San Diego Doctors Address Rise In High-Risk Pregnancies

Speaker 1: 00:00 High risk pregnancies around the rise, KPBS health reporter. Matt Hoffman has an inside look at how one San Diego hospital system is expanding operations to deal with growing numbers. Speaker 2: 00:13 Within the first week of us stating we definitely had the kid conversation and we both really wanted kids. Megan Speaker 3: 00:19 And Ricky Miller from San Marcos had been married for two years when they decided it was time to try for a baby. Speaker 2: 00:25 And, um, within a month we, um, we got pregnant. So it was pretty quick. Yeah, everything Speaker 3: 00:29 Was going great. But at around 19 weeks, when they went in to see the baby's gender, something was wrong. Speaker 2: 00:34 Her head was on, on track, but her limbs were a little bit smaller than they should meet. So that kinda got the concern going of like, maybe that's more in line with a genetic disorder. Speaker 4: 00:44 For me, it was scary because it was the same day we found out her gender. So it was, you know, we didn't know, we didn't know, it was a huge, happy day. We were stoked and we did the whole, like gender reveal via zoom, uh, with both of our families. And then like literally half an hour later, they called and said, something's Speaker 2: 01:03 Having a genetic disorder is not the worst thing, but there's a lot of complications that can happen in pregnancy like stillbirth and things like that. So that was really more, my fear was if the baby was going to make it or not, complications Speaker 3: 01:14 During pregnancy are scary. And while 80% of women have healthy pregnancies have blue cross blue shield study from last year, found rates of complications are rising due in part to more mothers with pre-existing conditions. One Speaker 5: 01:26 Of the ways to tackle our increasing number of premature births. Right? Well, it's, it's been steady, but we haven't been able to really put a dent in it for years and years. It's to make sure again, mom is in care Speaker 3: 01:38 Of Dr. Sean Donnish mint is the medical director for script's health [inaudible] program, which was started in 2018 and has been expanding Speaker 5: 01:46 Applications are on the rise. We've gotten more women who are, you know, uh, gaining more weight pre pregnancy diabetes is on the rise. Hypertension is on the rise. Something, we forget depression, anxiety is on the rise. And so therefore in order to address all these issues, you know, scripts, uh, decided to bring on a team. Donna Sherman Speaker 3: 02:05 Says the best way to address underlying conditions is to talk to a specialist before getting pregnant, because it could save the mother or the baby's life. Speaker 5: 02:13 Talk to the patient. We educate them. We refer them to our scripts. We'd have your colleagues for our diabetes and pregnancy program to undergo nutritional counseling, dietary counseling, you know, learn if they need to be on medication, how to take the medication. One Speaker 3: 02:26 Of the hardest conversations is telling a mother with pre-existing conditions that she maybe should not try to get pregnant right away. Speaker 5: 02:33 If a woman wants a child, it's very difficult. Let's say she has had a recent stroke. For example, a year later, she wants to have a child or she's had a recent heart attack or is she has cancer. And, uh, or again, some comorbidities that just are not conducive to a healthy pregnancy. And it's very difficult for women to hear that they shouldn't have children Speaker 3: 02:53 For Megan and Ricky Miller news, that their baby might have a genetic disorder and had a large hole in the heart cut off guard, especially because Megan had no known pre-existing conditions. Speaker 2: 03:03 We just decided early on that, we're not going to let this steal our joy because you can just have fear and be worried the entire time. Or you can say, no, I'm not going to have fear. I'm going to be joyful and believe that this is going to turn out. Well, Speaker 3: 03:16 Couple were told they might have to have their baby delivered at 25 weeks old, which would have required months of intensive care. But even after a small scare where Megan had to spend nearly a week in the hospital, Galilee Ryan was delivered at 36 weeks old weighing in at just three pounds, two ounces and the large hole in her heart. Speaker 2: 03:33 And they saw some, um, narrowing of the aortic arch. That's not there. Um, so yeah, it's just really a miracle baby Speaker 3: 03:42 Millers. Now spend most of their time at Scripps LA Jolla. Hoya's neonatal intensive care unit where Galilee is expected to be for at least a couple more. Speaker 2: 03:49 So she's eating about 50% by bottle right now. Uh, and then the rest they're putting through an NG tube. So that's increasing every day, she's eating more and more and having more strength every day. She's starting to cry and fuss, Speaker 3: 04:01 Megan says overall, while stressful, she's grateful for the care of the specialists who help her deliver her baby results from testing just found Galilee has no genetic disorder and there are plans for more kids, but yeah, we Speaker 2: 04:12 Want lots. I don't know. Well, Speaker 4: 04:16 She liked the day after she was born making us. Let's do another one. Let's do it. I Speaker 2: 04:21 Know if I want to be pregnant again, she needs a sister, brother. I don't know, five, seven. We'll see. Speaker 3: 04:27 Matt Hoffman. K PBS news. Speaker 1: 04:30 Joining me is Dr. Sean Donnish Monde and medical director for scripts. Health's Perry [inaudible] program. Dr. Donnish man. Welcome to the program. Thank you for having me Morena. Now we just heard this couple whose baby survived a high-risk pregnancy say they want many more children. Do you see that happening often? Speaker 5: 04:49 Absolutely. Absolutely. We see that quite frequently. And, uh, as we mentioned, uh, previously, uh, patients on women, um, will do anything, uh, for their children. And, uh, it's a, it's a very good time for patients, uh, to see their obstetrician and gynecologist to talk about again, pre pregnancy planning. This is a very important time where we can actually reduce some of the comorbidities we see in pregnancy. So some of the, some of the complications we've encountered in pregnancy Speaker 1: 05:18 Does having one high-risk pregnancy increase the chances that another will be high Speaker 5: 05:23 Risk. It depends. It depends. There are certain things that are really out of the patient's control. For example, if the patient has a baby with a chromosome abnormality or congenital abnormality, a lot of times those are out of the patient's hands. I mean, we always really, again talk about, uh, genetic and environmental, uh, risk factors. And, um, the combination of those obviously can lead to, uh, pregnancy complications. But, you know, there are comorbidities prior to pregnancy, such as obesity, such as chronic hypertension or elevated blood pressures or diabetes. These are things that we can on. If there are patients who are taking medications that may not be necessarily safe during pregnancy, if they're smoking, if they are using illicit substances, you know, if they're drinking alcohol, I mean, there are things that we can do to reduce the number of complications that we see in pregnancies, but, um, some of them may not necessarily recur begin again, again, it's not something that, uh, wasn't in the patient's control. Speaker 1: 06:22 Many women are having children at an older age. And I'm wondering how has that contributed to the rise in high-risk pregnancies? Speaker 5: 06:31 So, uh, women who are older have an increased associated risk for, uh, having preeclampsia, which is a condition in pregnancy where blood pressures, uh, rise, and they also have an increased risk for developing gestational diabetes, mellitus, uh, pre-Trump labor, uh, growth restriction with the baby. So, you know, uh, women that are older also have an increased associated risk with chromosome abnormalities. So these are some of the things we see and we counsel patients for, Speaker 1: 07:01 It must be so difficult doctor to advise a woman who wants a child that she should not become pregnant. I'm wondering how, and when does your team of medical experts, how do they come to that conclusion? Speaker 5: 07:14 It's a team effort, Maureen, we, uh, encourage patients to be, uh, seeking a preconception counseling, to talk to their providers about their medical history, their family history, their prior pregnancy history. And it is difficult. Again, there are some patients who are not good candidates to be pregnant. So we, uh, we offered them, you know, the option of adoption, obviously surrogacy, but, um, again, there are, it's it, there are opportunities, right? So it opens up the door for, if someone is for example, uh, obese or someone has hypertension or diabetes. Again, these are, um, w if a woman wants to be pregnant, then this is a good time for them to be able to, uh, really address a health, their lifestyle and, uh, uh, make sure they reduce their weight, you know, reduce their need for blood pressure medication or diabetes, and, uh, be more suitable to, uh, progress with pregnancy. Speaker 1: 08:11 Now it's ultimately the potential parent's decision about whether to have a baby. So how do you see your role as providing a warning or being an educator? Speaker 5: 08:23 Well, we see it as both. We see, uh, we are, um, educators, we're also educated by our patients to be honest with you. So I think that, uh, we, uh, as high risk obstetricians, I'm excited to come to work because I work with mothers and families that are interested in their pregnancies. They want the best outcome for their child. It makes it a wonderful time and worthwhile it's time for us to spend talking about pregnancy. What are the things that we need to do to ensure a healthy pregnancy for both mom and the baby? Uh, and it also, uh, can serve, like you said, as a warning sign for, for patients, for things to look out for in pregnancy. Unfortunately we're not as advanced yet. As far as prevention is concerned, we are very reactive, to be honest with you, Maureen and pregnancy. So we're very good at making diagnoses and preeclampsia and, you know, someone who's got diabetes, obviously someone who's got congenital abnormalities, you know, we're very good at picking these up, but I'm making the diagnosis. We're just not very good at prevention. So we have we're working on, um, on ways to make sure that patients are educated about the symptoms. For example, if high blood pressure in pregnancy, uh, making sure we can diagnose patients with earlier screening for diabetes. Uh, we can, again, warn patients that, that, uh, signs and symptoms in regards to premature labor. And so we all continue to learn from each other as obstetricians. And, uh, and as patients I've Speaker 1: 09:46 Been speaking with Dr. Sean Donnish Mon medical director for scripts Health's Periodontology program, and doctor, thank you so much for speaking with us, Speaker 5: 09:55 Maureen, thank you so much for your time. I appreciate you.