| 
Division of Maternal Fetal
Medicine Provides Advanced Care for High Risk Pregnancies
First diagnosed with Type 1 diabetes at age ten, Cheryl
Meidling grew up believing that she could never give birth
to a healthy baby. The American Diabetes Association reports
that as recently as 20 years ago, women with diabetes were
often advised to avoid having children because of the risk
of birth defects for the baby and complications for the mother.
I realized that if I was going to try to have a healthy
baby, that I needed the diabetes to be well controlled before
I became pregnant, says Mrs. Meidling. It was all in my hands.
In Type 1 diabetes, the body does not produce insulin, a
substance necessary for the human system to use sugar. When
sugar accumulates, it can damage the eyes, kidneys, nerves
or the heart. In the same way that high blood sugar can cause
complications for the mother, it can also cause birth defects
for her unborn baby.
In 1996, Mrs. Meidling worked closely with Robert Melfi,
M.D., endocrinologist with the Endocrine and Diabetes Group
at the Saint Barnabas Ambulatory Care Center, an affiliate
of the world renowned Joslin Diabetes Center, to tightly
control her blood glucose levels, and was referred to physicians
who checked the health of her eyes, heart and kidneys. Next,
she met with the perinatologists at the Division of Maternal
Fetal Medicine at Saint Barnabas to create a prenatal plan.
This plan included prenatal vitamins, folic acid and tight
monitoring of her blood sugars.
It is crucial for diabetics to control their blood glucose
levels prior to conception and during early pregnancy to
help prevent birth defects and lower the risk of miscarriage,
says Richard Miller, M.D., perinatologist and associate director
of the Division of Maternal Fetal Medicine.
A baby's organs, including the heart and the foundation
for the brain, spinal column, muscles, and nerves, are formed
by six to eight weeks of pregnancy, he relates. When diabetes
is well controlled, the risk of birth defects drops from
17 percent to 3 to 5 percent, which is the same as that of
women who do not have diabetes.
A Closely Watched Pregnancy
After carefully controlling her diabetes with the help of
an insulin pump, Mrs. Meidling became pregnant and monitored
the health of the baby with the assistance of the perinatologists
and their varied diagnostic tools, including ultrasound.
At first I was afraid that something was going to be wrong
with the baby, but the doctors kept a very close watch over
my pregnancy, she says. I felt very secure and comfortable
and was impressed by the care I received.
Mrs. Meidling checked her blood sugar levels with a home
blood sugar monitoring system performed seven to nine times
each day. In later pregnancy, high blood glucose stimulates
the baby to produce more of its own insulin, which causes
the baby to form extra layers of fat. This results in a large
birth weight, which makes delivery difficult. High blood
sugar can also cause hypoglycemia in the newborn. The baby
has been producing extra insulin to deal with the extra glucose
and at birth its blood glucose may drop precipitously.
After many months of careful planning and diligent monitoring,
Mrs. Meidling delivered a healthy 6 pound, 14 ounce baby
boy named Matthew on February 1, 1997. With the help of the
Division of Maternal-Fetal Medicine, Mrs. Meidling and husband,
Richard, continued to enlarge their family with the birth
of 7 pound, 9 ounce Sean on July 6, 1999 and 7 pound, 10
ounce Justin born on November 25, 2001. These days the busy
family participates in sports activities and manages to keep
up with the demands of three active boys.
When we saw each of our perfect babies we were just so thankful,
Mrs. Meidling says. I was in shock because I never thought
I would be able to have children. All the hard work and numerous
doctor visits and tests had finally paid off. The Division
of Maternal-Fetal Medicine helped me to deliver three healthy
babies. The entire staff was wonderful and I would recommend
them to anyone.
The Division of Maternal-Fetal Medicine
The members of the Division of Maternal-Fetal Medicine are
extensively trained experts in the field of perinatal medicine
and the treatment of women who anticipate or are experiencing
a high-risk pregnancy. High-risk pregnancies can be managed
with special testing and procedures to promote the health
of both baby and mother.
Care beginning in the months prior to pregnancy or during
the pregnancy can include advanced diagnostics (including
ultrasound, amniocentesis and chorionic villus sampling);
direct fetal assessment (including invasive procedures such
as intrauterine therapies and fetal surgeries); and genetic
counseling and education.
Treating Patients With Special Needs
Patients are most commonly referred for prenatal diagnosis,
to determine if the fetus is developing normally. When problems
occur, the perinatologists work with pediatric surgeons,
pediatric cardiologists, neonatologists and geneticists to
ensure that the baby receives the best care possible. Some
conditions involving the fetus, such as an arrhythmia, can
be treated through fetal intervention and surgeries.
Many women have pre-existing medical conditions, such as
diabetes, sickle cell anemia, hypertension or lupus, that
may worsen because of pregnancy and threaten the health of
mother and baby. The team treats these women with specialized
care, such as a comprehensive diabetic program, which includes
preconceptional counseling, home glucose monitoring, fetal
echocardiograms, antepartum fetal surveillance and postpartum
care.
Some pregnant women develop complications unique to pregnancy,
such as preterm labor, premature ruptured membranes, preeclampsia
or complications due to multiple pregnancies, and require
assistance. Other women are referred for evaluation of prior
pregnancy losses. Many of these losses may be due to a treatable
condition.
The Maternal-Fetal Medicine Team
The medical team consists of perinatologists, perinatal
nurses, ultrasonographers and genetic counselors with extensive
training in high-risk pregnancy care. The perinatologists
are board-certified in obstetrics and gynecology, as well
as maternal-fetal medicine. They serve as consultants to
physicians in managing a complicated pregnancy, and assist
obstetricians in the tri-state area in the care of high-risk
patients. As members of the departmental faculty, they are
involved in teaching and research in areas such as unique
fetal therapies and pregnancies with multiple fetuses.
For an appointment with the Division, please call (973)
322-5287.
[ top ] [ back to news
index ] |
