Mariam’s first pregnancy didn’t go as planned. However, the experience had one silver lining: developing a relationship with high-risk pregnancy expert Dr. Steve Rad.
After Mariam and her husband Arthur became pregnant in 2021, she searched for celebrity doctors on Instagram and saw that Dr. Rad received nothing but accolades from his almost 21,000 followers. “I thought, okay, he seems like a great doctor and a great person,” she says.
Unfortunately, after meeting with Dr. Rad, things didn’t go as planned, and Mariam had to end her pregnancy. However, she noted she was glad to have found Dr. Rad and would want him by her side for future pregnancies.
A second pregnancy begins brimming with hope
When Mariam and Arthur became pregnant again in 2023, Mariam immediately contacted Dr. Rad. “There was no question he would be my obstetrician,” she says. “My autoimmune condition and blood clotting disorder put me at a higher risk of having a miscarriage. He checked my baby’s heart because my previous pregnancy ended due to a congenital heart problem, and he wanted to be sure that these babies did not have the same issue..”
What is autoimmune disease?
Autoimmune diseases occur when the body’s immune system, which usually protects against harmful invaders like bacteria and viruses, mistakenly attacks its healthy cells and tissues. This happens because the immune system can’t distinguish between its own and foreign cells, leading to inflammation and damage in various body parts.
Two common autoimmune diseases are rheumatoid arthritis, where the immune system targets the joints, and lupus, which can affect the skin, joints, and internal organs.
Pregnancy in women with autoimmune diseases requires careful planning and close monitoring to manage the disease and minimize risks to both the mother and the baby. Collaboration between obstetricians, rheumatologists, endocrinologists, and other specialists is often necessary to provide comprehensive care when a patient has a genetic predisposition or family history that may cause issues.
How Dr. Rad approaches autoimmune diseases and pregnancy
Autoimmune conditions pose unique challenges and risks — especially during pregnancy. Depending on the specific autoimmune disease, these risks can range from pre-term birth and low birth weight to significantly more severe complications.
“It should be noted that the chances of congenital disabilities may increase if existing or developing conditions are not addressed immediately,” Dr. Rad says. “By reviewing and understanding conditions such as autoimmune disease, we can take measures to ensure a safe and healthy pregnancy.”
For Mariam’s pregnancy, Dr. Rad paid particular attention to every aspect of her health.
“If you’ve lost a baby, it’s important to have a doctor who’s on top of everything. I saw him every week, and he looked at every detail of my ultrasound,” she says, adding that other doctors rarely conduct weekly ultrasounds.
Call (844) 473-6100 or click here to schedule online
Dr. Rad’s prenatal care for patients with autoimmune disease involves:
Preconception counseling
This time is used to discuss the potential risks and management strategies.
A complete medication review
Medications that are typically used to treat autoimmune diseases may be teratogenic (unsafe) and interfere with a normal pregnancy. That is why it is critically important to look at every medication being taken and adjust, if needed, your medications for improved fetal outcomes.
More frequent prenatal visits
More frequent monitoring is usually necessary to effectively manage the autoimmune disease and the pregnancy.
Vigilantly maintaining a healthy lifestyle
It is essential to try your very best to eat well, pay attention to proper nutrition, manage stress, and, of course, avoid smoking (of any kind) and alcohol.
For those who are pregnant and have autoimmune conditions, this becomes critically important.
Intrahepatic cholestasis rears its ugly head at 34 weeks
Just when Mariam was in the home stretch of her pregnancy, Dr. Rad discovered she had been struck with intrahepatic cholestasis of pregnancy (ICP) after 34 weeks of pregnancy.
ICP is a type of liver damage that most often occurs in the third trimester of pregnancy. In this disease, the liver’s bile acid levels are reduced or stopped altogether. Bile is a digestive fluid produced by the liver that helps digest fats. When total acid flow is impaired, there is a buildup of bile acid levels in the liver, which can then spill into the bloodstream. ICP is the most common liver disease related to pregnancy.
The incidence of severe ICP occurs in 1 out of 1,000 pregnant women. Maternal bile acids can cross the placenta and accumulate in the fetus, and amniotic fluid increases the risk of stillbirth. Fetal complications may include gestational diabetes, fetal distress, preeclampsia, pre-term delivery, meconium-stained amniotic fluid and neonatal respiratory distress syndrome, and fetal death. This disease is very likely to reoccur, so patients with the disease should be monitored closely with subsequent pregnancies.
ICP risk factors include:
- Rising hormones the closer you get to your due date, which in turn may slow the liver’s bile flow.
- Genetics: This condition tends to run in families. Specific gene changes that may be linked to cholestasis of pregnancy have been identified.
- Although exact environmental factors have not yet been established, risk can vary by geographic location and season.
Immediate action is required to save Mariam’s babies
Mariam experienced intense itching in her third trimester, one of the symptoms of ICP. “At 34 of gestation weeks, my hands and soles of my feet started itching,” she says, adding she told Dr. Rad, and he had Mariam take a blood test to rule out this liver disorder.
“Unfortunately, these liver function tests can take a while to get results, but when my symptoms continued, Dr. Rad didn’t want to wait any longer because, after 37 weeks, ICP can be fatal to the baby.”
The timing of delivery is crucial, so at 36 weeks, the doctor scheduled an emergency C-section a month early, and Mariam delivered two healthy babies, a girl and a boy, Elia and Narek. The ICP results came back after Mariam’s delivery, proving that she had the condition.
“Thanks to Dr. Rad’s years of experience and knowledge, I delivered healthy babies,” she says, adding that her relationship with him has continued. “We’re in touch. He’s always been there. He still texts me.”
Why trust Dr. Rad with your high-risk pregnancy?
Expectant mothers with high-risk pregnancies worldwide are finding their way to Dr. Steve Rad’s Beverley Hills offices. Dr. Rad is recognized as one of the premier healthcare providers for high-risk pregnancy and maternal-fetal medicine.
A maternal-fetal medicine specialist (perinatologist) receives a traditional obstetrics and gynecology education but with an additional three years of training to treat medical complications and promote a healthy pregnancy.
Dr. Rad treats pregnant women with a full range of abnormalities, including vasa previa, placenta accreta (adherent placenta), placenta increta, placenta percreta (invasive placenta), velamentous cord insertion, and placenta previa.
Call (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.
Dr. Rad offers in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad travels to patients who need him throughout the U.S. and worldwide. The doctor offers virtual consultations worldwide.
Call (844) 473-6100 or click here to schedule online
Resources
Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomized controlled trial – The Lancet
https://doi.org/10.1016%2FS0140-6736%2819%2931270-X
Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates – Glantz – 2004 – Hepatology – Wiley Online Library
https://doi.org/10.1002%2Fhep.20336
Low serum selenium concentration and glutathione peroxidase activity in intrahepatic cholestasis of pregnancy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1245162
Prognostic and mechanistic potential of progesterone sulfates in intrahepatic cholestasis of pregnancy and pruritus gravidarum
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869673
Intrahepatic cholestasis of pregnancy
https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-obstetric-cholestasis.pdf
