Written by Marybeth Kotrodimos
Featured photo: Dr. Men-Jean Lee reviews a patient’s ultrasound at the UHP OB/GYN clinic, located at the Pali Momi Outpatient Center in Aiea. 2019 photo by Vina Cristobal
In commemoration of World Birth Defects Day on March 3, Dr. Men-Jean Lee of University Health Partners’ (UHP) Women’s Health Specialists spoke with us about how expectant moms can do their best to assure their babies are born healthy, especially during the COVID-19 pandemic.
Dr. Lee is the Division Chief for Maternal Fetal Medicine at UHP, and Medical Director for the Fetal Diagnostic Center at Kapiolani Medical Center for Women and Children in Honolulu, where she and her team provide prenatal diagnosis, ultrasound, genetic counseling and diabetes counseling for women who have complications during pregnancy.
With the pandemic upon us, one might think that those complications have increased, but actually, Dr. Lee tells us, there has been very minimal effect of COVID-19 infection on unborn babies. “With respect to women who contract COVID-19 infections during pregnancy, we can safely counsel them that we have not seen any birth defects associated with the mother getting sick,” she said. “COVID-19 is different from the ZIKA virus infection during pregnancy, which has been known to cause severe birth defects.”
Another surprising statistic is that there has not been an increase in the birth rate or the rate of women becoming pregnant during this pandemic. “Many thought that there would be a baby boom because so many people were staying home because of the COVID-19 pandemic,” Dr. Lee said, “but that still hasn’t happened. The birth rate in Hawaii has been steadily decreasing over the past year as it has been doing over the past ten years.”
“There is more social information coming out on women who are planning pregnancies,” Dr. Lee said. “Perhaps with job losses and the bad economy, women are thinking carefully about whether or not they want to start a family during a pandemic, especially if finances are tight.”
When asked about whether the COVID-19 vaccination is safe for pregnant women to take, Dr. Lee said, “Although there hasn’t been much research about the new vaccines on pregnant women, this new class of mRNA vaccines do not contain any virus particles. They are quickly eliminated by the woman’s body so that they are unlikely to reach the fetus to cause a birth defect. Whatever antibodies the mother makes from the vaccine will likely cross the placenta to protect the fetus. Pregnant women should decide what is more important to them after speaking with their doctors.”
Addressing the issue of people being afraid to go to a clinic or hospital during the pandemic, Dr. Lee was quick to mention the Midwifery Integrated Home Visitation (MI-Home) Program. Created by UHP with a generous grant from AlohaCare, the MI-Home Program provides the services of a traveling Certified Nurse Midwife who can “actually go to your home or shelter to provide prenatal and lactation support services there in the comfort and safety of your own home. And if the pregnant woman needs extra medical services because she has some high-risk issues, the midwife actually carries mobile telehealth equipment to telehealth back to one of the maternal fetal medicine doctors via the internet.”
Dr. Lee called this program, which has been in existence for about a year, “a lifesaver during the COVID-19 pandemic when many pregnant women are too afraid to leave their houses or aren’t allowed to bring their children with them to the hospital for a doctor visit.”
Telehealth is another service that can also help women who are afraid to come in to see their doctors, or who live in more remote locations. “A lot can be done with maternal telehealth,” Dr. Lee said, including tele-ultrasounds to help detect fetal birth defects prior to birth. “Prior to COVID-19, we learned that almost 5,000 women each year have to fly to Honolulu from the neighbor islands to get their prenatal ultrasounds. So at UHP, we’re looking at how we can bring tele-ultrasound to the neighbor islands, so that patients don’t have to fly to Oahu for healthcare or need to quarantine when they return home.
“During the pandemic, we had to quickly convert our in-person prenatal consultations to telehealth visits where we counsel women in the comfort of their own homes about how to reduce birth defects and improve maternal health. We’ve been very fortunate to be able to convert over 50% of our prenatal visits to telehealth visits with video conferencing.”
She also spoke about how UHP Maternal Fetal Medicine doctors are flying to the neighbor islands to do ultrasounds in person “for patients who are either too afraid to fly or don’t have the means to fly to Honolulu for pregnancy care.”
For prevention of birth defects, it is recommended that women get healthy and start taking prenatal vitamins before trying to conceive. “Too often people forget that in order to have a healthy baby, we have to take care of moms first. Most healthy babies start with a healthy mom.
“Folic acid is actually a great way to prevent birth defects,” Dr. Lee said. She also strongly advises women who are diabetic to “get their diabetes under control before they conceive. Women with poorly controlled diabetes are at high risk for carrying a baby with birth defects.”
Dr. Lee reviewed the role of genetic counselors who work closely with the Maternal-Fetal Medicine doctors to discuss genetic screening tests that assess each family’s risk of birth defects. “The information gained from the specialized testing goes beyond whether the pregnant woman is carrying a girl or a boy. In fact, some of these DNA tests can detect particular problems in advance so that the patient can optimize the birth outcome of her baby or even make a decision as to whether or not to move forward with the pregnancy.” This is particularly important for women who are 35-years old or older who are another group of women who are at high risk for carrying a fetus with birth defects.
Maternal-Fetal Medicine doctors have been the key to improving health care for pregnant women and their babies in Hawaii. However, according to Dr. Lee, “The Maternal-Fetal Medicine doctors are faced each day with having to give bad news to patients. We all want every pregnancy to be healthy and all women to have a positive birth experience, but sometimes bad things happen to good people,” she said, “That’s why the Maternal-Fetal Medicine doctors work closely with the pregnant woman’s primary obstetrics provider and the pediatric subspecialists to give the mother and baby the best possible outcome even in a bad situation.”
As the coronavirus pandemic has affected all of us in our daily lives, the work of the Maternal-Fetal Medicine doctors has also been made more difficult. “It is very hard to manage prenatal care during the pandemic,” Dr. Lee said. One of those challenges comes from misunderstandings and resistance many providers are facing due to public health and hospital mandates that have been issued to keep patients and their families safe from spreading the infection.
“The reality of living through the COVID-19 pandemic is unprecedented. The hospitals and public officials have been trying really hard to control the spread of the virus and keep everyone safe. Some of the decisions have not popular, but they are tough decisions that are working to keep our COVID numbers low here in Hawaii.” Dr. Lee said that earlier in the pandemic when “we couldn’t tell which women were COVID-positive or negative, there was a lot of bad press that accused healthcare providers of making women suffocate because they were asked to wear a mask while pushing the baby out during delivery or the hospitals limiting the number of visitors attending childbirth.” She explained that the recommendations were made when COVID tests and PPEs were hard to come by so that the providers who were also wearing PPE were trying to minimize the risk of infecting others as they were going from room to room to attend each delivery.“ Now that we have more rapid COVID testing for patients being admitted to Labor and Delivery and ample PPE for everyone, some of those rules have been relaxed.
“We want to remain data-driven,” Dr. Lee added, and praised the governor, the lieutenant governor, the mayors, and the public health officials of Hawaii for making the hard, unpopular decisions that have led to us having one of lowest rates of COVID-19 infection in the US. “No one can do this alone. We’re not going to win the fight against COVID-19 unless everyone does their part.”