, administrator for Women and Children’s Services at NMMC.
In addition to screening and diagnostic procedures, Brewer and his staff conduct targeted ultrasounds.
“We evaluate the anatomy in high detail,” Brewer said. “It’s why it takes an hour.”