Hypothyroidism: Should You See a High-Risk Obstetrician?

I am five weeks pregnant with my second child. My first child was born seven weeks early for no apparent reason, I am Rh negative and my husband is Rh positive and I have hypothyroidism, which is treated with medication. Do I need to see a high-risk obstetrician?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Although you have three potential complications that may or may not be related, I see no reason to seek prenatal care from a perinatologist. It will probably cost more and require visits farther from home. I would, however, seek a care provider who is experienced in managing thyroid conditions or who works with an internist who is experienced in such matters.

Nurse midwives often manage clients with hypothyroidism who are controlled by medication. If you are a healthy, fit woman and the thyroid condition is controlled by medication, you may well have a very normal pregnancy and birth. A thyroid panel should be drawn to see if the levels are within normal limits. While hypothyroidism can be a cause of preterm labor, it should not be a problem if you are controlling it well. And the Rh situation is not a consideration if your antibody titer is negative and you receive RhoGAM at 28-weeks-pregnant, as well as after the birth if your baby is positive. Your most important risk factor is your history of preterm birth. This, of course, puts you at risk for additional preterm labor and birth; however, it is not a given.

During this pregnancy, an effort should be made to carefully evaluate risk factors, such as smoking, beta strep, bacterial vaginosis, trichomoniasis, short cervix, uterine or cervical abnormalities, substance use, stress at work or in the home, strenuous work schedule, nutritional factors and more. A careful review of your past pregnancy, medical, social and gynecological history, as well as your previous labor and birth experiences should be completed. Initial care by a nurse midwife would assure that such a history would be obtained and appropriate consultation sought. (Call 1-888-MIDWIFE for a referral in your area.)

You will probably have additional cervical checks, especially as the time approaches when your last labor started. A transvaginal ultrasound may be requested to check the length and configuration of your cervix. Fetal fibronectin studies may be ordered.

The fetal fibronectin test is performed by collecting a small amount of vaginal secretion with a cotton tipped applicator device. If a certain type of protein is found (fetal fibronectin) between the 22nd and 34th week of pregnancy, this may predict preterm birth within one week. If you would like to get more information about this test, call (888)773-8376. Another resource for you is an organization called "Sidelines," which is a support group for preterm birth. They can be contacted at http://www.sidelines.org or at (949)497-2265.

The medical community has tried for decades to establish criteria for the high risk pregnancy. We used to assign codes for various conditions. If a woman received a score of seven or higher, she was considered high risk. We have come to acknowledge that women and pregnancies cannot be categorized in this manner. What is a potential problem for one woman may not be a problem for another due to such factors as social circumstances, age, smoking, life style and other variables.

I hope that you have a happy, full term pregnancy.

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