November 16, 2011
A recent medical study by Dr. Ira J. Chasnoff of the Children’s Research Triangle asserts that Hispanic women who have assimilated to American culture have a greater risk of having children born with fetal alcohol syndrome. According to Chasnoff , pregnant Hispanic women in San Antonio had the second highest drinking rate of 29 cities in the states that were studied. I find that rather hard to believe based on my twenty-one year history of taking care of Hispanic pregnant women. I have seen first, second and third generation Hispanic women and never encountered alcoholism among any of them. However, Chasnoff brings up an interesting point about alcohol and pregnancy. There are two schools of thought. According to Good Morning America, there are physicians such as Dr. Jacques Moritz, who think an occasional glass of wine is okay to consume during pregnancy however the U.S. Surgeon General and the American College of Obstetrician-Gynecologists advocate strict abstinence from alcohol while pregnancy.
According to medical literature, more than one-half of women of childbearing age report drinking alcohol and 1 out of 8 women report binge drinking. Alcohol appears to have negative effects throughout the entire pregnancy, not just during the first-trimester. At present, it is not known how many drinks consumed would affect the fetus, therefore strict abstinence is recommended before conception and during the pregnancy.
What happens if a pregnant woman is alcohol dependent? She will need close monitoring because of the adverse effect on the fetus including support from a multidisciplinary team of healthcare and social work providers. Women who consume three or more drinks per day are encouraged to enter an alcohol treatment program. Women who drink less than 3 drinks per day are encouraged to receive counseling. The pediatrician should be present at the birth of a woman who is alcohol dependent in the event the baby has alcohol withdrawal. Women who continue to drink should be discouraged from breastfeeding.
Dr. Chasnoff is to be commended for studying substance abuse and pregnant women but please don’t stereotype ethnic groups in the process. Pregnant women should abstain from drinking alcohol if at all possible. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 9, 2011
There are two types of physicians who practice medicine: those who choose medicine as a career and those who medicine chooses to serve. When you are called to serve, your relationship with patients extends beyond a 15 minute boundary. Such was the case of my relationship with my patient, Adriana Echeverri Tucker.
Adriana was 38 years old when she first entered my office both happy and anxious about her first pregnancy. If Adriana had medical insurance, I might not have met her. She was married to a U.S. citizen but had to wait the prescriptive time period for her green card so she was not eligible for state-funded insurance and her husband was self-employed.
Adriana was a dog trainer by trade and originally from Colombia, South America. Her ambition and entrepreneurial spirit was contagious and admirable. She was also a perfectionist and because we shared the same birth month, I intuitively understood her fears and concerns about this first pregnancy. I would see Adriana even without an appointment on days when her anxiety got the best of her. She was an older woman who had conceived without the benefit of In Vitro Fertilization and I, who was childless at that time, knew her pregnancy was a precious gift. She ultimately delivered a beautiful baby boy, who she named Martin. When she brought Martin to Colombia to see her family, she brought me back a gift that remained on my desk for years.
I eventually lost contact with Adriana until this past Friday night when I flipped through my local newspaper and saw her name in the obituary section. At first I wasn’t sure if it was the same person until I read the part about her being a dog trainer. A was a memorial service scheduled for the next day.
The parking lot was completely filled and there must have been over 100 people in attendance. When the pastor asked if anyone else wanted to make a comment, I was given a microphone and tearfully stated how fitting that her memorial service was held on the day before Mother’s Day because she was such a proud mother. Through the testimonies I learned that Adriana was a volunteer COP in her community. She organized a movie night once a month in her church. She became a U.S. in 2009 and her 7-year-old son, Martin, was thriving. I also learned that Adriana had late-stage cancer that was only recently diagnosed 2 months prior to her untimely death that occurred in Colombia, one day after she returned to the country of her birth.
Her service ended by the release of purple balloons in the parking lot symbolically returning her spirit back to God. Her life was abbreviated but purposeful. I am proud to have been her physician and equally proud to call her my friend.
September 7, 2009
Did you know that nearly seven babies will die before their first birthday for every thousand who are born in the U.S. and the rate for African American, Hispanic and Native American women, are even higher? Premature births occurring before thirty-seven weeks and low-weight babies, weighing less than five pounds account for the highest number of deaths in the U.S.
In recognition of September as the National Infant Mortality Awareness Month, I’d like to share some SMART tips to pregnant women:
S = Seek prenatal care early. Problems in pregnancy cannot be fixed at the last minute. Tests for genetic problems can only be detected in the early first and second trimesters. A first trimester ultrasound is also the MOST accurate in terms of a due date.
M = Mention all high-risk factors such as family history of diabetes, high blood pressure or bleeding. Do not omit information such as smoking or “recreational” drugs. It will come back to haunt you.
A= Ask to have your cervix measured during your ultrasound if there is a previous history of premature contractions or delivery. A cervical length of 2.5 centimeters or less is a risk factor for preterm labor.
R= Research your hospital and prospective physician or midwife carefully. Is the physician or midwife skilled in managing high-risk conditions? Will they continue to see you even if you lose your insurance? Has the hospital had any recent outbreaks of antibiotic-resistant – infections in the newborn nursery? Is there 24-hour anesthesia?
T= Test for potential problems such as Gestational Diabetes, Sickle Cell Trait or sexually transmitted infections.
The U.S. is one of the most industrialized countries in the world, yet we rank below Cuba and Taiwan, with respect to our national infant mortality rate. The health of a nation is judged by its national infant mortality rate. We can do better. We must do better. The health of our future generation is depending on it.