While disease modifying therapies (DMTs) have been shown generally to reduce relapse rates, none of them are indicated for use during pregnancy and lactation. Therefore, the question of when to restart DMTs postpartum remains a difficult one for physicians counseling MS patients who wish to breastfeed their children.
Trying to predict the risk of relapse for any one individual is very difficult. The risk factors for postpartum attacks include ...
A recent study addressed the outcomes of pregnancy in women with MS who were taking fingolimod (Gilenya). Of 66 pregnancies on the medication, 41 attempted to carry the pregnancy to term. 26 of the 41 had healthy newborns. There were, 9 miscarriages, 24 elective abortion, 4 ongoing pregnancies and 1 with an unknown outcome. Of the elective abortions, four were for fetal malformations. There were 5 cases with abnormal fetal development in the 66 pregnancies. Poor fetal outcomes were found in 14.6% of the pregnancies. This contrasts with a 3% rate of poor outcomes for most pregnancies.
This paper highlights the importance of care in planning pregnancies in MS. It is now known that women with MS have ...
The influenza virus, better known as the flu, has been proven over and over to have the potential to cause serious disease in pregnancy. That includes an increased risk that when pregnant women “catch” the flu, they may require admission to the intensive care unit, require a ventilator and, less commonly, even death. It’s serious. Babies of women who are infected with the flu during pregnancy are more likely to be born prematurely and are at increased risk for stillbirth.
We recommend the flu vaccine at any point in pregnancy and offer the single dose, preservative free vaccine in our office to all pregnant women (with the exception of those who have a medical reason not to get it.) A common misconception is that the vaccine causes the flu - it does not. Another misconception is that it is not safe for the developing baby to be exposed to the vaccine itself or the immune response it generates. There is no evidence to support this fear in almost 50 years of administrating this vaccine and close follow up of those receiving it.
We recommend the flu shot, which is an inactivated virus. The Flumist is a live attenuated virus that is not recommended in pregnancy.
Your family members should also receive the vaccine as they can pass the flu on to a newborn who has not yet gotten the vaccine. Babies can suffer severe complications if they are infected with the virus before they can receive the vaccine.
The other vaccine we recommend during pregnancy is the Tdap booster. The benefit of the pertussis booster outweighs any perceived risk. Pertussis, or the whooping cough, is at epidemic levels especially on the west coast including Washington State. That may be ...
Below are answers to a few common questions that I often receive from my patients:
What if I am taking birth control?
Depending on the type you use, you may want to stop birth control a few months in advance of planned conception. Birth control suppresses ovulation and impacts fertility. The good news is the affects of birth control do not last long. For example, we recommend that women finish a pack of birth control pills, have their next menstrual cycle and then go through one additional full cycle before attempting to conceive. During this time, it is important to use a barrier method of contraception (condoms) if you plan to engage in sexual intercourse.
An IUD (Intrauterine Device) can thin the lining of the uterus. I recommend that patients with an IUD ....
Odds are that if you live in or around Seattle, either you or your children were born at a Swedish hospital. And after last year, those odds are even greater after our nurses and doctors delivered a record 9,014 babies in 2013.
Last year included a record number of births at Swedish Issaquah (1,149) and Swedish Ballard (1,022).
We attribute last year’s growth to our excellent reputation in the community as well as our outstanding ability to provide our patients with a safe, convenient and comfortable birthing experience. Last year we expanded our range of offerings for families when we opened our new Lytle Center for Pregnancy & Newborns and our Level II nursery at Swedish/Issaquah.
Now for some fun facts:
August saw ...
Congratulations! You just found out you are pregnant and so many things start going through your mind. When you’re not dry heaving or completely exhausted you start planning for your exciting future but in the back of your mind you wonder… how do I know everything is okay with my baby?
We are entering an exciting time in the field of obstetrics that involves less invasive and more accurate options for genetic testing in pregnancy. ACOG, the American College of Obstetrics and Gynecology, recommends that all women, regardless of maternal age, be offered prenatal testing for chromosomal abnormalities.
For quite sometime our options for this testing have been somewhat stagnant. We have offered noninvasive risk profiling that involves a mixture of blood tests and ultrasounds at various times in the first and second trimesters to help evaluate the baby’s risk for Down syndrome or other lethal chromosomal abnormalities. Depending on how these tests are processed, the sensitivity ranges from 80-95% with about a 5% false positive rate. They are fairly accurate at identifying babies at higher risk, but can have false positive results (meaning an abnormal result followed by more invasive testing that shows normal results but of course this causes a lot of worry for the patient).
Obviously we want to be able to offer testing that has a high rate of detection and a low rate of false positives. More invasive testing is often offered also. This testing involves removing a sample of placental cells called chorionic villus sampling, or removing a sample of fetal cells from the amniotic fluid called amniocentesis. These cells are then analyzed for chromosomal abnormalities. Although these invasive tests are the most accurate, they do carry a small risk of miscarriage or fetal loss.
Fortunately, new testing has come out on the market called cell free fetal DNA testing. This is ....
Swedish’s Dr. Jennifer Jaucian, an OBGYN physician serving patients at the Issaquah hospital campus, spoke with Q13’s Tina Patel on Friday, Oct. 4 to talk about how much weight expecting mothers should gain during pregnancy.
The interview came after a new study shows that expecting mothers who gain more weight than is recommended have an increased risk of having overweight children.
Dr. Jaucian advised women to understand how much weight they should gain during pregnancy based on their body mass index, to work with their doctors to track their weight through each trimester and ideally to reach an ideal weight before becoming pregnant.