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Never Say Never to Pregnancy

Planning Pregnancy with a Chronic Health Condition

By Kelly Burgess

Micha誠Alegria of Spokane, Wash., has had severe asthma since she was 2 years old. When she and her husband were expecting their first child, her pulmonologist sent her to an allergist to get better continuity of care. "The new doctor immediately wanted to put me on prednisone, as my asthma was exacerbated at the time," she says. "When I asked him if it was safe during pregnancy, he actually shrugged and said that he didn't know! When I asked him if maybe he had a book or something he could look it up in, he acted very put out by my request."

Perhaps the biggest movement in health care in recent years has been patient awareness and self-advocacy. Nowhere has this been more apparent than in maternity choices. For someone with a chronic condition that must be managed during pregnancy, this is an even more compelling issue.

Dr. Bonnie Dattel is professor of obstetrics and gynecology at Eastern Virginia Medical School. In her specialty of maternal fetal medicine, she often counsels women who are thinking of getting pregnant and have chronic health conditions. She's found that there is no hard and fast rule for handling pregnancy with pre-existing conditions, because every woman's body reacts differently to pregnancy. "In general, chronic conditions turn out one of three ways," she says. "They can be the same as always, get better or get worse. Some people actually do better, depending upon the particular disease. Even those few that are generally not compatible with pregnancy, such as severe cardiac compromise, have to be evaluated on a case by case basis."

One thing Dr. Dattel would never do is tell a woman she shouldn't get pregnant because of a chronic condition. "I have people send me patients all the time to tell them not to get pregnant, but that's not my choice; it's theirs,"she says. "What I can do is tell them what the known risks are and what, statistically, is the possible outcome. Ultimately it's their decision."

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