“Mailbag #9: What does the Fox say?” – with Dr. Nathan Fox

Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I am 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 our ninth mailbag podcast, “What Does the Fox Say?” We’re getting a lot of questions and we’re gonna keep answering them. So, please, keep them coming.

All right, question number one today comes from an anonymous listener. Which also serves as a reminder, if you send in a question, you do not need to attach your name or you can just note in the question that you wanna remain anonymous and we will do so. Although this question is an awesome question, so, I don’t think it needed to stay anonymous because it’s so great. Here we go, “I just found out I am pregnant and was wondering if I’m still allowed to get gel manicures. Thank you and love the podcast.” So, full disclosure on this answer, I had to do some research on what a gel manicure is, so I guess that says a lot about me and who I am. And I realized I think I have heard of them, I’ve seen people get them before, but I had to do a little brush up on my gel-manicure science in order to answer this question.

So, the short answer is yes, you can get gel manicures when you’re pregnant, as far as we know. There’s no reason to think that the gel, the chemicals, or whatever it is, can somehow harm the baby or you, you know, during pregnancy. Again, it’s hard to study this perfectly but there’s no real suspicion that it’s harmful. There seems to be some potential issues related to allergic reactions, apparently some people get allergic reactions to their gel manicures. And allergic reactions, particularly on the skin, are more common in pregnancy, so it’s possible that if you are someone who normally gets gel manicures with no issues that you may start to get allergic issues in pregnancy which would not be so unusual. It’s also possible that, at some point in pregnancy, most likely closer to delivery, someone might ask you to remove the nails. Like, if you’re having a C-section, they have to monitor certain things related to your finger, that could happen. So, if you’re gonna get a gel manicure and it’s going to be very expensive, maybe don’t do it close to delivery without checking with your OB or midwife if that is a potential issue. All right, good question.

All right, batting second, Gabriella who has a question about GBS. “Hi, Dr. Fox, I’m a new listener. Heard you on ‘The Toast’ and I’ve really been enjoying the podcast. I was wondering if you would do an episode regarding women who are GBS-positive. I have four children, thank God,” nice work, “and had a very scary experience when my fourth child was born. My results from the GBS test came back negative and, therefore, I was not given antibiotics during the delivery. However, about an hour after my son was born, the nurse noticed that he was having difficulty breathing and didn’t sound right. They sent him to the NICU where he was put on a CPAP machine. They saw that his organs were starting to shut down and gave him four antibiotics before even knowing what the problem was. When the results from his tests came back and they told me that I was, in fact, GBS-positive, I was devastated and frustrated. I felt like I had gotten my baby sick, even though I did everything I was supposed to do. My son was in the NICU for two weeks but, thankfully, made a full recovery and is now a very healthy 2-year-old. Again, thank God. Do you have any patients who experience this? Do labs make this kind of mistake often? What can be done to prevent this situation in the future? Thank you so much.”

All right. Great question, I am sorry that you had that experience and your baby had that experience. I’m happy that he’s healthy now at age 2, so that’s terrific. So, as some background, so GBS is Group-B strep. It’s basically a bacteria, it’s a bug that about 25%, 1 in 4 women, have it. Right? It’s called “colonized with it,” meaning, if you do a vaginal culture, a rectal culture, you’ll find this bug in about 25% of women. It is not an issue for the health of the mother. Right? So, during pregnancy, the Group-B strep, it’s not an infection, there’s nothing wrong with having Group-B strep, it’s not an issue if you’re not pregnant. Meaning, we would never check for Group-B strep on someone who was not pregnant. The reason it’s relevant in pregnancy is that Group-B strep can be dangerous for newborn babies and they can get it during delivery. Typically, the way they would get it is during delivery, particularly vaginal delivery, as they go through. If the mom is colonized with Group-B strep, the baby can get it and then get infected with it and it can be very dangerous for them. If the mom gets antibiotics while she’s in labor, it greatly reduces the chance that the baby’s going to get Group-B strep.

So, what do we do knowing that, that about one in four women have Group-B strep and giving antibiotics lowers the chance of the baby getting infected with Group-B strep, which could be problematic for the baby? So, there’s different strategies of what to do. The current accepted strategy, which has been for a long time, is basically everybody in pregnancy gets screened for Group-B strep towards the end of pregnancy, usually 35, 36 weeks, give or take. And that’s basically a culture, it’s a swab, a vaginal rectal swab, gets sent to the lab. They culture it and they look for Group-B strep. And it’s either there or it’s not there. So, again, about 75% of people will be told, “You don’t have it,” and about 25% of people will be told, “You do have it.” And then, for those who have it, when they come in labor, we give the mom antibiotics, something like penicillin typically. Either penicillin itself or ampicillin, there’s allergies. There’s a whole algorithm for what we do.

So, a few things about that. Number one, it’s not 100% effective. Right? Even with this strategy of screening everybody and treating those who are positive, about 1 in 1,000 babies will get infected with Group-B strep. So, why would that be? It could be that the culture that was done didn’t find the Group-B strep that was actually there. It could be that they found the Group-B strep but the antibiotics didn’t work. It does not necessarily mean that the lab made a “mistake.” Right? It could be potentially that the swab wasn’t collected properly, that’s a possibility. It’s possible that there was no Group-B strep at the time the culture was done, but someone can develop it after the culture. Right? So, we do the culture 35 to 36 weeks, we do it at the end of pregnancy because we wanna get as close to delivery as possible but not miss an opportunity. So, we do it around 35, 36 weeks. But it is possible that if someone doesn’t have it at 35 weeks, they could have it at 38, it’s a bug that sometimes comes and goes. So, that’s another possibility. It could be that the Group-B strep was there and it was collected appropriately but, for some reason, it just didn’t grow on a standard culture, and so the lab didn’t see it. It doesn’t mean they made a mistake, it just means it didn’t grow.

And so, the short answer to your question, Gabriella, is, yes, we have seen that. There are moms who get swabbed, it comes out negative, and the babies are born GBS-positive. Again, fortunately, the chance of the baby getting very sick is low, about 1 in a 1,000. But, you know, 1 in 1,000, you know, in a hospital that has thousands of births…it’s gonna happen, right? So, it does happen. Fortunately, with treatments of the baby, they do well, like your baby is doing.

In terms of the future, one of the things we do with Group-B strep screening is there are certain people we don’t screen, we don’t do a swab, but we just automatically treat them in labor. So, one of those is someone who’s had a baby with Group-B strep infection before. Why do they automatically get treated the next pregnancy? Again, the thought is maybe there’s something unique about them or about the strain of Group-B strep they hold or something, and also, obviously, sort of, like, the emotional trauma of going through that, so they’re automatically treated. Other groups who are automatically treated, someone who had Group-B strep in their urine earlier in pregnancy. Like sometimes we do urine cultures in pregnancy, if we find Group-B strep in the urine, we don’t bother culturing at 35, 36 weeks, we just assume they’re positive and we treat them. So, for you, presumably, every future pregnancy, if you have any, they would treat you with antibiotics in labor no matter what, you wouldn’t even need to get cultured. Great question.

All right. Rachel, here we go. “Hello, thank you so much for an entertaining and informative podcast. I’ve listened to almost every episode.” Hey, thanks, Rachel. All right, “I listened to your last mailbag episode and really appreciated your advice about having a preconception appointment to review past pregnancy questions. I think I’ll do that ASAP myself since I have had three pregnancies, two of which had IUGR. Do you have any suggestions about what to ask during this appointment? I do have the lab reports from my placentas, as well as the reports from all of my scans. I still don’t know why I had two very tiny babies and would like to avoid the stress of that in a future pregnancy, if possible. Thank you so much. Rachel.”

All right, Rachel, first of all thank you for listening. Thank you for the nice email. Thank you for the question. Yes, I think it is worthwhile to have a preconception consultation for you. And, in general, if someone had any complication of pregnancy, it’s often very helpful to have a preconception consultation. Now, not always, obviously, it depends on the exact circumstances. And the reasons to do that, again, this is review because you’ve already heard this on a prior podcast, but the main reason to do it is to try to understand what happened, why that complication occurred, if possible, to try to also help process that, you know, there’s, like, an emotional component to that sometimes, again, based on what it was. And to see if there’s anything that needs to be tested and, possibly, done prior to a next pregnancy, and to map out a plan for the next pregnancy so you don’t have to start figuring that out when you’re pregnant the next time.

So, that’s sort of the reasoning behind this. I find them very valuable myself, on the doctor end of it, to have an opportunity to meet with someone before they’re pregnant, to go over things sometimes, things that need to be done before pregnancy. Sometimes it’s just to plan, I mean, things that could be done at the beginning of the next pregnancy but it’s just sort of nice to plan ahead so everyone’s on the same page for what happens.

Okay, in terms of your specific situation, so, you had three pregnancies, two of which had IUGR. So, IUGR, for our listeners, stands for intrauterine growth restriction. It’s often called nowadays fetal growth restriction, same thing. It’s basically a catchall phrase for when the babies are born small. Or, if we’re doing an ultrasound during pregnancy, we suspect that the baby is small, meaning smaller than expected for how far along pregnancy you are.

There is a wide range of possibilities for what causes this. Right? And so, when I meet with someone, either during pregnancy or after pregnancy, who has a suspected small baby or baby was born and actually had a small baby, the majority of the time there’s nothing wrong, right, that some babies are big, some babies are small, some babies are tall, some babies are short. It’s like, you know, there’s a lot of variation in human sizes, that’s true with adults, that’s true with children, that’s true with newborns. And so, most of the time a baby is small they’re just…whatever, they’re on that end of the curve versus a baby being big, and there’s no issue whatsoever, fortunately.

Now, sometimes there is an issue where the baby was “supposed to be bigger” but the placenta maybe didn’t provide enough nutrients to the baby. Again, that’s rarely an issue with the mother, right, there’s usually enough nutrients in her body, but it’s just the placenta which is supposed to transfer those nutrients from her to the baby was, for whatever reason, not working well. There are tests in pregnancy that we can do that will suggest that’s the case, either suggest a little bit or suggest it strongly. And, on the flip side, if they’re normal that would suggest there’s no issue with the placenta. Or if there is it’s mild enough that we don’t really need to do anything other than watch and wait.

Those are the two most common reasons a baby would be small. Either the baby’s just normal and small or the baby’s supposed to be bigger but the placenta is not working completely. And then there are other more rare causes that are more concerning, like if there’s a genetic abnormality in the baby or an infection in the mother sometimes, I mean, rarely but some infections can do that. Or something else, like some other exposure, potentially, that she has that can be causing this.

Now, in pregnancy sometimes we have a good sense of what’s going on, sometimes we don’t, but, if the baby’s already born, having that consultation will help us sort of go through the possible causes of having a small baby to see, was there any other concerns in the baby after birth health-wise, genetic-wise, something like that? Assuming no, then we’re generally left with the first two causes, the baby’s just small and healthy or there was an issue with the placenta. As you noted, you can get pathological examination of the placenta where they look at it. You know, sometimes it’s helpful, sometimes not. It’s not always a great direct correlation between how the placenta appears on pathology and what’s going on with the baby, it’s a science that is still evolving and, for many people, somewhat mysterious. Because we can see placentas that look horrible on the reports and the babies are fine and you can see placentas where the report’s like, placenta is great, and the baby was, you know, very small, or whatever it was. And so, it’s not a perfect correlation.

There are some circumstances where we wanna send blood work to see if there’s any issues with clotting, and there’s, you know, some circumstances where we wanna check maybe the shape of the uterus. And, you know, again, there are sometimes things that we can pick up. I would say most of the time I see someone for a pre-pregnancy consultation about a prior baby that was small, assuming the baby’s healthy and there’s no concern for a genetic condition, we usually don’t know for sure was it the placenta or was the baby supposed to be small. And if it was the placenta it’s not like it’s definitely gonna recur. So, all we typically do is, you know, talk about it, make sure there’s nothing else, you know, crazy going on. And then the next pregnancy just sort of watch to see how the baby’s growing with ultrasounds. So, it doesn’t tend to be a very complicated consultation but a lot of people find it very helpful, mostly to see if there’s anything that didn’t get tested last time or didn’t get thought about during the last pregnancy that may have been the cause of the small baby. All right, Rachel, thank you for that question.

Next question is from Erin. “Hi, Dr. Fox. I learned about you from ‘The Toast’ and I’ve been a listener ever since. I’m 27 and my husband and I have started talking about having kids. I wanna go into the whole process as leniently as possible and hope to keep my lifestyle more or less the same, at least in the beginning. I do enjoy the occasional glass or two of wine, particularly on weekends, and I can imagine us getting pregnant on an evening when I have consumed alcohol. I know the general medical advice is to avoid alcohol at all costs when trying to conceive but I can’t imagine that everyone is always completely sober when they conceive. Wine is an aphrodisiac after all,” smiley face emoji. “How dangerous is it really? Should I completely give up alcohol for the unforeseen future until I’m pregnant? Also, what if I have a drink after getting pregnant and just don’t know it yet?”

So, Erin, this is a great question. We get this question all the time, it’s really, really common. Alcohol can be very dangerous in pregnancy to the developing fetus, that is a true statement. However, a few things should be noted, and that’s specifically related to the amount and to the timing. So, in terms of amount, there is very good evidence that large amounts of alcohol, and different studies define that differently, can cause something called fetal alcohol syndrome, which is not good, and it can also cause other neurodevelopmental issues in the newborn children and beyond.

So, because of that, alcohol is typically avoided in pregnancy and it’s recommended not to drink in pregnancy. The question though is, how much alcohol, right? Is it any amount? Is there a threshold below which it’s perfectly safe and above which it’s very dangerous? Are there, sort of, gradations where a certain amount is very dangerous, another amount is a little bit dangerous, and another amount is not dangerous at all? Is it like if you have one glass of wine, will it drop the IQ point by one? And, as far as we can tell from all the evidence that we have thus far, there does seem to be a threshold, and different studies define it differently, but having a glass or two of wine a week is below that threshold. However, it’s defined sometimes it’s, like, one drink a day, sometimes it’s X amount per week, but one to two glasses of wine a week is below the threshold in those studies. And in the studies where they looked at a very either moderate or low, however they name it, amount of alcohol consumption, let’s call it one to two classes of wine a week, give or take, they’ve never been able to find any issues with it. Meaning, when they do studies and look at long-term outcomes on children born to women who had that kind of alcohol exposure in pregnancy, they haven’t been able to identify how that could be risky.

Now, that either means there is no risk at all or it’s so small that it’s not perceivable in a study like that, that we haven’t been able to find it but maybe one day we will. It is true that the recommendation in pretty much every organization is not to have alcohol in pregnancy. But I would say that the reasoning behind that recommendation is not because it’s known that very small amounts are dangerous, it’s because there’s no proven benefit to having one to two glasses of wine a week. So, the thought is, okay, we know that high amounts are not good, so, don’t do that. Low amounts we can’t prove are not good, they might be not good, but there’s no real upside to doing the one to two glasses of wine a week. So, that’s why pretty much everyone recommends not drinking in pregnancy. Again, when I see people, I’ll tell them that, as far as we know, it’s safe and it’s not like, you know, therefore, someone might conclude, “All right, I’m gonna have a glass or two a wine a week because I really enjoy it, I really need it, it relaxes me,” whatever it is. And they’re saying, all right, the risk is either non-existent or very, very low but it’s not like we recommend a glass or two of wine a week because it’s not known to have benefits.

So, that’s the terms of the amount. So, just the amount you’re talking about is probably not particularly dangerous is number one. Number two, the timing. Right? So, in order for something to affect the development of the baby or an organ in the baby, it really has to be present while that organ is being created or developed. So, for example, things that can lead to abnormalities in the fetal heart in terms of, like, the structure of the heart would need to be present at the time the heart is being formed, which is early in pregnancy, so it’s in the sort of middle to end of first trimester. So someone’s on a medication that could possibly cause a heart defect but they don’t start it, let’s say, until the mom is 16 weeks pregnant, well, the heart is fully formed by that point so it’s not going to cause a heart defect. Now, obviously, there are things that can affect the heart in other ways, like the heart rate or the rhythm, okay, so that’s a different thing. In terms of the structure, like, it’s not gonna cause a hole in the heart that wasn’t already there.

So, now, there’s also an earlier end to that. So, if it’s before the heart is being formed, the same principle applies. So, someone’s on a medication and that could, in theory, cause a heart defect and they stop it before the heart is being formed, it also should not increase the risk of a heart defect in that particular baby, right, it has to be during the window where that heart is being made. Brain development, which is really the main issue with alcohol, is ongoing throughout pregnancy, which is why we wouldn’t tell someone, “Hey, you’re 16 weeks, it’s okay to start drinking heavily,” because the brain, unlike the heart, is not so much the structure but more the function. And so, the brain function and sort of development happens throughout pregnancy, so the recommendation not to drink heavily lasts the whole pregnancy.

But, on the other end, it does seem that there’s also an early…like a starting line before which it does not seem to have an impact. And so, generally, the development of the brain is not gonna begin within the first few weeks of conception, right, from when you conceive until you get a positive pregnancy test, it’s typically about two weeks, give or take. And so, in that two-week period, when someone might be drinking, might get pregnant, but not know they’re pregnant, it seems to be too early in order to cause issues with brain development. Right? Alcohol leaves your system quickly, like, you know, within a day, so it’s not like it lingers on forever. And so, if someone was drinking until they got a positive pregnancy test, it does not appear to cause any of those issues even if it was in higher amount. So, that happens frequently, someone says, “Oh my God, I got drunk and I got pregnant, and now what?” So, they may not want to be pregnant, that’s a separate issue, but in terms of risk to the baby, it does not appear to do that. It appears that if someone has something “toxic” that early, if it’s that bad, it would potentially cause a miscarriage but should not cause, as far as we know, sort of, neurodevelopmental issues in the baby because it was done too early.

So, with all of that in mind, for your specific question, I don’t tell people that they have to stop having a glass or two of wine on the weekends before they know they’re pregnant or if they got pregnant when they had more to drink that night, as long as they’re not continuing after…you know, certainly after a positive pregnancy test or even possibly a little bit after that, it should be fine. So, I wouldn’t change that.

Okay, next question is from Riley. This is a new one. “I started listening to you because of ‘The Toast.’ My husband and I are traveling to New Zealand, the bungee-jumping capital of the world. We are also trying to conceive. If I do become pregnant I would be about four to five weeks pregnant during our trip. Is it reasonably safe for me to bungee jump?” Wow. A, I would never bungee jump in my entire life, I’m terrified of heights, that is, like, the last thing on Earth I would ever do. I’m also not likely to be pregnant, so this question is doubly not relevant to me. I have not heard this question before, pretty hard to study this one. Not sure how anyone would do a really good study looking at pregnant bungee jumpers and what the effects are. I would say that, in general, what are the possible risks, right? So, the possible risks are the altitude. Okay, but the altitude does not seem to be an issue, people are allowed to go up on a mountain, people are allowed to live at high altitudes. So, that doesn’t seem to be an issue. There’s the concept of the sudden, like, jerking when you’re jumping off and then you get pulled back up. There are situations in pregnancy where sudden jerking like that can cause what’s called a placental abruption where the placenta separates. Like, if people are in car accidents, and there’s a problem, that’s frequently the reason, the abruption. Now, which is not really relevant at four to five weeks because there is no placenta and it wouldn’t really separate, so that doesn’t seem to be an issue.

The main issue is probably just related to injury, right? That, A, certain activities might be more likely to cause injury. Number two, when you’re pregnant, you’re more prone to certain injuries, like related to your joints and whatnot, because they’re a little bit looser in this. And so, I would say it’s hard to say for certainty what is the problem specifically with bungee jumping at four to five weeks pregnancy. And, more likely than not, I would think it’s not gonna cause a problem, particularly if you don’t get injured, it’s unlikely to do anything. But, you know, it’s really hard to say anything like that with great confidence. I found this online when looking up bungee jumping. “Bungee jumping during pregnancy is highly discouraged.” I think that sums it up. I probably wouldn’t be so keen on someone bunging jumping at any point in pregnancy. Again, more related early in pregnancy to the risk of injury, later in pregnancy to the risk of abruption. I don’t get asked a lot about bungee jumping.

I do get asked a lot about skiing, and it’s conceptually the same. Right? Skiing is not a problem. It’s not a problem to get on skis, it’s not a problem to go on the altitude, it’s not a problem to be on the chairlift or go on the Gondola, or even ski down the mountain, or anything like that. The problem with skiing is you could fall or someone can plow you over, even if you’re an amazing skier and you never fall, you can get run over by somebody and you can injure yourself. And even early in pregnancy when it’s not so much a risk of, like, placental abruption or this, you know, if you tear a ligament when you’re pregnant, it’s harder to treat, it’s harder to have surgery for that, it’s harder to rehab. You know, if you’re on bed rest, you’re more likely to get blood clots. I mean, all these things are worse when you’re pregnant, so we really discourage people from doing activities which could lead to injuries, whether it’s an orthopedic injury, whether it’s a head injury, whether it’s an injury causing bleeding, whatever it might be, we generally tell people to avoid those in pregnancy for that reason. So, I would probably put bungee jumping in that category.

All right, we’re really rolling today. So, the next question is from Katie. “Hi, I’d love to hear you discuss partial molar pregnancies. I’ve had two this year, one in March at 10 weeks and one in August at 11 weeks, and there seems to be very little information about them and the recurrence risk. My husband and I had genetic testing and chromosome karyotyping and there were no issues found. And we also have two children who we had no problem with conceiving. No issues. I’m currently four weeks pregnant and I’m just searching for more information on partial molar pregnancies to understand my risk of a third fully.”

Okay, Katie, great question. So, this is gonna require a lot of background. Molar pregnancies are confusing. Interestingly, they were first described by the man himself, Hippocrates, as in, like, the Hippocratic Oath, in the year 400 BCE. There are lots of other names for molar pregnancies, another one you might hear is something called gestational trophoblastic disease or gestational trophoblastic neoplasia. Essentially, the way to think about a molar pregnancy, it’s when a pregnancy, more specifically the placenta, starts to behave like a cancer. If you think about it, cancer is, generally, an unusual and unchecked growth that doesn’t stop. Right? And that’s why cancer is a problem. Now, pregnancy has a lot of overlap with that. Pregnancy is a time of rapid growth. Right? You go from two cells to a full baby and placenta in nine months, right? If it wasn’t a baby and placenta, in any other part of your body, that would be horribly abnormal. But in pregnancy, obviously, it’s desired. But every now and again this rapid growth that’s happening in the baby and the placenta sort of flips and behaves like a cancer would. Meaning, it doesn’t stop growing after either a miscarriage or delivery or whatever it is.

And it can happen to different degrees, right, a smaller risk to a very higher risk. And so, we categorize them, typically, as something called a partial molar pregnancy, which, Katie, was what your question was about, or a complete molar pregnancy. So, a complete molar pregnancy, the pregnancy, usually there’s just placenta, no fetus, no baby, it’s a very abnormal placenta with a lot of growth, something we call hydropic, it’s filled with, like, fluid. If you checked the chromosomes of the placenta, they look normal, right, there’s a normal number of chromosomes, 46, but actually, it typically happens when you have an empty egg and then 1 sperm that has twice the amount of DNA or 2 single sperms fertilizing that empty egg. So, at the end, you end up with 46 chromosomes, but instead of 23 from the egg, 23 from the sperm, you end up getting 0 from the egg and 46 from sperm and that causes some, sort of, like, chain reaction where this no baby in the placenta just goes gangbusters and it’s growing, it’s growing, it’s growing. It is dangerous, there’s a very high hCG, which is a pregnancy hormone level, high risk of bleeding, and that is a higher risk of leading to a cancer, typically in the uterus, and then it can spread. So, that’s a complete molar pregnancy.

A partial molar pregnancy can have a fetus, can even have a heartbeat, but they very commonly miscarry, that they don’t develop and they miscarry, and so frequently they’re not even diagnosed. Right, so if someone had a partial molar pregnancy and there’s a fetus or an embryo with or without a heartbeat and then they miscarry, you wouldn’t even know it’s a partial molar pregnancy unless you happen to send the tissue that came out to a pathologist and they look under a microscope and say, “Oh, this is molar or hydropic tissue and you have a partial molar pregnancy.” In terms of the genetics, there typically is extra chromosomal material, so instead of 46 chromosomes, it tends to be 69 chromosomes, so 3 times instead of twice, called diploid 46, it’s actually triploidy, but usually it’s 2 sperms fertilizing 1 egg. So, you get 23 from the egg, 46 from the sperm, you get 69 chromosomes. This can turn into cancer but at a much lower rate than in the complete molar pregnancy.

Now, whether someone has a partial or a complete molar pregnancy, the treatment, essentially, is to empty the uterus, either she’s already miscarried with a partial molar or you do a D&C and you empty the uterus of the placenta. And often that’s all that needs to be done. And the way we verify that is we do serial blood tests, you know, every week, every month, whatever it is, and there’s a lot of protocols, until the pregnancy hormone hits zero, the hCG is zero, and then you continue to verify at zero for X amount of time and then we’re highly confident it’s gone and is not coming back. There are situations when it does not go away or it does come back or someone either needs a repeat D&C, and sometimes even chemotherapy. Fortunately, this kind of cancer is almost entirely and universally treatable. If it’s recognized, you know, diagnosed and treated, again, most people need nothing or just one D&C. Some people need a repeat. Some people need chemotherapy but it tends to be very effective and it tends to be curative.

Okay. So, that’s the background for what we’re talking about here. The incidence, the likelihood of a pregnancy being molar seems to be about 1 in a 1,000. Right? So, pretty low, not 0, but pretty low, 1 in 1,000. Interestingly, and this is relevant to your question, Katie, one of the risk factors for having a molar pregnancy is having one in a prior pregnancy. So, for someone who had a molar pregnancy in a prior pregnancy, instead of the risk being 1 in 1,000, in the next pregnancy it’s now 1% to 2%. So, 1% to 2% is low overall but that’s 10 to 20 times higher than everyone else. If you’ve had two molar pregnancies, like you have, the risk seems to be 10% to 25%. So, again, more likely than not you won’t have one but it’s definitely a higher chance the more molar pregnancies you’ve had.

We don’t know definitively why that’s the case but it’s probably because of some genetic predisposition either in the mother or the father to have an abnormal egg or an abnormal sperm. There have been a few genes that have been identified that can increase the risk of a molar pregnancy. So, and, Katie, you said you had normal genetic testing, it depends what they tested. If they just checked your chromosomes, I’m sure yours came back normal as 46 XX and your husband came back normal 46 XY, but that wouldn’t be the testing that would need to be done. There’s very specific molecular testing to see if you are one of the people, or your husband, that carries a specific mutation that can lead to an increased risk. That’s something that, in order to do that, you probably need to have an appointment with a genetic counselor or geneticist and they can talk to you and see what’s going on and arrange that testing to find out to see how high your risk of recurrence might be.

Wow, that’s a really tough topic. That is a hard thing to explain, molar pregnancies are really confusing, really tough. But again, fortunately, most of the time they are totally treatable and just end up being frustrating or annoying. But, usually, if they’re treated well, they can be dangerous but, ultimately, are not if they’re treated well. All right, this concludes our ninth mailbag podcast. Thank you, everyone. Please keep sending in the questions and we’ll keep doing them. Have a great day.

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