[REBROADCAST] All About Preeclampsia and What You Need to Know to Reduce Your Chances Of Getting It with Dr. Cecily Clark Ganhart

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I wanted to revisit this episode about preeclampsia because of the recent, tragic loss of Dr. Chaniece Wallace MD, who was the Pediatric Chief Resident at Indiana University School of Medicine.

She passed away on October 24 after giving birth to her baby Charlotte via emergency c-section. She experienced severe preeclampsia, so I wanted to bring back this conversation with Dr. Cecily Clark Ganhart about what preeclampsia is, what the symptoms are, and why we need to take it seriously.

Dr. Cecily Anne Clark-Ganheart, MD, FACOG, is a maternal-fetal medicine physician (AKA high-risk obstetrician/perinatologist). She works with women who have a high-risk condition or a baby who is high-risk.

Dr. Ganhart and I also cover how common preeclampsia is, how you can reduce your risk for it, and how preeclampsia can affect both mom and baby. And we discuss why Black women are more at risk for preeclampsia due to inequalities in society and maternal health care.

While severe preeclampsia is pretty uncommon, I want you to have all the information you need to advocate for yourself during pregnancy and birth in case you experience these signs & symptoms.

You can donate to the Wallace family at the GoFundMe page linked below, as well as previous episodes with stories about pre-eclampsia. 

In this Episode, You’ll Learn About:

  • What preeclampsia and eclampsia are
  • How common preeclampsia is and why the only cure for it is delivery of your baby
  • Risk factors for preeclampsia and some reasons why Black women are more at risk
  • The signs and symptoms of preeclampsia to be aware of & keep an eye on
  • How preeclampsia can affect parent and baby and why you should contact your medical provider ASAP if you are experiencing any symptoms
  • How you can reduce your risk of preeclampsia

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I want this podcast to be more than a one sided conversation. Join me on Instagram where we can connect outside of the show! Through my posts, videos, and stories, you'll get even more helpful tips to ensure you have a beautiful pregnancy and birth. You can find me on Instagram @drnicolerankins. I'll see you there!

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[REBROADCAST] All About Preeclampsia and What You Need to Know to Reduce Your Chances Of Getting It with Dr. Cecily Clark Ganhart

Nicole: In this episode, we're revisiting preeclampsia.

Nicole: Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy in birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it. Hello. Hello. Welcome to another episode of the podcast. Thank you for being here with me today. Today's episode is a rebroadcast of an episode I did back in September of 2019 on preeclampsia. I decided to rebroadcast this episode after the recent devastating story of Dr. Shaniece Wallace. If you didn't see this story, she was a pediatric chief resident at Indiana university, meaning she was in her last year of training before she was going to go on and practice as a pediatrician independently and her baby girl, Charlotte, who was her and her husband Anthony's first baby. Charlotte was born by C-section four weeks early. And Dr. Wallace died two days later from complications related to preeclampsia. Now like all instances where a mom dies, this story is of course heartbreaking. And it's especially heartbreaking because she seemingly had so many advantages. She was smart. She was accomplished. She had a loving, supportive husband, and she still had this devastating outcome.

Nicole: Now, I don't know the details of her care, uh, just from hearing like kind of secondhand and chit-chat and Facebook groups. I don't think that the medical system failed her. In fact, it sounds like she got outstanding care, but part of me wonders about the measurable contribution of her being a black woman and that chronic stress that accumulates from existing in a society where sexism and racism are still problems. I talked about this in episode 72 of the podcast about how structural racism creates maternal health disparities. And I mentioned in that episode, how it stood out for me that of five of my black female physician friends, who I trained with at Duke, uh, as OB GYNs, three of us had preterm deliveries and two of us had severe preeclampsia despite being very healthy. Otherwise, now, obviously there are racial and ethnic disparities in preeclampsia where black women are disproportionately affected, but preeclampsia can affect anyone, which is why I decided to re-air this episode today.

Nicole: I've actually had several birth stories on the podcast from white women. And I will say that I am identifying them as white women. Typically people should be able to identify themselves for what they believe they are, but I don't think it's a stretch for me to identify them as white women, a Savannah in episode 58 of the podcast had severe postpartum preeclampsia, Emily in episode 61 had preeclampsia with her first pregnancy as did Jessica in episode 68. And of course, I'm not telling you these stories to scare you. I'm telling you this because it's reality and you need to be prepared for the possibility. Every pregnant person needs to be in, especially black women need to be prepared. So with that being said, in this episode of the podcast, this rebroadcast, I talk with Dr. Cecily Ann Clark-Ganheart. She's a maternal fetal medicine specialist in the greater Kansas City area.

Nicole: Her area of focus includes maternal complications of pregnancies and really optimizing outcomes for women who have problem pregnancies. She also uses lifestyle medicine before pregnancy to reduce the risk of pregnancy complications. Particularly for women who have extra weight or women who are of size or plus size or obese, her hope is that by improving mom's health status prior to pregnancy, that will lead to better pregnancy outcomes for both moms and babies. So we have a really informative conversation about preeclampsia, what it is, how it affects moms, how it affects babies, who's at risk, the symptoms and ways to reduce your risk. So definitely check out this episode, listen to it, take notes, if you need to. It's really important information that every pregnant person should know. So here's the episode with Dr. Cecily Ann Clark-Ganheart as we talk about preeclampsia.

Nicole: Hey Cecily! Thank you so much for coming on to the podcast and helping us understand all about preeclampsia.

Cecily: Thank you. I'm happy to be here. Thank you for having me.

Nicole: Well, let's how about we start off by having you tell us a little bit about yourself and your work and your family.

Cecily: Yes. So I am a maternal fetal medicine physician, which is also known as a high risk obstetrician or a perinatologist. All of those terms are interchangeable. And so what I do is I work with women who either have a high risk condition because of their personal health or that their baby has a high risk condition. And so I'll work together along with their obstetrician or care provider to help maximize and try to improve their pregnancy outcomes. And that's what I do for the majority of the time. I also see women prior to pregnancy who are interested in conceiving, but may have a high risk condition either because of their weight where weight loss would benefit them or some other condition, and try to help them address that prior to conception so that they can maximize their health.

Nicole: Yes, as we were talking about before we started recording, I'm going to have to have you come back on and talk about some of those preconception issues and weight loss specifically. That would be great.

Cecily: Yes. And I think I would love to do that just because I think a lot of people don't recognize how important it is to maximize your health prior to pregnancy. And so, especially if you're planning a pregnancy, you can definitely help improve your health before that happens.

Nicole: Yeah. Yeah. Now, oh, and what about your family? Do you want to tell us a little bit about your family?

Cecily: Yes, so I am married, my husband and I, we live in Kansas with our two sons, both very active. My oldest son is into baseball and baseball season is just wrapping up. So we're always running around there. And then my youngest son has decided he's a skateboarder. So we are, that's new to us, because neither of us know how to skateboard. So they definitely help to keep life interesting.

Nicole: For sure. For sure. Yeah. We're a two girl family, so yeah. Yeah. All right. So let's get into preeclampsia. How about we start off with just basically what is preeclampsia?

Cecily: So how I like to explain preeclampsia is that it's basically high blood pressure when you're pregnant. So think of it as if you didn't have high blood pressure before pregnancy. And then later on towards the latter part of pregnancy, your blood pressure starts to rise. Traditionally, we say if your blood pressure increases to either the top number, which we refer to as the systolic blood pressure, of 140 or the bottom number, which is referred to as the diastolic number, is greater than 90. And you have to have that on two separate occasions, not just one time, because you were nervous or whatnot, but elevated blood pressures are kind of the hallmark of that. We also describe it as having protein in the urine. However, we don't hang our hat on the protein requirements anymore. It's really about what are your blood pressure's doing. And then what are some of the other effects that it's having on the rest of the body and the pregnancy.

Nicole: Okay. Now, what is the difference between preeclampsia and say, just gestational hypertension or hypertension that develops in pregnancy? Like what's the spectrum of all of that stuff?

Cecily: Right. So there's several different spectrums and classifications and whatnot. So gestational hypertension, again, would have the blood pressure criteria that I discussed before, but it does not come with protein in the urine. Versus when you have preeclampsia, you have different stages of preeclampsia. You'll hear people talk about preeclampsia with, or without severe features, which was traditionally referred to either as severe preeclampsia or mild preeclampsia. Once you get past the protein component, both of those, the distinguishing factor is whether or not you have other signs of organ disease. So in addition to protein in the urine, your kidneys can start to fail or not function as well. You can have problems with your liver, which can cause changes in your lab values, or actually cause pain, headache, blurred vision, new onset nausea, vomiting. These are items that would move you into the class of severe. And it's important to note that you can have severe features even without protein in the urine. And so this is why we have now recently, but I say we, the American College of Obstetricians and Gynecologists, we've moved to now not requiring that you have to have protein in your urine for us still to take this disease seriously.

Nicole: Okay. All right. And I know one of the reasons, oh, and I guess real quick, what's the cutoff for what's considered severe blood pressure?

Cecily: So severe blood pressure. If you do not have any symptoms and you haven't been diagnosed by symptoms, blood pressure criteria alone is a top number again, the systolic of160 with the bottom number and, or so you don't have to have both, I should say that bottom number being 110, the diastolic. Okay. And I'm sorry, I forgot to mention also along that spectrum of preeclampsia, you have even more severe conditions such as eclampsia. So really. Yeah. Oops, sorry. Let me talk about that. But eclampsia, so what preeclampsia means is before seizures and eclampsia means seizures. And so this, this is seizures, not due to a separate medical condition. This is someone who has no other reason to seize other than the preeclampsia has now moved into eclampsia. And then you'll hear people talk about something called HELLP syndrome, which is a manifestation along that severe range. But that's when you're starting to have breakdown of your blood cells, that's called hemolysis elevated liver enzymes. That's a marker of liver dysfunction. And then the low platelets, which you may hear people throw out and call the term thrombocytopenia. But that just basically means low platelets, low platelets are designed to help our bodies clot.

Nicole: Okay. Now how common is preeclampsia?

Cecily: So preeclampsia different estimates, put it anywhere from 3% at the low end up to 10% occurrence in pregnancy. You know, I'm a little bit-

Nicole: I swear it feels higher than that.

Cecily: I was going to say, I feel like we see it all the time. So I don't know if we're just behind on our estimates and need to do an updated population search, but according to the published literature, that's what the rate is. But I feel like every other person has preeclampsia.

Nicole: Yeah, it just feels common sometimes. And we should say that the severe form with seizures and that is not very common.

Cecily: No that's going to be where that's going to be less than 1% of people are going to experience that. And some of that decrease, hopefully with seeing the severe form, um, comes with proper management. So preeclampsia, the only cure for preeclampsia is delivery. However, we have to balance how severe your preeclampsia is with how far along you are in the pregnancy. Because while I'll often talk to patients and co-manage people who have been diagnosed with, we're just going to call it mild preeclampsia with a milder form of preeclampsia. And they said, well, you know, why can't you just deliver me now? And I'm like, well, because you're stable, we're monitoring you closely, baby's stable, and it's actually better benefit for your child to get further along in pregnancy versus someone who comes in seizing because of their preeclampsia. Well, it's no longer safe to keep you pregnant. And so I think we are fortunate because if you do start to progress and show signs where it's not safe for you to continue pregnancy, that's a lot of times when your obstetrician is going to recommend delivery. And so we're not necessarily seeing some of that progressiveness of the disease.

Nicole: Yeah. I think this is an important point to mention is that the treatment is very individualized. So you may hear one person get delivered at one point in pregnancy, another person at different point in pregnancy, it's not a one size fits all.

Cecily: Correct. Yeah. There's so many factors that come into play, but the goal, the common goal is to make sure that we are balancing risks to mom because we need to have healthy moms, right. So they can be around to take care of their children. So we do not want to put the mom at unnecessary risk, but we want to balance those risks with also the risk of the baby, because gestational age is a huge determinant of long-term outcomes, you know, in childhood and adulthood. So we're trying to balance those things. And just, as you mentioned, that's going to look like different things in different patients.

Nicole: For sure, for sure. Now what are some of those problems that preeclampsia can cause for moms? We talked about obviously eclampsia the seizures, but what else are the big things that can affect mom?

Cecily: So stroke is a big thing and I'll just, just, you know, just in general, like you said, you said seizures already. We have stroke. You can get fluid in the lungs. That's called pulmonary edema. You can have heart failure, whether or not that's just the preeclampsia itself or because of poorly controlled blood pressure, you know, which came first, but you can definitely have heart failure. We talked about liver failure, bleeding. I mean, worst case scenario, even death. Stroke is something that we really, I mean, all of those obviously are bad complications, but the not controlling the blood pressure, which then can lead to stroke, which then can lead to death, permanent disability and things like that is really especially of concern. And the thing people don't realize about preeclampsia is that yeah, if you have the classic symptoms, the headache and the blurred vision and all of that, you definitely need to seek your care provider, get your blood pressure checked, make sure you don't have preeclampsia, but there are definitely a subset of women who just come in for a labor check or came in because of decreased fetal movement or whatever. We take their blood pressure. And we're all like, how are you still sitting here? Your blood pressure is 180 over, you know, and so aggressive treatment of blood pressure definitely has been shown to improve maternal outcomes and prevent some of these more serious complications for mom.

Nicole: And, and we don't want to scare you by telling you the things that you know can happen, but we want to be realistic and help everybody understand that preeclampsia is very serious. And unfortunately on our side, not all obstetricians take it as seriously as we need to take it. I think we have a little bit of work to do in that regard, in that respect, in terms of the managing blood pressure issue specifically, I don't know if you would agree with that Cecily like how we're trying to push for more, like not getting rapidly treating those blood pressures. So we just want to make you aware so you can be informed and, um, you know, ask the questions and take care of yourself when you need to.

Cecily: Right. And it's definitely one of those things definitely don't want to scare you from not being pregnant at all. And that that's not the goal, but I, I do want people listening to get a sense of just the self-advocacy. Yeah. It's one of those things where like, yes, it's, it's unfortunate that you may not necessarily be able to walk into any ER, in the country and know that protocols will be followed, but by you also just being aware, I don't, you don't necessarily need to know the numbers, anyone who's pregnant. I do think you should know the signs and symptoms of preeclampsia and hopefully your provider's going over that with you talk about those in a minute. We'll talk about that. But just knowing that if you go to your care provider and you normally have normal blood pressures, however you see on the measurer that your blood pressure is 150 over 90, and no one addresses that, you know, I, I want you to feel empowered to say, oh, what was my blood pressure? That's not normal for me. You know, sometimes it's just in the, in the busy-ness and then the hustle and bustle people may just, things may slip their mind, but you know, if you're noticing it, at least bring it up and if your care provider repeats it or whatever, and they at least investigate it. And then you guys come to a conclusion, so be it. But at least it was addressed. And that's, that's kind of all, I want to take home message to be.

Nicole: For sure, absolutely. Now what can preeclampsia, how can preeclampsia affect babies?

Cecily: So with babies, there are also a host of conditions. One preeclampsia, I think one of the biggest things is whether or not you have to deliver preterm or prematurely earlier than what you would have had to. Because as I mentioned before, that is a significant determinant goes into, you know, future outcomes. So preeclampsia that has to be delivered before 28 weeks, you're going to potentially look at some very serious complications of prematurity, if that does not occur, you know, just in general having a smaller baby. So we call that intrauterine growth restriction is the medical term, which basically means that baby is not reaching its full growth potential, or, you know, here's to the baby's too small all the way up to, unfortunately, sometimes we do see stillbirth from preeclampsia, especially if it's severe complications, et cetera. People will have stillborn aside from having preterm delivery or too small babies. So those are some of the things we see. There's also a condition called placental abruption, which kind of is at the interface of both maternal and baby complications where, because you're getting bleeding behind the placenta that then will decrease mom's blood count, but it also can affect like oxygen status and, and cause some complications for the baby, too.

Nicole: Yeah. So basically we think that preeclampsia affects the placenta, essentially which in turn affects the baby, is that fair to say?

Cecily: Yes. Yes.

Nicole: Yeah. Yeah. Okay. So what are risk factors? And let's just do like three big risk factors for preeclampsia.

Cecily: So your strongest risk factor is going to be prior history of preeclampsia. So I like to tell people in, you know, just obstetrics, pregnant patients, et cetera, OB is a field where the path sometimes does predict the future very well. So if you had a history, like you had a history of preterm delivery, you are at increased risk of that happening again. If you've had a history of gestational diabetes, you are at increased risk of that happening again. And just like that preeclampsia, if you've had preeclampsia before, you are at increased risk of having that happen again. Outside of preeclampsia, other factors include being either obese or overweight chronic medical conditions. So we can kind of just lump all those together. Like if you have high blood pressure, hypertension, diabetes, or kidney disease, those are risk factors. And then multiple gestations, in vitro fertilization IVF, those as well. And I guess this is more than three, sorry, but.

Nicole: No. We're educating here. Let's go for it. Yeah.

Cecily: First pregnancy. So people who have their first pregnancy are actually at higher risk of having preeclampsia. And then sometimes we also forget about the kind of age is a factor. So younger patients actually like in their teens actually have a higher risk. And also patients who I guess we refer to as advanced maternal age are also going to have increased risk of preeclampsia.

Nicole: Okay. What about race or ethnicity?

Cecily: Yes. Sorry. So I did not mention race. So black race is a risk factor for preeclampsia, at least to my knowledge, unless you've read something more recently. I don't know that we have actually elucidated why that is. So like studies will say this and you know, we'll get into aspirin probably later, but when we're looking at who can we try to help reduce the risk of preeclampsia for, but biologically, I don't know why that is. I mean, I we've seen that in stats, but just myself, I've not come to any plausible reason why after controlling for other things like socioeconomic status, obesity, or, you know, other comorbid conditions, you still end up having black race as a risk factor for, for preeclampsia.

Nicole: Yeah. And I'm sure that has to do with chronic stress and racism within our healthcare system. Certainly plays into it as, as well.

Cecily: That's true. That's true. And there's something that, unfortunately it's just difficult to measure from like a, you know what I mean, quote unquote scientific method standpoint, but I mean it's, there's definitely something systemic. Do you know what I mean? That's quite odd because it just, it's hard to say it's just, well, it's just hereditary. Do you know what I mean? Like exactly. Like to say that for a lot of things, but when you start digging deeper, you find out, well, is it really hereditary or is there, is there something else? And so hopefully we can start to tease that out, especially with the attention that's coming to the disparities in maternal mortality. I, I really hope it helps makes the healthcare system as a whole take a hard look at itself and really see what our personal biases, how they are actually influencing outcomes and why, and, and really start to tease that out more.

Nicole: Yes. Yeah. So I, I absolutely say that, uh, really all women, you have to be extra vigilant about advocating for yourself. Like, you know, she talked about earlier, we, we want to advocate for yourself, but there are certain groups who may have to advocate a little bit harder for themselves, just because of the difficulties they run up against and black women. And pregnancy is one of those groups where you just may have to advocate harder for yourself than, than other women. And that's just kind of the reality of it.

Cecily: It is. And what I tell all of my patients is that when you ask questions, I think sometimes people are afraid or nervous to ask questions of their physicians or care providers. And so whenever someone sees me, I give them a chance. I'm like, are there any questions? And if I see that kind of pause, I'm like, you know, go ahead and ask. I said, now you may or may not like my answer, but because that's, that's what we're here for. There's no silly question, you know, that's, that's what you're there for. They're supposed to be the knowledgeable expert on whatever it is you went to see them for. So definitely feel empowered that it is okay to ask questions.

Nicole: And if you're not getting your questions answered, then please feel free. Or please not just feel free, but find another provider who will answer your question.

Cecily: Yes, that's what I say too. If you're, if you're not satisfied, it's, it's uh, definitely you, you should search and find someone who meets your needs.

Nicole: Yeah, for sure. Okay. So what are signs and symptoms of preeclampsia?

Cecily: So signs and symptoms, and there are a lot, so we may repeat these classically. You'll notice people talk about headache. And so, you know, headache can be tricky, right? Because people do get headaches in pregnancy, but I mean a headache that is unrelenting. It won't go away. You are having to treat yourself with Tylenol, you know, every couple hours it's there, it's pounding, blurred vision. So visual changes or what we call the fancy term is a scotoma, but it's, they're like little black spots is kind of how people describe them. A little flashes in your vision, new onset, nausea and vomiting, particularly in the third trimester. And so notice I said new onset, right? Because typically, you know, we have early in pregnancy where many people complain of different, uh, nausea, vomiting, et cetera, but usually that gets better. And so if all of a sudden you're near the time of delivery and it's not just that you ate something that didn't taste great, it's I am constantly now nauseous around the clock. I haven't felt this in two months. That is something you need to take up with your provider. And again, with the vomiting, if that's starting again, up again on a regular basis, that's not normal. When we talk about pain, so there's something called epigastric pain, which if you just want to touch her abdomen now and kind of trace your hand up the center of your belly, it's like right under where your breastbone would be just a little below that that's epigastric pain. And then if you just move your hand over from there to the right, that would be right upper quadrant pain. So not necessarily you picked up something and you stretched wrong, but that you're just not doing anything and you have this kind of just internal pain. And then it can even get to the point where if you touch that area, if sore it's like tinder when you touch it or someone else touches it, those are all signs, you know. Swelling, we don't use swelling as part of the criteria for severe preeclampsia, but certainly having a significant onset of new swelling needs to at least again, be addressed by your provider. If you're weighing yourself at home and in a week you put on seven to 10 pounds, that's probably water weight. And so preeclampsia is associated with like retaining water and swelling. So again, not saying we use that to make a diagnosis, but this is something that should be noted, right? No one pregnancy is gaining seven or 10 pounds in a week.

Nicole: Exactly. Yeah. And one thing I also find, it may not be frank like nausea or vomiting, but some women will just say, I just do not feel right. Like something feels off. I don't feel like myself.

Cecily: Yes. And that's a, that's an excellent point. Some of the earlier descriptions talk about just a general feeling of unwellness. You just, something is off. And so those are all reasons that you definitely need to discuss with your provider. What I tell people too. And it's, it's something that always makes me scratch my head, but you know, I'll have a patient who comes to see me just for their scheduled ultrasound. But then they'll tell me about the symptoms that they've been having for the last three days. And I'm like, so if you're starting to have these symptoms, please call your provider because I can't tell you how many people are like, well, I have an appointment at the end of the week. It's Monday. Well, I already have an appointment Friday. So I'm just going to wait until Friday to talk to them about this.

Cecily: I would definitely say you're having signs and symptoms like this. You should call your provider and see if they want to see you sooner than that. The other thing is, if you have any of those risk factors that we mentioned before, sometimes having a home blood pressure cuff is a good idea. So certainly I recommend that for all of my patients who have hypertension or high blood pressure, even before pregnancy, I'm like, you, you know, you should have a home blood pressure cuff, you should just have a general idea of what your blood pressures are doing. And so that is also something, because if you, you know, have a headache, but you're assuming your blood pressure cuff is functioning correctly, if you have,

Nicole: Yeah. So take it in, take it in hours, they take it in and have it calibrated against what's in the office. Yeah.

Cecily: Yes. And I don't like wrist cuffs. Those are not accurate. So we want to make sure you have a cup that is appropriately sized for your arm, but assuming all of those things are true. If you have a home blood pressure cuff and you have a mild headache, just kind of curious what your blood pressure is, and it's 90, over 50, well, you know, still call your doctor and talk to them about it. But they're probably going to tell you not to come in and they'll probably give you some other tips or whatever, versus if you are taking your blood pressure and you're seeing it at home creep up, you definitely know that, okay, this is not something you should be waiting until the next visit to talk to them about like, you need to definitely call your provider. And a lot of providers, if they know their patient has home blood pressure cuffs will give you different cutoffs to just check your blood pressure once a day. You know, if you have, especially if you have a high risk condition, just so that you can be at the forefront of knowing if something is off, because we probably only see you once a week towards the end of pregnancy, a lot of stuff can happen in those six days when we're not seeing you.

Nicole: Yeah. And that's the thing like preeclampsia guys, it can evolve over time. It doesn't necessarily like some of the symptoms may start, and then over a few days, things will start to progress. And again, we don't want to alarm anybody. Most of the time you have a headache, you take Tylenol and it's fine. So we don't want to scare you, but just want you to be aware. And so you can know those things to look for just in case.

Cecily: Exactly. Exactly. And then hopefully some of this will make sense. If you do have a provider who is kind of monitoring you for gestational hypertension or preeclampsia, and they're asking you to take your blood pressures at home, you know, hopefully you won't say, oh, why do I have to do that? Hopefully it will all make sense as to, they're trying to get more data on you rather than the 20 minutes that you're in there.

Nicole: Exactly. Yeah. Yeah. Okay. So we talked already about how the only treatment for preeclampsia is delivery, but what are things that women can do to reduce their chances of developing preeclampsia in the first place?

Cecily: So we'll talk about aspirin, but I do want to just say in general about improving your health prior to pregnancy. So this doesn't mean you have to be the gold standard of health before you try to conceive, but if you are obese or overweight, try to see if you can have a five to 10% weight loss before pregnancy. If you have a history of diabetes, so pre-existing diabetes and you know, it's poorly controlled because your hemoglobin A1C, which is a marker of what your blood sugars have been over the last three months, is at an eight or higher, you know, work on getting that down. If your blood pressure is poorly controlled and you rarely take blood pressure medications, et cetera, you know, make sure that is controlled. All of these things are going to help maximize the likelihood of a healthy pregnancy outcome. But what we are recommending kind of widely to people who are either at moderate risk for severe risk of preeclampsia is low dose aspirin. And there was a trial called the ASPREE trial, basically there's been others, but that was really a big well-designed trial that showed that given women anywhere from, in their trial, they use number, they did closer to like 160 milligrams of aspirin a day, but ranges that you'll see as prescribed or anywhere from the 81 milligrams a day up to 162 milligrams a day, depending on your condition, that's been shown to decrease the risk of preeclampsia in women who were at high risk of disease.

Nicole: Gotcha. So number one get in is, and this is just in general for pregnancy, get in as healthy of a state that you can before you get pregnant and then talk to your doctor about the possibility of whether or not you're a candidate for aspirin. We're not going to go into all the who is and who isn't, that's a conversation you can have with your healthcare provider.

Cecily: Right. Yeah. And, and have it early on. The only thing I'll mention is that for it to be beneficial, we believe you need to start it before you're 16 weeks pregnant. So, you know, if you're asking in the third trimester, you've kind of missed the, missed the boat for this pregnancy. So at your first prenatal visit, make sure to, to bring this up is what I would recommend.

Nicole: Okay, awesome. Now let's just finish up just by asking you a few questions about you and your work. So what would you say is the most part of your work?

Cecily: I think, you know, I just enjoy being able to work with women and obviously their pregnancies and help guide them through and help support them during just a time of uncertainty. What I say is that pregnancy is just a time. Anyway, it's a time of joy, but when you receive a diagnosis that you weren't expecting, we all go into pregnancy with this ideal picture of what we think it's going to be like, you know? And so when that ideal picture is tainted or now deviated, I enjoy being able to still assist women in having an optimal outcome, even though the circumstances around that outcome may be stressful.

Nicole: Awesome. That's certainly rewarding for sure. To help women through what can be a difficult and challenging time when they weren't expecting it at all. Yeah. And on the flip side, what's the most frustrating part about your work?

Cecily: You know, I think I'm probably like most clinicians and the fact that I definitely think, uh, documentation and charting, et cetera are important, but I think that administrative work is becoming greater a proportion of our time during medicine. Most people that I know that are in medicine in general enjoy treating patients. Right. I mean, that's, we'd like, and we like that aspect, that's why we got into medicine, but I feel that just even from the time that I finished residency to now as a practicing attending, I've noted just the amount of paperwork or, you know, um, discussions with insurance companies, peer to peer reviews, all of these different things seem to take up increasing amounts of time in our day, which then really you have to really try to prioritize, making sure you get in that patient time. And so I would say I'm probably no different than any other clinician in that aspect. Just how some of the administrative roles are, are becoming more of an impeachment to really spending the time that you want with the patient.

Nicole: Yes. Yeah. Y'all have no idea how I'm, and we're not trying to like turn this into a complaining fest, but like how many, like check boxes and things you need to fill out in the electronic medical records. So it doesn't feed back at you or click at you or, or whatever, and then paperwork. And then the insurance company denies this and you have to get on the phone with somebody who's not even an obstetrician to get some things approved. All this stuff can kind of weigh on you, so I totally totally get that for sure. One thing I heard you talk on another podcast about how you chose midwifery care during your pregnancy. Why did you do that and how was that experience?

Cecily: Yeah, so for my first we had an OB GYN and she was fantastic, Dr. Scott, and then in fellowship, this was the first time that I had honestly been exposed to midwifery services. So in residency, we did have a midwife group that was starting, but they didn't have their own patients yet. They mainly were in our triage area and helping them provide support there. When I was in DC for fellowship, this was the first time that I really was exposed to, you know, all midwifery practices. And so I just, I really wanted to try the experience and see what the difference was. If there was a difference. I've heard a lot of things about, you know, the dangers potentially of having a non-certified midwife or, well, you may hear referred to as a lay midwife versus in our hospital, all of our midwives were certified and, you know, we're following OB GYN standard guidelines.

Cecily: So I wanted to try that. I was also interested in having a natural childbirth. And so, you know, I thought that they may have a little more time to spend in labor kind of, do you know what I mean? Like be involved in some of those techniques that I know myself, obviously as an obstetrician that I, you know, I just don't necessarily have that sort of time to spend with a patient like that during labor in terms of like, if the ball and all of those things. And I do check on my patients frequently, but I just know that me, myself personally, with other tasks that I have to do wouldn't have that time. So that's kind of what led me to, to try that. And I did have a wonderful experience both times, honestly. So with, when I was with my OB GYN, I had a great experience and I had a great experience with my midwife, but I think for me, the experience of having both were valuable because it really let me understand more of the scope of practice so that when I, as a high risk obstetrician, I have a patient referred to me, whether it be from an OB GYN or from a midwife, I feel like I'm now more familiar with what should stay with a midwife and what should really go to an obstetrician.

Cecily: And I, I don't know that I would have that sort of, I would have just kind of a blanket answer, right. But one that I would actually have the understanding if I hadn't have had that experience myself. So I think it's helped me both personally and professionally.

Nicole: So you're definitely supportive of obstetricians and midwives working together to provide the best options and care for women.

Cecily: I do. I really think it should be collaborative. I think, you know, some of the European models show that it can be a beneficial, collaborative relationship. I don't think, you know, sometimes we'll see in the media going back and forth with one group talking about the other and the other group vice versa, talking about, you know, it's, it's, we're here. If we're involved in the care of women, then our common goal should be optimal outcomes for mother and baby. And I believe we can do that together.

Nicole: Absolutely. Yeah. Yeah. We're definitely better working, working together. It shouldn't be this sort of tension at all. And there are lots of folks. I work with midwives in my hospital and we work very well together. So there are certainly models that exist. And then just a couple last quick questions. How have your personal experiences as a mother influenced your work as a maternal fetal medicine doctor?

Cecily: I think it's definitely helped me to kind of understand, obviously every person reacts to a diagnoses different, you know, so you can tell two people that they have preeclampsia, same gestational age, and they're going to have two different reactions, so you can never kind of predict, but I think it just gives me more compassion and more insight into, well, what happens if this would have been me during my pregnancy? You know, how, how would that affect me? I think it just gives me more compassion. And I also think it allows me to do a better job of also explaining things because it's kind of like, well, what would I want to know? So whenever I do a consult with someone, I always make sure to hit the points that I would've wanted to know. And sometimes by the end of it, they're like, wow, you answered almost all of my questions. Like you actually explained it. I understand what's going on. And so I think that has helped me, you know, as well, just that influence to help me to deliver better patients.

Nicole: Yeah. It's you hate to say, not that OBs who haven't had children are bad by any stretch of the imagination, but I think I hear that over and over again, for women who are OBs, once you have children, it helps you to be a better obstetrician.

Cecily: Yeah. Yeah. I think just because there's something that you would not have anticipated either being a concern or something being important. So you actually experienced that yourself. So I think birth plans, I think before I had our first child, I was always kind of like, why are birth plans a big deal? Like yeah,

Nicole: Yeah, yeah. I was, I felt that way too.

Cecily: And then after actually, you know, going through labor and having vaginal delivery, I can see still for myself, for my second child, I didn't make a birth plan per se. The only thing was I wanted to try nitrous oxide. That was my thing. I was like, I want to try nitrous, but I didn't have a plan per se, but I, it made me understand why this is important for someone who chooses to make one. When honestly, I didn't understand that before.

Nicole: Yeah. Yeah. All right. So what is your favorite piece of advice that you'd like to give to expectant moms?

Cecily: I think one just be kind to yourself in terms of there, there are a lot of things. I think we go into pregnancy with kind of ideal expectations and sometimes it goes perfectly according to plan, but other times it doesn't, and I'll see a lot of people who, for some reason, blame themselves when there is an outcome that's not expected. So for instance, someone goes into preterm labor-that's because I worked out, you know, if only I would've done this, you know, is it that I don't know, canola oil that I cooked with, and this is why my baby has a birth defect. And so the thing is when you have a pregnancy complication, it's not your fault. And so what you need to do is just lean on the support of hopefully have a support system of your family or friends. And then also discuss that with your care provider. I mean, we're here to help try to maximize those complications or things that have went unexpectedly still into good outcomes, but just, you're not, you're not at fault if things don't go as planned, it's not your fault.

Nicole: Yeah, absolutely. I like that a lot. So thank you so much for coming on. This was a ton of useful information and like I was saying, um, you're going to have to come back on and talk about some of the other things that you can do, which kind of feeds into where can people find you?

Cecily: Yes. So right now I am on Instagram, Facebook and have a website. So they all kind of center around my interests of weight loss, especially prior to pregnancy, trying to help people improve their health status prior to pregnancy. So the name is all the same. It's fasting F A S T I N G work girl. That's all one word. And so that's my website, that's my Instagram and Facebook. And we're there. I talk about health and wellness, but also using intermittent fasting as an approach to obtaining health.

Nicole: Okay. Yeah. So just real quick, how many, how much weight did you lose personally yourself with intermittent fasting?

Cecily: Well, intermittent fasting, close to 60 pounds around like 55 pounds with intermittent fasting. So yeah, I mean, it's worked personally for me and I still continue to do it just for general health and wellness.

Nicole: Yeah. So she's working on some things like that and where, and how to help women get in optimal shape, you know, with their weight before pregnancy and then postpartum weight loss. So we'll certainly have to have you back want to talk about some of those things too.

Cecily: Yeah. Great. I would enjoy that.

Nicole: Yeah. Okay. All right. Well, thank you so much again for coming on. Appreciate your time and you have a wonderful day.

Cecily: Great. Thank you. You as well.

Nicole: All right. Bye-bye.

Nicole: Wasn't that a great episode? Tons of useful information. Now, after every episode I do something called Nicole's Notes where I go through my top three or four takeaways from the episode. And here's Nicole's Notes from this episode today. Number one, if you're early in pregnancy ask whether or not you're a candidate for aspirin to prevent preeclampsia, the American College of Obstetricians and Gynecologists has something called a committee opinion that discusses low dose aspirin use during pregnancy. And it covers who is a candidate, which women should be on aspirin to help prevent preeclampsia. And I'll link to that committee opinion in the show notes. Number two, be sure you know, the signs and symptoms of preeclampsia. Preeclampsia can come on at any time during pregnancy, it's far more common in the third trimester. And actually most of the time it happens in the third trimester, but you should really be aware of the symptoms because although most of the time, it's not serious, in rare circumstances, it can be quite serious.

Nicole: So know those signs and symptoms: increased blood pressure, headache that's not relieved by Tylenol, if you have new nausea and vomiting that you didn't have before, changes in your vision, if you have significant new swelling with those other things, or a rapid weight gain, that will also raise some red flags potentially. Also, you may just not feel right. You just may feel like something is off. So when those happen, then call your doctor or midwife. Most of the time, it's not anything, but you want to check in to be sure. Now I don't want you to obsess about this. I've seen some women who were taking their blood pressure like five or six times a day, and that's excessive. I don't think you need to do that, but you should be mindful of the symptoms, kind of have them tucked in your back pocket. And if you have anything that pops up, then bring it to your provider's attention.

Nicole: And then number three, and this is the take home message that Dr. Clark-Ganheart wanted to convey. And it's one that you hear me say time and time again, please, please advocate for yourself. If something isn't right, then speak up. If your questions aren't being answered, then speak up. If you need to change providers to get someone who is answering your questions, then do that. The reality is that sometimes women need to be insistant to get the appropriate care. So don't be afraid to advocate for yourself, or if you have trouble doing that because I get it. That is not always easy to like speak up, quote, unquote against a doctor, or are bring those kinds of things up. Then have a support person, have a partner, have a friend, have a family member who can advocate for you on your behalf. So that is it for this rebroadcast episode.

Nicole: Be sure to subscribe to the podcast on Apple Podcast, Spotify, Google Play, wherever you're listening to me right now. And I would so love it if you leave an honest review on Apple Podcast, those reviews in Apple Podcasts in particular really helped the show to grow and help other women find the show as well. Also, if you want to donate to the GoFund Me for Charlotte Wallace, the baby girl of Dr. Shaunice Wallace and her husband, Anthony, I will link that GoFund Me page in the show notes, I believe it's GoFund Me forward slash Charlotte Wallace, but again, I'll link it in the show notes and I cannot end this episode without reminding you that in order to be able to best advocate for yourself, you need good comprehensive childbirth education. Of course, I have an option with my online childbirth education class, The Birth Preparation Course, it will ensure that you are calm, confident, and empowered for your pregnancy and birth.

Nicole: However, if you don't choose to enroll in the Birth Preparation Course, of course, I hope you do. Oh, no. I forgot to say you can check it out at drnicolerankins.com/enroll. But even if you don't enroll in the Birth Preparation Course then do invest in some sort of childbirth education. It is absolutely critical. So, so important. Now next week on the podcast, I'm going to talk about a topic that I get asked about a lot, and that is twins. So do come on back next week. And until then, I wish you a beautiful pregnancy and birth

Nicole: So much for listening to this episode of the All About Pregnancy & Birth podcast, head to my website, drnicolerankins.com to get even more great information, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information on my free online class, on How To Make A Birth Plan that works as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerankins.com and I will see you next week.