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>> good evening.

Welcome to "talk with your doctor."

I'm dr. doug eberhart.

>> i'm and dr. israel zighelboim.

>> 6 to 8% of pregnancies are considered high risk in the united states.

>> they have an increased potential for complications affecting the health of the mother, baby or both.

Tonight, we highlighted what increases the risk and what is necessary for care in the mothers.

>> in just a minute, we'll be joined by our panel of experts.

"talk >> welcome back to the show.

Whether it's your first pregnancy or third, carrying a baby to term does carry a certain amount of risk.

What are the risks?

How can they be managed?

Among the things we hope to find out from our panel of experts.

Let's meet them.

>> absolutely.

We are lucky to have dr. meredith birsner.

She trained at johns hopkins and did additional training at jefferson.

Other way around, actually.

She has been with us a couple of years now.

Dr. andrea ardite worked at a unit in brooklyn that took care of high-risk pregnancies.

Dr. gifford one of our on former trainees cape to us from northwestern.

She is one of our great obgyn doctors.

I'll start with dr. birsner.

What makes a pregnancy high risk?

There are those that take care of high risk pregnancy.

What makes them high risk and what are high-risk pregnancies you take care of?

>> there are a lot of reasons a woman's pregnancy can be more complicated.

That may be maternal reasons, complications that are preexisting such as high blood pressure or diabetes.

There are a lot of different fetal conditions that make a pregnancy more complex.

Maybe two or three babies.

Hopefully not more than that.

There are various structural conditions that can complicate a baby's in utero development.

There are a lot of other complex factors such as the prior preterm bertha can make a pregnancy complicated.

Our job is to identify the risk factors and st stratify them and manage them as the pregnancy goes forward.

In an ideal setting, we'll discuss them prior to pregnancy to set a woman up best as possible for a good out woman come in the pregnancy.

There are a lot of reasons people can be high risk.

>> you identify patients that have the risk factors.

Part of your job is to assure them that they won't necessarily have a bad outcome.

You refer them to your colleague.

What is the journey of the pregnancy like?

How do you share the patients with specialists during the course of the pregnancy?

>> it's nice to have the added support we need for conditions we don't see all the time and maintain the relationship you have.

The patients get used to seeing you, but things must be done by specialists that we wouldn't be able to take care of, so we feel comfortable sending them to the maternal field office so they could be seen, get more accurate risk factors and risk reduction that we wouldn't be able to share back with us so we can carry on with care of the patient.

They are able to keep the relationship with the general o.b.

And get all of the special care they need.

It's important because we know the relationship they form with the general ob will help them receive better care than sending them somewhere we don't receive back.

That bond is important forfacients.

It carries on for future pregnancies and post pregnancy also.

>> something we do well at st.

Lukes, we pride ourselves to have the continuing care.

The third piece of the puzzle is what happens in the hospital.

Dr. gifford, you chose to be an obgyn hospitallist.

What is the advantage to having someone like you in the hospital 24-7, what added expertise and safety that brings to the patient?

>> i think it's about important role.

There is always someone to meet a patient if there is an emergency or unexpected delivery.

An obgyn laborist knows the system and is prepared to handle routine births to emergency c-sections or complications that were to arise any time during labor.

That's a role that prioritizes safety and prioritizes consistency in a setting that can often times be unpredictable.

>> that's an added layer of security ye i'm sure is provided.

We touched on pathology that can affect mother and baby.

Sadly, social factors, some of those social epidemics one being the drug epidemics we hear about touch the lives of pregnancy.

Can you talk about opioid disorder and how it affects pregnancies in the community today?

>> absolutely.

Opiate is one of the common complications we see in pregnancy.

It is not unique to the area.

It's a problem across the country.

Women with untreated opiate use disorder have not great access to medical care.

They often have many major life stressors that make regular daily living challenging.

Many of them have coexisting psychiatric disorders like depression.

Often those are untreated.

Many of these women have a higher risk for complicated pregnancies and not the best pregnancy outcomes.

We try to treat women with opiate use disorder in a nonjudgmental way.

We believe it's a chronic medical condition that needs treatment throughout pregnancy.

We will encourage women to use medication assisted treatment.

That is the term that we use to encompass medications that help treat a woman's craving for various opiates.

We know the medications reduce the risk of relapse in pregnancy, reduce the risk of overdose related deaths.

This helps women continue good quality prenatal care.

Because we treat it as a chronic medical condition, we treat them in parallel with their regular routine prenatal care because we are trying to treat this particular issue.

I think our hospital and this department in particular has been extremely supportive of our efforts.

As you know, about a month ago, we trained about 30 doctors prescribing because you have to have a special training for the dea.

Dr. ardite is one of those factors.

Dr. birsner as well.

>> you mentioned the ability to use those drugs during pregnancy doesn't only treat the cravings, importantly, it's safe to use them, which is important for our audience to know.

Dr. ardite, can you describe to us the difference between what a patient experiences during normal prenatal care and how having one of the conditions we talked about -- we mentioned maternal and fetal factors such as diabetes, high blood pressure, fetal growth restriction.

From the patient's experience, what do they see differently in prenatal care with these conditions?

>> a number of visits are greatly increased with complication or high-risk pregnancy.

One of the options we have is to explain that our part is important to their care as the prenatal center and medicine doctor.

We try to set up a whole plan so they know what their apartments are so most of our patients work and some is problems with access to care in terms of schedules and stuff.

That's the biggest thing.

They have multiple eyes on them throughout their pregnancy they wouldn't have with one set of eyes.

Sometimes the appointments become burdensome.

They understand that early in pregnancy.

I feel like that's important to them.

>> can you have dr. birsner explain to the audience, what are things that happen during prenatal care?

Ultrasounds are something that women pregnant even once have been exposed to in the last few decades.

What else are they trying to do in terms of diagnosis of complex conditions and ensuring mom and baby are doing well?

Do you want to share that?

>> we think about ultrasound as another piece of data on the patient.

It's not the first and foremost thing we take into consideration regular vital signs like blood pressure and patient's weight.

We take all of that into consideration.

Some of the ultrasounds involve doppler studies where we look at umbilical cord or the baby's brain.

There are procedures we'll do in the office if a woman needs diagnosis of a particular genetic condition or if we worry the baby has severe anemia.

We use those tools which are important.

>> what about in the general practitioner's office?

>> we ask questions in multiple ways about the same thing.

Sometimes we pick up more and more information about them.

Sometimes we find out what happens in the previous pregnancy that patients don't think are important in terms of this pregnancy.

Counseling and history taking is one of the strongest parts of our care to get them to the area they need to go to.

>> how about in the labor and delivery unit?

How do we ensure mom and baby are doing well?

>> patients play a roll in monitoring their own data.

With blood sugar, we rely on patients to check their own blood sugar and do home monitoring so we can help optimize blood sugar.

>> in terms of assuring well being in labor and delivery, if you can briefly share with us the things you do to ensure mom and baby are doing well?

>> ultrasound and doppler radar, listening to the fetal heartbeat is a comforting feeling for moms and an important way to monitor delivery.

Lab tests everyone gets on admission, and we follow closely in high risk conditions like pre-clamps ya, making sure organ functioning is going according to plan.

And we check to see if conditions are evolving over the course of labor.

>> suffice it to say, how well a mother takes care of herself before and during pregnancy will ensure how smoothly the pregnancy goes.

Away.

>> a number of things may need to be monitored during a pregnancy.

We are discussing those things and what gives the mother a best chance of having a safe and healthy delivery.

We continue with a caller's question.

Walt has phoned in.

Walt would like to know what is the earliest in a pregnancy am knowcentesis can be done?

>> around 16 weeks.

There is a sampling to be done between 11-13 weeks.

>> when you are expecting, the unexpected can occur.

Scott has a question.

Let's hear it?

>> scott wonders what the effects of alcohol are with respect to the newborn?

>> alcohol causes fetal alcohol syndrome.

It can cause facial abnormal altties or delay.

No amount of alcohol is acceptable.

Patients on birth control that are sexually active, i talk to them about alcohol.

I remember my mom said we were told to have a glass of red wine in the third trimester to sleep.

I said we don't say that anymore, mom.

Nobody knows what that does to the baby.

>> if a patient comes to you to get pregnant what do do you recommend as far as a healthy weight?

>> you may continue diet and exercise you are familiar with.

For patients overweight or obese, we recommend weight loss before conceiving.

During pregnancy, you can continue that activity.

Other important things pre-pregnancy period are to take a daily multivitamin.

Avoiding drug use, avoiding alcohol, avoiding smoking and having a regular checkup, blood pressure and other chronic medical conditions.

>> you have great advice.

Knowing about many of these things before pregnancy occurs is beneficial.

Pre-pregnancy visits are becoming commonplace.

Those are the time to discuss the things dr. ardite was saying.

Sounds like patients are hearing more and more about the use of aspirin, full strength dose or baby dose during pregnancy.

What is the science or conditions behind which this is being used?

>> we are now using aspirin in pregnancy to reduce a woman's risk of pre-clamps ya that affects 5 to 10% of women.

When there are 4,000,000s births a year in this country, that's a lot of women.

We are prescribing regular aspirin on a regular basis.

In pregnancy, 325-milligrams is not the dose to take so the american college of on stret tricks and gynecology says 21-milligrams is a good amount to take on a daily basis in pregnancy 11 to 12 weeks and continuing to delivery.

Since the publication last summer, there have been recent and larger studies done in countries where 81-milligrams is not the dose.

Looking at dosages of 100 to 150-milligrams. we are recommending higher dose of low-dose aspirin to reduce the risk of pre-clamps ya.

>> most women's pregnancies follow a healthy course.

When something goes wrong, can it be minute.

>> st.

Luke's weight management program presents a free information seminar thursday april 25th at 6:00 p.m.

>> when a woman learns she's pregnant, her first question is often, is my baby going to be okay?

A number of factors and developments go into answers that question.

We are talking about high risk pregnancy with our panel, and we continue with our question from jill in allentown.

>> jill wonders how common is gestational diabetes and any help to manage it?

>> that's a great question.

We tie that with other screenings we do.

We recognize the benefits of identifying and treating it.

Can you share the screenings we do in pregnancy?

>> sure.

All screening is done to optimize the mom's health and in turn optimize the baby's health.

Throughout that, we look at things common for pregnancy such as gestational diabetes.

We check to be sure there are no infectious diseases that affect the mom and could be transmitted to the baby such as hiv.

>> we check for for gonorrhea.

We test for j gestational diabetes.

We do a glucose test.

We check the sugars in one hour.

We want their bodies to intake and what the placenta is making to help the growth of the baby.

We do it early enough to make sure the patient gets a good amount of time with normal sugar and be well controlled for side effects such as large babies leading to c-sections and shoulder dislocation and optimizes mom's health.

Most of our women are young when they have a baby.

They are a captive audience.

Taking care of them during pregnancy, you set them up for lifelong wellness.

Gestational diabetes is done third trimester.

You can manage them with diet and exercise.

We send them to the nutritionist and medication as needed.

>> what every new mom to be should know.

Next question is from debbie in bethlehem.

>> debbie wonders why age 35 is the threshold of a high-risk pregnancy?

>> have the guidelines changed?

Why is that?

>> we think about increasing age along a spectrum.

One of the reasons 35 is considered advanced maternal age is because that is the age at which the risk of having a pregnancy affected by down syndrome equals the risk of a miscarriage to diagnose down syndrome in a pregnancy.

There is not anything particularly special that happens when a woman turns 35.

Just knowing that a risk of having a chromosome abnormalty increases over time.

>> why don't you share with us things we do actively or offer to all women to screen for abnormal m malts during pregnancy?

>> we offer testing for anything other than a normal number of chromosomes in a pregnancy.

We offer to every pregnant woman diagnostic testing in amniocentesis.

The american college sup supports diagnostic testing regardless of age or really anything.

We offer that to all patients, the blood work screening or diagnostic testing.

>> many problems can't be anticipated or come up with no explanation.

It's good that people like you are there to raise awareness and guide the expectant mother through the process.

Thank you for coming in tonight.

>> we have another show next monday, the subject of which we'll leave a surprise, but we promise it will be interesting and informative.

That is it tonight.

We hope you will join us for that program month.

Monday.

In the meantime, have a great night and a great week.