Maternal-Fetal Medicine
What’s the difference between a maternal-fetal medicine specialist and an obstetrician?
A maternal-fetal medicine specialist (MFM or Perinatologist) receives a traditional obstetrics and gynecology education but with an additional three years of training to learn how to treat medical complications that are related to pregnancy. In addition, the maternal-fetal medicine specialist has extensive training in assessment and treatment of fetal problems.
You may be referred to a maternal-fetal medicine specialist if you have a pre-existing medical condition prior to pregnancy, develop a medical condition during pregnancy or have problems during delivery. Additionally, you will see a maternal-fetal medicine specialist during pregnancy if there is any question about your baby’s growth or wellbeing. In this case, the maternal-fetal medicine specialist will coordinate your care as well as your baby’s during pregnancy and at delivery with the help of a pediatric care team.
Should I see a maternal-fetal medicine specialist before pregnancy?
It may be beneficial to consult with a maternal-fetal medicine specialist before pregnancy if you have one (or more) of the following:
- Pre-existing medical condition. There are many pre-existing medical conditions that need to be monitored closely during pregnancy, (e.g., diabetes , lupus , kidney disease and high blood pressure). In some instances, a maternal-fetal medicine specialist may change the medication you’re taking to maintain your health and prevent any adverse effects to your growing baby. If you have diabetes optimizing your blood sugar control prior to getting pregnant can help reduce the risk of fetal anomalies. If you struggle with obesity , we can review the benefits of weight loss before pregnancy, and help devise a plan to achieve this. Gaining less weight or losing weight in a healthy manner can reduce your risk of developing conditions such as high blood pressure and gestational diabetes during pregnancy.
- Genetic risks. Preconception genetic screening has become more common in recent years as technology has advanced and testing has become more accessible. If you have family members with certain diseases or if you belong to an ethnicity that has a greater risk of developing specific conditions (such as sickle cell disease or Tay-Sachs disease), genetic screening can be used to assess your and your partner’s risk of being a carrier. Also, common genetic conditions, such as cystic fibrosis or spinal muscular atrophy, can be screened for with a blood test.
Additionally, if you have a child affected by a genetic disorder or syndrome, a maternal-fetal medicine specialist can help determine how likely these genetic disorders are to occur again in a future pregnancy. Always speak with your healthcare provider to determine what’s best for you and your pregnancy.
Dr. Ward on Maternal-Fetal Medicine
What conditions may lead to a high-risk pregnancy?
The following list contains some of the most common conditions that would likely lead to a maternal-fetal medicine specialist helping care for your pregnancy.
- Diabetes. If you have diabetes before you become pregnant, you will likely be referred to a maternal-fetal medicine specialist to monitor your condition and determine the proper medications. Preconception counseling is ideal. Developing diabetes during pregnancy (gestational diabetes) is very common, and your obstetric provider will likely be able to care for you without a maternal-fetal medicine consult. If a maternal-fetal medicine specialist is consulted for gestational diabetes, he or she will follow your baby’s growth and well-being, and manage your health with nutrition counseling, glucose monitoring and, possibly, medications.
- Pre-eclampsia. Pre-eclampsia is a condition unique to pregnancy where you have high blood pressure in conjunction with protein in your urine and edema (swelling of the skin). In some women with pre-eclampsia, liver or platelet abnormalities are present. You may be referred to a maternal-fetal medicine specialist depending on the severity of your disease or if you are preterm. The only way to treat pre-eclampsia is to deliver your baby, so this condition has to be closely monitored to balance these complications against the risks of delivering your baby early.
- Hypertension (High Blood Pressure). If you have hypertension before pregnancy, a maternal-fetal medicine specialist will monitor your baby’s growth and may be consulted if problems arise. Some medications commonly used outside of pregnancy to treat high blood pressure do not work in pregnancy.
- Multiples. Pregnancies with twins or higher-order multiples have a greater risk of complications. Women with multiple pregnancies are more likely to develop pre-eclampsia or go into preterm labor. Twin pregnancies have a higher risk of fetal anomalies and growth problems, especially if they share a placenta. If you have a multiple pregnancy, a maternal-fetal medicine specialist will closely monitor the pregnancy by performing additional ultrasounds. The maternal-fetal medicine specialist will recommend how and when your babies should be delivered.
- Sexually transmitted diseases (STDs). In general, your obstetric provider can treat you for sexually transmitted diseases that may occur during pregnancy or if there is a pre-existing STD, such as herpes. In certain cases, consultation with a maternal-fetal medicine specialist will be required. For example, if you are being treated for syphilis and an ultrasound shows that your fetus may be affected, a maternal-fetal medicine specialist will provide further care and management. Women with HIV are also generally cared for by maternal-fetal medicine specialists because the medication regimens are complex.
- Obesity. Women who are obese have a greater risk of developing diabetes, hypertension and pre-eclampsia during pregnancy. Obesity is the one of the only health conditions affecting pregnant women that can be changed before pregnancy, which is why maternal-fetal medicine specialists encourage women to lose weight through healthy strategies.
Will all my future pregnancies be high-risk?
Having one high-risk pregnancy does not mean that all your future pregnancies will be high-risk as well. You may have a fetal complication occur in one pregnancy that wouldn’t in another, and certain health conditions may change over time.
However, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy. If this occurs, your obstetric provider will manage your pregnancy using medication, and a maternal-fetal medicine specialist will monitor your cervical length with ultrasound surveillance.
Ultimately, the most important thing to remember about having a high-risk pregnancy is that your maternal-fetal medicine specialist and Ob/Gyn have the knowledge and experience required to keep you and your baby as healthy as possible.
