Patient Selection and Safety With TNF Inhibitors - Episode 23
Christopher Robinson, MD, MSCR, FACOG: A lot of people want to know: What is a maternal—fetal medicine specialist, and what’s our role in taking care of women who may have many diseases, including an autoimmune disease? Really, we’re the high-risk specialty experts. We have been trained in both obstetrics and gynecology but have gone on to do additional training, specifically in medical, surgical, and genetic management of women who may bring risk to the table because they have certain medical conditions—things that involve autoimmune disease but could also involve other concomitant conditions like diabetes, hypertension, and things of that nature.
Women of autoimmune disease represent a very large proportion of women who could become pregnant. We refer to that as women of childbearing age, meaning that women could potentially conceive, carry a pregnancy, and deliver a baby. Obviously, 1 of our focuses is making sure those women make it through that pregnancy in a healthy state. I would say that autoimmune disease is a very broad topic. In other words, autoimmune disease can really affect any portion of the body, whether that’s the GI [gastrointestinal] system, or the heart and lungs, or the skin. And so it probably makes up about 10%, sometimes 15%, of our overall patient population because of how broad the disease process is itself.
When patients come to see us, it’s oftentimes at the request of a physician. Sometimes it may be the physician they’re interacting with for their specialty care. It may be a GI specialist, it could be a dermatologist, or it could even be a person who is working with them with joint disease, such as an orthopedist. We also see women who are sent to us, however, from their primary care physician. That could be their ob-gyn, in many cases. It could be a family physician or an internist who wants them to be seen to discuss the possibility of reproduction and address some of the issues surrounding planning of pregnancy and how to improve those pregnancy outcomes.
Some women come to us because they, themselves, want to have more information. And so, they don’t even have a physician that necessarily sends them to see us. Rather, they have concerns based upon their own health and they just want to know, “Can I carry a baby? And, if so, can I do this in a healthy manner, such that I have a healthy outcome and my baby has a healthy outcome?” I think that’s very important, too. Preconception care oftentimes comes about as a result of the patient specifically wanting to seek that information and care.