Some authorities feel strongly that management with a maternal-fetal medicine specialist should occur if there is a history of lupus in association with any effect of disease upon the major organs (lungs, heart, kidneys), history of stroke, recent lupus flare, history of problems with pregnancy (such as preeclampsia or recurrent miscarriage), or antibodies that could affect the baby (antiphospholipid antibodies, or SS-A or SS-B antibodies). SLE or other rheumatic diseases in pregnancy - Patients with a history of lupus are frequently followed in conjunction with a maternal-fetal medicine specialist. Systemic Lupus Erythematous, Sjogrens Syndrome, or other rheumatologic diseases *.In addition, patients should be followed closely with regular ultrasound for growth to screen for FGR and have fetal monitoring in the third-trimester pregnancy to prevent stillbirth. Generally, patients with moderate to severe kidney disease should undergo close follow-up of blood pressure and kidney function with more frequent visits, blood tests, and urinalysis. Medications customarily used for this condition may have to be discontinued due to effects on the baby, and possible medication alternatives should be immediately discussed with your obstetric provider, maternal-fetal medicine provider, or nephrologist. An increased risk of preterm birth, fetal growth restriction (FGR), and stillbirth occur in gestations complicated by renal disease. Renal disease in pregnancy increases the likelihood of preeclampsia, and the pre-existing kidney disease may make it more challenging to diagnose. ![]() Renal disease - Patients with moderate to severe kidney problems may be aided by seeing a maternal-fetal medicine specialist and nephrologist (kidney specialist) in conjunction with their obstetrician. Centers accredited in fetal echocardiography by the American Institute of Ultrasound in Medicine may be found at the following link looking under the specialty of fetal echocardiography - click here Due to the specialized ultrasound required and intensive follow-up, maternal-fetal medicine follow-up is recommended. Fetal echocardiography also requires specialized training and equipment usually performed only by maternal-fetal medicine subspecialists or pediatric cardiologists. A fetal echocardiogram is recommended to rule out heart defects at a visit between 18-24 weeks of pregnancy. Furthermore, close follow-up of growth, glucose levels, and antepartum fetal testing (a test of fetal well-being) is needed. ![]() Detailed ultrasound (usually performed by maternal-fetal medicine specialist or a provider with specific specialized training is warranted and often only available within maternal-fetal medicine subspecialist offices. Diabetes - To decrease the risk of miscarriage and congenital disabilities, diabetic patients ideally should undergo preconception counseling.
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