Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
Hey, everyone. Welcome to “Mailbag number 20: What does the Fox say?” All right. Our first question is from Rachel. “Hi, Dr. Fox. Loved your podcast so much during my pregnancy.” Thanks, Rachel. “I’m still breastfeeding my eight-month-old, and just had a chemical pregnancy. Is there any proven correlation between breastfeeding and miscarriage/chemical pregnancy?” All right. Thanks for the question, Rachel. Sorry you had the miscarriage, the chemical pregnancy.
For our listeners who may not know what that means, a chemical pregnancy is basically a very early miscarriage where the only “evidence” of a pregnancy is a positive pregnancy test, either a urine test or a blood test, meaning it’s prior to seeing anything on ultrasound. And so, the term for that is a chemical pregnancy, but it’s basically a very early miscarriage.
In terms of your question, Rachel, no. As far as we know, there is no correlation between breastfeeding and miscarriage. Meaning, If you were to get pregnant while breastfeeding, there is not an increased chance of miscarriage compared to somebody else. Now, it is more difficult to get pregnant while breastfeeding. It is somewhat of a natural contraceptive. It’s not entirely reliable, which is why we don’t advise women rely on breastfeeding for contraception if they don’t want to get pregnant, but it is more difficult to get pregnant while breastfeeding.
However, if one does get pregnant while breastfeeding, it does not increase the risk of miscarriage. Whether someone should or shouldn’t stop breastfeeding while they’re pregnant is not related to risk of miscarriage. It’s related to whether there’s enough nutrients for both the mother and the newborn or the baby who’s breastfeeding, and the developing pregnancy. That’s a complicated question with different answers on it, but it’s not because of a risk of miscarriage. That is not…fortunately, that’s not an issue. So, I’m sorry you had the chemical pregnancy, the miscarriage, but it was not related to your breastfeeding.
Okay. Next question is from Danielle. “Hi, Dr. Fox. I discovered your podcast recently, and have been LOVING it.” That’s in all caps. Thank you, Danielle, for caps-ing that. “Thank you for providing a platform for women to learn more about our health and wellness. As a first time expecting mom, your episodes have brought me much peace. So, thank you. I’m almost 16 weeks, and recently found out that I’m a carrier for cystic fibrosis. None of my family had knowledge of it running in our bloodline. So, it was quite a shock. As I’m waiting for my appointment with genetics, would you be able to elaborate on any potential negative impacts this could bring the baby while in my womb? I’ve been trying to stay off Dr. Google for obvious reasons. Any information you’d be able to provide would be very helpful and appreciated. Thank you for all you do.”
All right. Thank you, Danielle, for the kind words. Thank you for the question. So, first of all, we did a full podcast on genetic carrier screening. I’m pretty sure I did it with Dr. Tamar Goldwaser. So, you can go back and check for the long answer, the long form answer on this. But the short answer is, in general, there’s nothing to worry about. When we do carrier screening, right…so, it’s a certain form of genetic screening, and there’s many forms of genetic screening we do in pregnancy, which is why it sometimes gets confusing for people. But the carrier screening is the kind of genetic screening where we’re testing the parents to see if they carry certain genetic conditions. Cystic fibrosis is one of them. There’s actually hundreds of them that we test for.
And since it’s a genetic test on the parents, it could be done prior to pregnancy. It could be done during pregnancy. The results are the same. Meaning, it’s not related to this particular baby inside of you. It’s related to your own genetic makeup. So, it can be tested at any time. And there’s a good argument to be made that, ideally, it should be tested before pregnancy. But that’s not always logistically possible.
But either way, what we’re testing for is to see if the parents carry certain genetic conditions. If you carry a genetic condition, the principle typically is that being a carrier has no impact on your health. Meaning, if you are a carrier of cystic fibrosis, you will not have cystic fibrosis as a condition. You will not have disease. You will not have symptoms. You will not have anything. You just carry it. But since it’s what we call an autosomal recessive condition, if you go back to high school biology with the Punnett square, big A, little A, big A, little A, this is the kind of condition where you would need both of your genes to have a mutation in order to have the condition. So, how does that happen?
Let’s say the mother is a carrier. So, she is perfectly fine. She has no symptoms. She has nothing, but she carries it. And let’s say the father is a carrier. Similarly, he has no symptoms, has no condition. He’s perfectly fine. And they have a kid together. One out of four of those children will actually get the gene from each parent, right? One out of two of the mother, one out of two from the father, 50% times 50% is 25%. One out of two times one out of two equals one out of four. So, 25% of the kids will actually have the condition cystic fibrosis.
And so, what we do in pregnancy or prior to pregnancy is we test the parents. And you can either test them at the same time or test the mother, then test the father, to see if they carry the same genetic mutations. And if they do, they would know that there’s a 25% chance of their child having the condition. And then if you are pregnant, you can choose to do, like, an amniocentesis or a CVS to check if the child did in fact get that condition. If you’re prior to pregnancy, you have the option of, let’s say, doing IVF and then selecting embryos that don’t have the condition and using those.
Okay. So, in your case, you found out that you’re a carrier of cystic fibrosis. What I would say is, number one, when you do expanded carrier screening on people in pregnancy, what you find is the majority of people do carry some genetic condition. If you test for these hundreds of conditions, probably 70% plus of people do carry a genetic condition, and they would not know about it, nor would anyone in their family know about it because all the people have passed it down from generation to generation have passed it down as carriers. Meaning, none of them had the disease. And so, that’s not something that you would know in your family that one of your parents is probably a carrier for cystic fibrosis and one of their parents is a carrier and so forth.
So, what we do is we test and we find if the…let’s say the mother is a carrier of cystic fibrosis. And then if the father’s not a carrier of cystic fibrosis, either he carries nothing or he carries some other condition, then you’re good to go. Nothing to do. The chance of the baby having cystic fibrosis, it’s not zero, but it’s almost zero. Right? And then you’re done.
So, what typically happens is, at this point in pregnancy, you found out that you’re a carrier for cystic fibrosis. They’re going to have you meet with a genetic counselor, but what they’re essentially going to tell you is you’re fine. The father should get tested. Right? To check if he’s a carrier of cystic fibrosis. And if he’s not a carrier of cystic fibrosis, which is the likelihood, then you’re good to go. No issues.
If he is a carrier cystic fibrosis, then what they’ll tell you is, okay, this child you’re carrying has a 25% chance of having the condition cystic fibrosis, and then you could decide what to do about that. Do you want to do an amniocentesis and find out before birth, or do you want to test after birth? But again, the likelihood of being in that situation where he’s also a carrier of cystic fibrosis is fortunately pretty low, again.
So, that was sort of, like, an overview of carrier screening as related to your question, but we did do a full podcast on this. So, you can definitely go back and check that one out if you want more information. Thank you, Danielle.
All right. Next question is from Meredith. “What does the Fox say about epidurals and mobility while laboring? Thank you for such a comprehensive evidence-based podcast that both gets into interesting medical details and also is relatable for the average person, most importantly, my husband who knows nothing about women’s health and medicine.” Oh, shots fired, Meredith’s husband. All right. “Love the epidurals episode, but I’m a little unclear about mobility after an epidural is placed. If placed early in active labor induction, is the dosage level low enough that it’s safe for women to get out of bed? Is it okay to walk, or is the patient limited to movement in bed? Thanks, again, for both educating and entertaining.”
All right. Meredith, great question. Meredith’s husband, if you’re listening to this, glad she didn’t say your name and call you out. All right. So, there is…it’s interesting. If you Googled, there is a concept called a walking epidural. And you would think that a walking epidural would mean that you get an epidural, and you walk. But most of the time, that’s not what it means. There are situations where people can get an epidural and walk. I’ve actually not seen one of these situations. Meaning, in all the hospitals I’ve been in, patients have never gotten an epidural and then walked around with it.
But the concept is, when you get an epidural in labor — or it doesn’t have to be in labor, but we’re talking about labor here in this podcast — what happens is they’re threading a catheter just outside the spinal cord, what we call the dura, which is the bag that holds the spinal cord. They leave that catheter in place just outside. And then they put in medicine either as a one-time or as a drip. Usually, it’s a continuous drip to sort of numb those nerves, to sort of make you have less pain from the uterus down. All right. You can’t just localize the uterus. Sort of with the spinal cord, it’s that and everything down.
And so, on the plus side, it takes away pain from the uterus. On the downside, it frequently does take away some sensation and some power in the muscles, like in your legs and whatnot. So, it’s difficult to walk. So, the thought was, hey, maybe if we give a very low dose or if we change what medications are in there, we can focus more on just the pain component, and not knock out the mobility component. Right? And so, there’s usually two drugs that they put in an epidural. One is sort of, like, a lidocaine type, a Novocaine type, which is the one that would also block your motor ability or ability to walk. And the other one is a narcotic type, like a morphine or fentanyl or something like that, which would block the pain.
So, the thought is, hey, if we give much more of the narcotic type and much less or none of the mobility-blocking type, maybe someone can get an epidural, have no pain in labor, have full mobility, and be able to run around. And it is conceptually possible. And apparently, there are places where they do this. But I would say, practically doesn’t happen much. Meaning, what typically happens with a walking epidural is, if it works, you have no pain or much less pain, and you have better mobility than you would. Meaning, you’re not, like, paralyzed from the waist down, and your legs can move, and you have sensation. But it’s not typical that someone will have…still have enough power to be able to walk around. And apparently, in places where they do walk around, you have someone help you, you’re holding onto a pole. It’s still, you know…it’s not, like, perfect mobility.
So, I would say, there are places where you can actually walk with an epidural. I’ve never seen them. But most of the time, what we’re talking about is just trying to adjust the dose to focus more on the pain, and not knock out the mobility. In practice, sometimes it’s hard to do because, in practice, sometimes in order to knock out the pain, you also have to knock out the mobility. Hope that answered your question.
All right. Next question is from Ellie. And it reads, “Hi, Dr. Fox. Love the podcast. I would love to hear your thoughts on natural variation in gestation length. I’m currently pregnant with my third baby. My first two babies were induced at 42 and 41 weeks, simply for going too long. Although there was no other indications that anything was wrong, normal blood pressure, no diabetes, normal heart rate, no other signs of distress. Both are normal weights, 8 pounds, 3 ounces, 6 pounds, 15 ounces, respectively, in normal, uncomplicated vaginal deliveries. My mother and her mother had seven children between them, and none were born before 42 weeks. All normal. I assume they misdated their pregnancies back in the day, but I’ve experienced it myself, and been absolutely certain of when I conceived, and being induced at 40 weeks and zero centimeters. I’m not so sure. I would like to avoid induction again, if possible. What do you think about letting pregnancies go past 40 weeks when there are no indications of maternal or fetal distress and the mother had a history of healthy, uncomplicated late-term deliveries? Does a pregnancy go from ‘late term’ to ‘post term’ at 42 weeks or 42 weeks and 6 days? I would love any insight you could offer on those, who happen to carry babies longer than average. Thanks so much.”
All right. Long question, great question. A lot of things to unpack there. So, first, in terms of length of gestation and what’s “normal.” So, when we say 40 weeks, which is the due date, 40 weeks, again, is 40 weeks from the first day of your period, which is actually 38 weeks from conception. And that is really just an average. Right? The average gestational length left in nature is about 38 weeks from conception. There is variation in that, and it’s normal to deliver a few weeks before to a few weeks after. And so, typically, the sort of, like, the bell-shaped curve would have 40 weeks as the peak and then plus/minus two weeks. So, it is normal to go from 38 to 42 weeks.
Now, we also have what sort of throws a wrench into this, as we have definitions. Right? So, pre-term, we say, is less than 37 weeks. We don’t say 38. Full term, we say, is 37 weeks plus. But now, we have these terms called full term, late term, post-term, early term. There’s all of these different sort of terminologies, and it has confused people. But part of the reason for these terminologies is not based on the physiology of when labor is going to happen, but it’s based on what are the risks.
So, for example, you are correct that we said that we now define post-term as 42 weeks and zero days, and late term as 41 weeks. But again, it’s really…the definitions are more of a medical thing for when we think risk changes. I would say, in nature, it’s very normal for there to be variation in the length of pregnancy. Again, the bullseye seems to be around 40 weeks. And in the bell-shaped curve, it tends to go from 38 to 42 weeks. Meaning, that’s when the bulk of people are going to deliver. There are people, like you said, for whatever reason, who go past 40 weeks, 41 weeks, 42 weeks, who are outliers. Whether that runs in families, probably to some degree, but it’s hard to map that out exactly. And also, not everyone is left to nature. Right? Because we intervene. We induce people for various reasons. And so, it’s sort of hard to know exactly what’s going to happen in any given family if, you know, induction is taken off the table, and this or that.
So, first part of your question is there is variation. Some people tend to run late, some people tend to run early. There is probably some family…familial component to that, but it’s not exactly mapped out. Like, you couldn’t…when people ask me, “Hey. My last baby went to 41 weeks. Am I going to go past my due date again?” I would say, you’re more likely to go past your due date probably than somebody else. But it’s absolutely frequent that someone might go 41 weeks one pregnancy and 39 weeks the other pregnancy, and 40 weeks the third pregnancy. So, hard to be very predictive of this.
The second part of your question is really what to do when someone goes past their due date. And that’s a much more individualized type of answer because the concept is, ideally, right, it’s great if everyone just sort of stays pregnant, goes into labor, and delivers. But the problem is there are certain risks that go up as you go at and then past your due date, namely the risks of the placental function decreasing. Right? The placenta has, like, a shelf life to it. And at some point, it’s going to start decreasing in function. And that typically…that risk starts going up as you get…approach the due date and then past the due date. And on top of that, there’s certain people who have an increased risk of that for various reasons, whether they have high blood pressure, whether they have diabetes, whether, you know, older maternal ages, IVF, whatever it is.
And so, we’re trying to gauge, is it safe to go past 40 weeks? Is it not? And on top of that, again, this…we had a podcast on this this year. We used to think that inducing labor was problematic and that you were increasing the risk of C-section, but that’s sort of been debunked. It doesn’t increase the risk of C-section. There might be other reasons you don’t want to be induced, but it’s…the reason about C-section seems to be not so much. And so, there’s this constant reckoning of, is it better to stay pregnant, or is it better to induce the labor?
And as time has passed, number one, we’ve become much more comfortable with inducing labor, again, mostly because we believe with good data that it’s not increasing the risk of C-section. But also, with the risks of ongoing pregnancy, people are more concerned about that because they’re becoming more known. Right? The risk we’re talking about…mostly, the big risk is stillbirth. Right? So, the risk of stillbirth goes up every week you stay pregnant past your due date. And so, where do you draw the line? Right? What risk of stillbirth is high enough for people that they would want to be induced? The risk of stillbirth isn’t 50%. Right? It’s not like that. Let’s say it’s 1%, one in a hundred. So, one in a hundred is a low number, but it’s higher than anyone wants it to be. Right? Like, stillbirth is the worst outcome that we’re talking about. It’s horrible.
And so, different people look at that differently. And by people, I mean different doctors look at that differently. Patients look at that differently. And there’s a lot that goes into that. So, what I would say is that the general sort of how things are done nowadays is most people in the U.S. are recommending, like, pushing for delivery if someone gets to 42 weeks because the risk of stillbirth just seems too high for people. Again, there’s nothing magical about 42 weeks exactly, but that’s sort of the number that people…it’s a round number. That’s what people do. A lot of people are uncomfortable after 41 weeks. They’re saying, you know what, it’s not worth it at this point. So, you should deliver by 41 weeks. Again, people includes doctors, midwives, patients. Right? Different people look at this differently.
What I would say is, in my practice, what we typically do is that anywhere from 39 to 41 weeks seems to be a reasonable time to deliver for pregnancies that are going uncomplicated. Right? There’s some people who should be delivered earlier or before 40 weeks. I’m talking about uncomplicated, healthy pregnancies like you’re describing. Anywhere 39 to 41 weeks seems to be quite reasonable. And the data suggests that there’s not a huge difference in terms of outcomes of whether someone wants to be more on the earlier end of that, closer to 39 weeks, or more on the later end of that, closer to 41 weeks. So, in my practice, I give patients a lot of leeway if they’re the type of person who’s like, listen, I’m…either I’m afraid of the risks or I just don’t want to be pregnant anymore or whatever. And I want to be induced closer to 39 weeks. Fine, 39 weeks or closer to 39. Someone says, you know what, I really want to wait longer. Try to go into labor on my own. Up to 41 weeks, that’s fine.
In terms of going past 41 weeks in a healthy, uncomplicated, normal pregnancy, we will do it. We’d be okay with it. We do tell people that there’s…you know, there are some risks, and they go up compared to that 39 to 41-week window. We do monitor very closely in that time period. And we have a few patients who are up for that. Meaning, a lot of people are just like, I’m done by 41 weeks. I’m out. But for the people who are motivated to go into labor on their own and they really, you know, don’t want to be induced, we’ll go past 41 weeks, again, monitoring very, very closely. It’s not a lot of people who get that far. And then, typically, by 42 weeks, we’re pushing hard, and most patients don’t want to be pregnant past 42 weeks anyway. So, it doesn’t come up that often in terms of people getting into 42 weeks and not wanting to be induced at 42 weeks. So, it doesn’t come up that often.
I hope that answered your question. Again, it’s a long conversation, and it definitely has to be individualized, is one of the things I would say as a principle that there aren’t…there shouldn’t be very hard rules here because it depends on the exact nature of the pregnancy and the risks involved. And also, of course, what are your wishes in terms of being induced versus not being induced, and also, obviously, what’s going on with your doctors and midwives.
All right. Next question from an anonymous listener. “Hi. I’ve been really enjoying your podcast. I was wondering if you could do a podcast on pregnancy with half a uterus. Can someone with half a uterus deliver vaginally? And is it a hereditary condition? Someone just told me that her mom has half a uterus, and therefore, had four C-sections. Just wondering about the topic now that I know that this even exists. Thank you. If this makes it to a ‘Mailbag’ podcast, please leave my name out.” All right. As a reminder, anyone who wants to send in “Mailbag” questions, you can ask to remain anonymous, and we will do so.
All right. Thank you for that question. I think this probably will also at some point be a full podcast because it is a longer topic. But basically, what you’re asking about is something called either uterine anomalies or the fancy medical term is Müllerian anomalies. That’s M-Ü, with an umlaut over the U. That’s the two dots next to each other. And coming from the Müllerian ducts.
Basically, what happens is, as the uterus is being formed when you are a little embryo, it starts out as two separate tubes that fuse together, and then the middle gets chewed out to end up being one sort of pear-shaped organ. And 95% of the time, that’s what happens. And about 5% of the time, there are abnormalities in how the uterus is formed, and they can range. There’s a whole range of what can happen. You could have, like, a heart-shaped uterus, which is a bicornuate uterus. You can have sometimes what’s called a septum hanging down from the top of the uterus, which is like a little piece of tissue hanging from the top of the uterus. You can have something called the didelphous uterus, which is basically two totally separate uteruses that are not connected. You have two cervixes, two uteruses.
You can have what’s called a unicornuate uterus, like unicorn, unicornuate uterus, which is basically…it’s not from the term unicorn. It’s from cornua, which means, like, a horn of the uterus, and uni meaning one. That’s why it’s called unicornuate. It just sounds like unicorn. And that is probably what you’re talking about, a half a uterus, because a unicornuate uterus is one uterus, but it’s formed by only one of those ducts rather than two. So, it tends to be smaller, and it sort of…like a boomerang points to your left or points to your right.
In any of these uterine anomalies, there are risks in pregnancy. The more pronounced the abnormality, the higher the risks. Meaning, someone who has a unicornuate uterus, a half a uterus, as you called it, the risks are higher than someone who just has, let’s say, a very small indent on the top of the uterus. But basically, the risks we’re talking about are there’s a higher risk of C-section, as you mentioned, mostly because the baby is more frequently breach, head up. And there is a higher risk of fetal growth restriction, the baby not growing so well. People think that’s because the uterus is smaller, but it’s actually not. It seems to be more related to the decreased blood flow to the uterus because you’re basically…if you have a half a uterus, as you call it, a unicornuate uterus, you get blood flow predominantly from one side versus both sides. But there is an increase of fetal growth restriction, and there is an increased risk of preeclampsia, where your blood pressure goes up in pregnancy.
It does tend to run in families. Meaning, if your mother had it, it’s more common than you have it. Or if you have it, it’s more common than maybe a sister might have it, or one of your daughters might have it. Not directly, but it’s just more common. And there’s an interesting association between abnormalities of the uterus and abnormalities of the kidneys, because the uterus and the kidneys start out in the same location when you’re an embryo. And so, if there’s sort of something that’s not built exactly right with one, often the other. So, if someone has a uterine abnormality, we always recommend getting an ultrasound of the kidneys to make sure that there’s two of them, and they’re both in the right location and looking normal.
All right. Last question today is from Hannah [SP], related to CMV in pregnancy. “Hi, Dr. Fox. I’ve been listening to your podcast for over a year, and I’ve learned so much. I live in Chicago.” Hey. Good job, Hannah. “And I love seeing your parents when they are in town.” Whoa. All right. Shout out to Barb and Jack Fox in Chicago, Illinois. “I’m an IBCLC, PNP, and proud mother of six awesome kids and grandmother to many.” Hannah, good work. “Have you discussed maternal CMV infection in the first trimester? It came up recently, and I’d love to know how you address this with an expecting couple.”
All right. Hannah, great question. Please say hi to my parents. So, CMV is probably also its own podcast topic, but just briefly, CMV stands for cytomegalovirus. It is a virus that is pretty common. A lot of kids get it. A lot of adults get it. Most of the time people get CMV, they wouldn’t know that it’s that versus cold or a mild flu. It’s sort of the same symptoms, very overlapping.
The reason CMV is relevant in pregnancy is that it is one of the unique viruses that can go through the placenta, infect the fetus, and cause problems in the fetus. And so, there’s only a few viruses that seem to do that. Meaning, when people get the flu, the flu doesn’t directly harm the fetus. When people get a cold, the cold does not directly harm the fetus. But there are a few viruses that can, and CMV is one of them.
The issue with CMV is we don’t have a vaccine for it. So, for example, you know, German measles, rubella is something that’s a virus that can affect fetuses, but we get MMRs. The R is rubella. We get vaccinated for that. So, it’s very unusual for people to have German measles and it to cause problems in their pregnancies. But CMV is pretty common. It’s around. And so, that’s problem number one. There isn’t a vaccine. Problem number two is there is not…and we’ll talk about this. But there’s not a great treatment for CMV.
So, the question is, what do you do about CMV in pregnancy? Do you test for it? Do you screen for it? How do people avoid it? And there’s a lot of different strategies about what to do. I would say, up until several years ago, pretty much the strategy was, hey, if you’re around little kids, if you’re a school teacher, if you’re a parent, whatever it is, just try to, you know, avoid viruses. Wash your hands, you know, things like that, because it’s not great to get CMV in pregnancy. And that was it. Right? That’s all we had. And the question is, should you screen people for CMV in pregnancy? Should you do blood tests to check for antibodies in this? And the thought was, I don’t know if it’s worth it because a lot of people get it. There’s not much to do about it. And so, there isn’t much testing for it in pregnancy.
What happened is, there have been some studies recently that have suggested that there might be a treatment that’s effective in pregnancy for people who have CMV, namely valacyclovir, which is Valtrex, which is a lot of people might know it because it’s a treatment for herpes, it’s a treatment for cold sores. And there have been some studies…there have been a lot of studies actually coming out of Israel, where using very high-dose Valtrex in people who get CMV in pregnancy or might have CMV in pregnancy could lower the risk of transmission to the baby. And because of that, consequently, there’s been more and more screening for CMV in pregnancy, particularly in some countries. Like Israel, for example, does it routinely. In the U.S., it has not been adopted yet as a routine prenatal care practice. But in Israel…so, a lot of patients who come to our practice, they spend time in Israel, they were in Israel, they have relatives in Israel, whatever it was, they’ll have this question that you have, Hannah, about CMV early in pregnancy because it’s picked up.
And another wrinkle in this is when we test for CMV, we’re not testing directly for the virus. We’re testing for antibodies to the virus. And if you have antibodies to the virus, then there’s a whole exercise of, well, how old are they? Did you get them recently? Meaning, you got infected recently, or could they be a year old? In which case, this is an old antibody where you got CMV before you got pregnant.
And so, it’s a very complicated topic. And essentially, what we do when people present with the possibility of CMV, it depends on the circumstances. Were they actually ill? Did this come about just from a blood test? Did it come about because there was a concern from an ultrasound where the baby had signs of CMV in ultrasound? And so, we use all of those to try to determine, A, what is the likelihood the mother actually got CMV while she was pregnant? B, when did that happen? C, has it affected the baby? D, is it worth giving the high-dose Valtrex or not? Again, in the U.S., it’s basically considered more experimental, hasn’t been proven, but there are some suggestions. E, do we recommend doing an amniocentesis, which you can check the amniotic fluid around the baby for the virus itself?
And so, it is really a very individualized conversation based on those specifics. For someone who has antibodies and they’re very early, sometimes we conclude, hey, this is probably very old. You probably got CMV six months ago. You don’t have much to worry about. It should be fine. That’s on one end of the spectrum versus the other end of the spectrum is, I see an abnormality in ultrasound. Four weeks ago, I had a fever. My kid had CMV, and I probably got it. And those are two very different situations. And so, they would be counseled very, very differently, and everything in between.
I know that wasn’t a perfect answer to your question, Hannah. Please tell my parents I answered your question as best as I could. But it is a very complicated topic, and it’s getting more complicated now, not in a bad way, but it’s becoming more common. And there’s another wrinkle because, now, we’re trying to make decisions about whether to do the treatment or not do the treatment in any given person.
All right. Thank you all for those awesome questions. And we will see you all next week.
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