“The Native New Yorker Returns to Talk About Autoimmune Disease in Pregnancy” – with Dr. Samantha Do

In this episode, Dr. Fox interviews Dr. Samantha Do, who recently returned to New York to join Maternal Fetal Medicine Associates after a residency at Stanford University. They discuss immunology, why pregnant women are considered immunocompromised, and treating women with autoimmune diseases through pregnancy.

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Dr. Fox: Welcome to today’s episode of “Healthful Women,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN 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. All right, we’re here with Dr. Samantha Do, who is an OB-GYN and maternal-fetal medicine specialist and has returned to New York to practice medicine. 


Dr. Do: It feels very circular coming home to deliver at Mount Sinai where I was born. 


Dr. Fox: Now Samantha was delivered herself as a youngun at Mount Sinai Hospital on the Upper East Side. And now you are gonna to be the deliverer. 


Dr. Do: I’ve been in exile in California. It was beautiful. But I’m glad to stop wandering and be back. 


Dr. Fox: Wonderful. So we’re gonna be talking today about autoimmune disease in pregnancy. But first, I wanna give our listeners a chance to meet you. So tell us, we know you’re born in New York City at Mount Sinai. Tell us your story. 


Dr. Do: I grew up here and my parents were artists living in Soho. They’ve been in the same loft for the last 30 years, will never move. I went to Horace Mann, real New York kid, and then went to Yale for college. And I realized in college that I love the stories that people come up with and how they think about themselves. And I planned to go into neuroscience or neurology because that seems like the part of medicine that was closest to literature, which I was studying in college, to get to the core of being human for a scientific angle as well as a literary angle. 


Dr. Fox: So how did you end up in medical school, specifically, and not like a Ph.D. program or something like that? 


Dr. Do: A year after college I spent in Paris in a neuroscience lab, dissecting rats in French, and going to lab meetings in French and having really delicious hospital cafeteria meals in between and getting to talk with wonderful scientists. And I realized that my favorite part was going to the hospital and shadowing the doctors that were MD PhDs, and getting to see how the science applied to interacting with people and their stories. 


Dr. Fox: So when you went to France for the year, you were not certain what you were gonna do afterwards? 


Dr. Do: I was not certain what I was gonna do afterwards. I was thinking about medicine, but also thinking about science. 


Dr. Fox: And did you know French when you went or did you learn it? 


Dr. Do: I knew French when I went, thankfully. And a lot of the words are the same. Like rat is rat. And we’re sending shockwaves which are put on in the brain that was le shockwaves. 


Dr. Fox: Oh, that does sound a lot better. 


Dr. Do: Everything sounds better in French. 


Dr. Fox: So you’re in France did you apply to medical school from France. 


Dr. Do: I didn’t. I took the year afterwards, I came back to New York taught English and worked in a lab and applied from New York as I was still kind of finding my feet but wanted to go forward with medicine, got to medical school at Columbia, and did my neurology rotation and everything was so sad. There was all these interesting questions and no good solutions, it felt like. And my very next rotation was OB-GYN. There are all these great interventions that we could do to help people through difficult times. 


Dr. Fox: That’s so interesting you mentioned that because when I was your age, and I was also thinking about what to do, my last two choices were neurology and OB-GYN. 


Dr. Do: Makes some kind of sense in that they both have to do with like fundamental parts of being human. 


Dr. Fox: So you decided you wanted to go into OB, then what? 


Dr. Do: I knew from the beginning that I wanted to do maternal-Fetal medicine because what I really loved was the intersection between the mom as the patient, the baby as patient, and how we could kind of get mom safely through difficult pregnancies. 


Dr. Fox: Okay. You went into residency, saying, “I’m gonna do this, but I’m ultimately gonna do maternal-fetal medicine.” 


Dr. Do: Exactly. 


Dr. Fox: And you were in California. 


Dr. Do: I was in California at Stanford outside San Francisco. It was a great place to train. I had wonderful mentors. 


Dr. Fox: Shoutout to Yaeger Blumenfeld. 


Dr. Do: Yes. 


Dr. Fox: He left us and went out to California. But I guess one of the good things is he trained you. 


Dr. Do: Excellent mentor, excellent teacher, and had great advice about where to come settle back when I came back to New York. 


Dr. Fox: Right. He was basically your agent. So you’ve been back now a few months. How’s it been in terms of the transition back from California to New York City? 


Dr. Do: It’s been so great and getting to be around family, having my daughter, who’s a big part of my life, be around her extended grandparents, and having her love Central Park and remembering how bagels only really exist in New York. Yankees broadcasts better on the radio here [crosstalk 00:04:03]. That’s a good time. 


Dr. Fox: All right. That’s good. What’s the comparison of the pandemic between California and New York? You got both coasts? How would you compare and contrast them? 


Dr. Do: I was very lucky in that we missed the peak in California and we missed at least the spring peak here so far. 


Dr. Fox: Wow. 


Dr. Do: It seemed that we had all the preparation in California and run off the spike before I left. 


Dr. Fox: Right. So you did the right timing. You moved at the right time. Awesome. Well, Samantha’s in our practice. You’re seeing patients. Once the hospital privileges go through, that’s just paperwork stuff, you’ll be doing deliveries. You’re doing ultrasounds, procedures. It’s great. We’re certainly really happy to have you on the team. And I know that our patients are very happy to have you on our team. And today we’re gonna talk about a really interesting and common situation in pregnancy which is autoimmune disease. And this is also something that you did research on in your fellowship. 


Dr. Do: I was lucky that one of my other mentors was [inaudible 00:04:54] who did a lot of the early autoimmune disease work in pregnancy actually here in New York before he also was a transplant to California. Pregnancy is such a phenomenal state for many reasons, but one of them is that the body, which has usually just our own cells is now responding to the baby that’s half self and half not self, which is kind of amazing that our bodies can do this. 


Dr. Fox: Right. So I mean, there’s this whole concept, the discipline, the field is called immunology. And essentially, when we talk about our immune systems, what we’re referring to is the body’s ability to essentially fight off foreign materials. So we think of things like viruses, bacteria, stuff of that nature. And it’s basically our bodies has an uncanny ability to recognize something that’s not supposed to be there and attack it. And that’s the immunologic system. And one of the fascinating things is when women are pregnant, why does that not happen? Right? How does the body realize that even though the baby is foreign, so to speak, why does a body not attack the baby? And that is really not well understood. But we know that that’s the case. 


Dr. Do: And there’s some great hypothesis of the why of it of how our bodies are designed brilliantly to respond. And one of those is having the placenta that has special cells that protect the baby from the maternal circulation and the maternal body. And another is some of the changes and downregulation of parts of the autoimmune system or part of the immune system, the immune system is able to respond so it’s not attacking this part that’s foreign, this part, that’s the baby, not cells. 


Dr. Fox: Yeah. I mean, it’s really fascinating. And the placenta is sort of like border control, I like to say, it really does separate the mother from the baby. And it does, let through nutrients and let through certain antibodies and not let through others. And so that’s one of the ways that sort of the baby is physically sequestered from the mother’s immune system. And the other way, what you’re referring to is this whole idea that the mother’s immune system is altered in pregnancy, in some ways. In some ways, it just changes. So it learns not to attack the baby, but in other ways it’s lowered, meaning there’s just a general lowering of the immune system, which is not so good if mom gets an infection in pregnancy. And that’s one of the reasons we’re a little more cautious and a little more aggressive about treating infections in pregnant women because they’re to some degree, what we call immunocompromised. It’s a long word that basically just means your immune system is a little bit less than it should be. 


And that’s like, for example, with the flu. You know, that’s why we take flu so seriously in pregnant women. They should have vaccines, and we’re worried about it, and why we were very worried about COVID, that it may be the same. Fortunately, it does not seem to be that way for women that COVID does not seem to be worse if you’re pregnant. But we definitely know that that happens in pregnancy. 


Dr. Do: It can be unfortunate when moms get an infection and exactly we’re trying to prevent infection at all costs, by having the flu vaccine, by monitoring moms really closely. And so that can be not beneficial to have a lower immune system or a modulated immune system, but it is beneficial for being able to not attack the baby. 


Dr. Fox: Right. I mean, the ideal system would be one where the mother retains her immune system entirely, but it’s able to recognize that the baby is supposed to be there. And for the most part that happens. It’s not like women walk around and are at a horrible risk of infection. It’s just higher than sort of before. And so the system is really pretty good. Maybe not perfect, but it’s pretty good. And one of the reasons that this comes into play is there are these whole host of conditions that we label as autoimmune conditions. And just as a background, even in non-pregnant state, how would you explain, like what is an autoimmune condition? What does that mean? 


Dr. Do: An autoimmune condition is when the body thinks something that’s supposed to be there isn’t supposed to be there and responds to it with inflammation or attacking it. And autoimmune conditions happen to be a little bit more common in moms or in women than in men. So it’s something we see more in pregnancy because women are the ones who are pregnant. Autoimmune conditions are things like lupus or rheumatoid arthritis, or Graves’ disease, bowel disease, that can come up where the body is, mistakenly identifying its own self, its own proteins as something that shouldn’t be there like a virus. And so it’s confused and attacks it as if it were an infection when it’s really self. 


Dr. Fox: Right. And what’s interesting is each one of these diseases is different. Right? So you may have a condition like Crohn’s disease, which is what happens to the intestines. And these are treated by gastroenterologists, and it’s very intestinal specific, and you may have something in the thyroid like Graves’ disease, which is a thyroid disease. And so, they’re totally separate organs. They’re treated by different kinds of doctors, but they’re both the same underlying problem. And so sometimes some of the treatments might overlap because they affect the immune system and also the effects in pregnancy and how they’re dealt with in pregnancy overlap. So autoimmune is kind of an umbrella but many different doctors in almost every specialty are gonna be dealing with people with some form of an autoimmune condition. I guess the specialists like most specific to immunology and autoimmune is what we call rheumatology, which is interesting because rheumatology really means like joints, but I guess because I guess I know rheumatoid arthritis is one of the first ones that was discovered but they sort of get the immune type of conditions and under their umbrella more so than everyone else, I guess, which is an interesting facet of medicine. 


Dr. Do: And some of the different autoimmune conditions that affect different parts of the body can run together. You don’t fully understand the mechanisms of why some people are more prone to autoimmune diseases, but we know that they run in families and that if you have one autoimmune disease, you might be more likely to have one even if it’s in a totally different organ. 


Dr. Fox: Right. And what you said before is so true that statistically, they’re more common in women. And they’re also more common in women in their 20s, 30s, and 40s. That’s like the highest risk group. And that’s known. And it’s not known why that is. There are theories that potentially some of these are brought about actually by pregnancy, or pregnancies or something related to maybe different genetic material inside of her whether it’s with, you know, pregnancy that ends up being a baby, or even a miscarriage, or even potentially just having sex. Like, it’s very confusing why that is, but that’s a theory. There are theories related to viruses that potentially cause this. And then there’s a whole host of other theories, but no one really knows why someone would or would not get one even if we know someone’s at risk to get one like has a strong family history. 


Dr. Do: It’s so interesting that they happen more in women and it doesn’t have to do with the hormonal milieu. It doesn’t have to do with pregnancy, or kind of when we see more miscarriages, that predates kind of an autoimmune condition. Is it because there is kind of beginnings incipient of the autoimmune condition that then gets uncovered, in a work-up of kind of bad pregnancy outcomes. 


Dr. Fox: Right. And one of the reasons that autoimmune diseases are so interesting in pregnancy is when women become pregnant and their immune system is lowered, like we said, that’s good if you’re the fetus, not so good if you’re the mom who gets an infection, but it could be good if you’re a mom with an autoimmune condition, because whatever your immune system is doing to attack those organs of yours, that’s also gonna be lowered. So frequently, women, when they’re pregnant, do better if they have an autoimmune condition. 


Dr. Do: Particularly they’re gonna do better if they’re going into pregnancy with what we call a quiescence state or a lack of having disease players are in a high activity of their autoimmune condition before pregnancy, then they’re kind of set up where their body’s less likely attack itself. And then it responds with maybe suppression of the immune system in pregnancy to do better in pregnancy. 


Dr. Fox: Yeah. When we see women in pregnancy, who have medical conditions, or either pregnant or thinking of getting pregnant, there’s always like, I think about like three different separate topics. One is how is the pregnancy gonna affect the medical condition? Meaning, “Do I have a medical condition such that if I get pregnant, I’m gonna get much sicker, it’s gonna be worse for me down the road, it’s gonna shorten my life,” things like that. Fortunately, those are pretty unusual that that would happen, but there are some exceptions. The second thing is how is the condition gonna affect pregnancies. It could put me at risk for a C-section, a birth defect, preterm birth, something like that, and that definitely can happen. And the third is the treatments. And each condition is unique. And we think about diabetes, a little different from hypertension, a little different from cancer. But what’s interesting is there’s so many of these autoimmune conditions, and each one again, is different. There’s lupus is very different from Graves’ disease, or Crohn’s disease, multiple sclerosis, which is a neurologic disorder, Myasthenia gravis, also a neurologic disorders. They’re all very different in terms of like, what specialists we’re talking to, and what symptoms women have. But when they come to us, we always sort of have the same general conversation at first, which is for most of these conditions, she should expect to get a little bit better during pregnancy, which is really nice. But on the flip side, after she delivers, when sort of that immune system comes back to normal, she’s at a higher risk of having a flare of whatever condition it is. And that’s one of the things we talk about a lot with women either during or before pregnancy, who have one of these conditions. 


Dr. Do: And that’s one of the reasons that we often recommend keeping on the treatment that’s worked for them for the condition, post-partum, especially and talking with us and talking with their specialists in whichever field to make sure that treatment is safe with breastfeeding, but that it’s something that’s really gonna be protective for their health to continue that treatment in the post-partum period. 


Dr. Fox: Right. And a lot of times, it’s hard, because many of the symptoms women would get from their condition overlap with common postpartum symptoms, right, like being tired or fatigued, or maybe headaches, or maybe certain pains. And it’s hard to sort that out sometimes, but we always let women know that they should be very attuned to what’s going on in their bodies. And if they notice something different or something worsening, they should err on the side that it might be their condition and come in for evaluation for testing potentially increase their treatments. And the specialists know about this, but a lot of women are surprised to learn this when they’re, considering pregnancy for the first time that they have this sort of like, you know, it’s great when you’re pregnant, but then it could be worse after you deliver. And that’s not something that they may have known beforehand. 


Dr. Do: And the postpartum period is such a unique and exceptional and also challenging period for many reasons. So it can make it good to know in advance to prepare for it. 


Dr. Fox: Right. And not only the symptoms overlap, but sometimes the triggers for these things like what you’re eating, how you’re sleeping, I mean, again, these are all significantly altered in someone after they deliver compared to what they were having earlier in life. So that’s a really important point that we make. And the other interesting about autoimmune is since they’re caused by antibodies that’s like the way your body attacks skin, bacteria, and foreign objects but also in autoimmune the organs it’s not supposed to attack. In most of these conditions, the antibodies stay in the mother, but there’s a couple of them where the antibodies can actually go through the placenta and “attack” the baby and affect the baby. Again, those are the exception. It’s not typical. And most of the conditions that does not happen. Like someone with Crohn’s, their baby is not born with Crohn’s, but there are situations Myasthenia is a classic one, and there’s another one called Sjogren’s when those antibodies can cross. So we have to check the levels of those antibodies, and then to potentially not just watch the mother, but watch the baby during pregnancy. 


Dr. Do: And the good news about that is we know ahead of time, we can both do surveillance in pregnancy to watch how baby is doing. And we can also do sometimes some interventions that some of the medications that are actually used to treat some of the conditions can be protective for the baby and decrease their risk of having things like neonatal lupus, for moms who have lupus in pregnancy, by treating with Plaquenil in pregnancy. 


Dr. Fox: Most of the time, it’s hard for us to treat the fetus during pregnancy. Right? There are these exceptions like [inaudible 00:16:08] for fetal therapy, fetal surgery. These are things that people see on the news or read about and they’re like, really fascinating and cool, but those are really, really rare. But this is one of those times that from a medical perspective, we can actually evaluate and treat the fetus for a medical condition that’s caused by the mother’s antibodies. Again, it’s not that usual, but it’s something we could screen for and any of us would know which of those conditions the baby is at risk, for and which conditions the baby is not at risk. But that’s one of the other fascinating aspects of taking care of these women that we’re not just following how she’s doing, we have to follow how the baby is doing for a lot of these conditions to make sure the antibodies are not affecting the baby. 


Dr. Do: And something that makes it even more helpful to talk with your OB or an MFM before you get pregnant. So you can get testing for the antibodies if you have an autoimmune condition to be able to strategize and plan for pregnancy. 


Dr. Fox: Right. And then the third thing we talk about medical conditions is the treatments. Right? So a lot of people are really worried that the treatments that they require when they’re not pregnant to stay well are gonna somehow be dangerous during pregnancy. Usually, they’re concerned about the danger to the baby like is it gonna cause a birth defect or somehow affect the baby’s function of some sort. Occasionally, they’re worried, you know, maybe it won’t work on her when she’s pregnant, she needs a higher dose or a different medication. But for the most part, that’s really not the case, with these medications. They tend to work and they tend to be safe. 


Dr. Do: There are very few medications that are absolutely to avoid in pregnancy, but exactly as you’re saying, most of them are ones that are safe and actually beneficial to continue because when moms have better control of their disease, babies do better, too. 


Dr. Fox: Right. And that was specifically one of the focuses of your research when you’re looking at women with lupus. Right? 


Dr. Do: That was one of the products I did in fellowship looking at moms with lupus and looking if they continue their hydroxychloroquine or Plaquenil in pregnancy, how they did, and also how their babies did. We saw not only that moms had less flares in pregnancy, which is going to be good for them, but also that it was a suggestion that they were less likely to get some of the adverse outcomes that we can see in pregnancy in moms with autoimmune disease like preeclampsia, or having babies born early. 


Dr. Fox: Right. Now Plaquenil is a medication that if you’ve had lupus or you know about it, you may have heard of it, but it also got a lot of press over the past several months, because that was the medication that everyone was going back and forth. Does it help for COVID? Does it not help? You know, everyone’s sort of debating that. So I imagine that your research ended up on Google searches a lot more in the past summer than you would have thought. 


Dr. Do: I definitely never expected my pregnant patients to be having shortages of their Plaquenil because it was in the news for COVID. We know it’s great for lupus in pregnancy, and things like rheumatoid arthritis. The jury’s still out on COVID. 


Dr. Fox: Right. It’s a great medication for a lot of conditions in pregnancy, because it’s actually a really old medication. And so the safety of it is pretty well established. Usually the older medications we just know more about because it’s been used for a long time. And so we rarely have an issue with women taking Plaquenil in pregnancy and they take it for a whole host of conditions. Lupus is one of the famous ones, but there’s others for which they take that medication. It seems to be really safe, well-tolerated, and it seems to work. So that’s a great option. And then in the past, I don’t know 10 to 20 years there have been so many of these other new immune-modulating medications that are used again for so many of these different conditions. Women with Crohn’s disease use them, women with lupus use them, women with other autoimmune diseases, and they basically affect her immune system by again, lowering it more or altering it almost sort of like what happens at pregnancy and these medications have been more and more… I think the earliest one is probably Remicade. That’s probably the first one that was used and Infliximab, I believe it’s called. You’re nodding. Good. 


Dr. Do: Yes. 


Dr. Fox: Good. Samantha says that I’m correct. She’s the smart one. So she knows. But since then, there’s been a bunch and you must see a lot of women on these medications and a lot of them are injections or infusions because they’re not just pills that people take. 


Dr. Do: And the good news is because of national registries and looking at kind of large groups of women that gotten them, we don’t see kind of an increased risk of birth defects with almost all of these medications. We see they’re really well-tolerated in pregnancy and we think again, kind of having a better immune kind of response for moms that they’re not attacking themselves also was beneficial for having better pregnancy outcomes. 


Dr. Fox: Right. So I agree that most of the data on all of them has shown really no increased risk of birth defects. Again, we’re still learning and there’s always potential and so we talk about it, but it hasn’t seemed to be a problem in that regard. One of the other concerns that people have with these medications is maybe they’ll affect the baby’s immune system such that the baby will be born at an increased risk, temporary increased risk of infection. And that has not really seemed to play out so much in most medications. And a lot of times people will like not take their last one right before they deliver sort of just in case and they take it right after they deliver. But it’s not clear how much of a risk that truly is for babies, again, towards the end of pregnancy. 


Dr. Do: And we do think it’s really important to pick up close after delivery to prevent some of those post-partum [inaudible 00:20:58] or flares, that we can see when the immune system comes back into full force. And for babies, we always say to talk to their pediatrician about it, that you’ve been on that medication. And sometimes they’ll just delay giving some of the vaccines that they might give in the very early beginning before it washes out of the baby’s system. But again, there haven’t been long term problems even for babies so far. 


Dr. Fox: Right. And this is one of those topics where probably by the time this podcast drops, there’ll be more research on this because there’s so prevalent for different conditions. And there’s more and more research on this. And so it’s always good to be updated for whatever medication you’re on because particularly this kind of medication because we will learn more and hopefully their research will continue to just be reassuring. And so you have a greater pile of data showing reassurance but you never know it’s possible. One of them may show a greater risk of the baby’s immune system than another and different recommendations. So it’s always good to be up-to-date. Let’s say there’s any of our listeners, either they themselves or they know someone who has an autoimmune condition and is thinking about getting pregnant. So what would you recommend? 


Dr. Do: I’d recommend that the goal would be to have kind of a good state where you’re not having a flare or an increase in your autoimmune condition right before pregnancy, usually for a few months to maybe six months of having a good state before pregnancy beyond kind of a pregnancy compatible drug regimen so that you don’t have to go off it in pregnancy which can increase your risk of flare early in pregnancy, but to be on one of these medications that we’ve talked about, that we have good data on that is safe in pregnancy for moms and babies. And then also to see your OB and let them know you’re planning on getting pregnant because there’s some labs that they might wanna check or some vitamin supplementation they might recommend depending on your condition. 


Dr. Fox: I totally agree with that. And I think that one of the themes that’s come out on this podcast and something that we talk about all the time you know, amongst ourselves as the doctors is how much better it is for women when they do this planning before a pregnancy. Sometimes it’s not possible. Sometimes people, they’re pregnant, it wasn’t expected. Okay. It’s not the end of the world. We can work with anyone and sort of any circumstance. But it’s really ideal to speak to whether it’s your rheumatologist, or gastroenterologist, endocrinologist, or neurologist, whoever’s treating your condition primarily, and to speak to your obstetrician and say, “Hey, I’m thinking of getting pregnant. Do I need to do anything? Like, do I need to change my medications? Do I need any testing? Is it okay to try? Is it not okay to try?” And sort of get that all sorted out on the front end. Rarely, is there a lot to do. Typically, it’s, “You’re fine. You’re ready to go.” Sometimes it’s, “Hey, let’s tinker with your dosing or your medication, or let’s make sure this, let’s do this test. Fine.” And occasionally one of them will say, “You know what, let’s just get you one more opinion. Meet with what we do maternal-fetal medicine just to go over so you understand everything.” 


Usually, by the time we meet with them, the plan is mostly in place, and we’re just sort of like, blessing it or going over why all these things are happening to sort of explain it or just for the people who have an hour to spend with them and talk about everything. But I find that women who do that in advance then when they’re pregnant, there’s so much less anxiety, and commotion, and sort of trying to figure out what to do. I mean, pregnancy is hard enough. I mean, like, you might as well just get as much off your plate as you can before you just embark on it. And so that’s something that I always, always recommend for women. Even if they’re not sure if they wanna get pregnant just to have a plan in place in case you do or in case it just happens. That happens all the time also. 


Dr. Do: And that’s one of the wonderful parts about our job to get to talk with people in these moments and kind of imagine what pregnancy would be like for them. And for the most time, it’s gonna be a kind of good story with good planning. Very rarely, there’s a condition where we say, “It’s so high risk that we wouldn’t recommend getting pregnant.” But most of the time, it’s gonna be like you said, just make sure that things are on the right page with all of your specialists, make sure we have a good plan for pregnancy, and you’ll be good to go. 


Dr. Fox: Yeah. I remember I saw someone maybe now a couple of years ago, and I mean, she had several autoimmune conditions. She was on a bunch of medications, had a lot of complications. So she had a lot of issues going on. And she met with a doctor who basically told her, “You can’t get pregnant,” because I mean, he said like literally, she would die. Like, she could not get pregnant. It was like that horrible. Oh, my God. So that’s pretty devastating. And then she ended up coming to me for a second opinion or someone a friend of a friend. I’m not really… I don’t remember exactly how she came across. And I saw her and I said, “I don’t think it’s as drastic as the prior doctor said.” And got her whole history, we talked about it, we talked about these principles and sort of the medication she’s on. And they were all okay, and really didn’t seem that risky. And she left and I called up her other doctors, and I got their opinion. Like, “What do you think?” And we all sort of caucused together, and all of us agreed that we didn’t think it was so risky. And we thought that probably she would do, okay, and we sort of had a plan in place for everything. And so when she decided she’s gonna do it, she got pregnant, she really didn’t have that crazy fear, walking into pregnancy that she would have had if she just showed up pregnant. And she required a lot of close follow-up and blood tests and ultrasounds and appointments. And she saw, you know, seeing three doctors. So it was a lot of stuff going on. But she did great. A healthy baby. You know, she was so excited afterwards. She actually did not have a flare after she delivered amazingly three different diseases. I guess, the medications worked, and she did great. And I’m sure she’s planning on doing this again now. But again, it’s like that’s a real success story, because the fact that she planned in advance, I guess, on the first side it was pretty bad because someone told her, you know, she might die. But after that when everyone got together and discussed it and went over it more thoroughly, it was a really great thing for her and her pregnancy. And I can’t imagine if she just showed up pregnant, how hard that would have been without any planning, and how much anxiety and commotion that would have cause for her. 


Dr. Do: I think that both speaks to how it’s good to be up-to-date and how far medicine has come because some of the medical conditions, some of the autoimmune conditions previously were a lot worse outcomes for moms in terms of their health and risks to their life. But because we have these new medications that we’ve seen over the past few decades are safe in pregnancy, we can say, “You can have a healthy pregnancy and a healthy baby with increased surveillance and good coordination of all your doctors.” 


Dr. Fox: Absolutely. We’re here. That’s what we do. The maître d’ of the medical establishment. We’re there to coordinate all the doctors and all the tests during pregnancy. And Samantha, we’re just glad that you’re here. You’re on our team. You’re bringing expertise to this and you’re native New Yorker, Yankee fan, apparently, which, okay, not so happy about that, but we’ll work on it. But yeah, and you’re gonna be full circle, Mount Sinai. 


Dr. Do: It’s so good to be back. My mom’s from the Bronx. So I feel like I was born into it. So, you know, certain things are hereditary. 


Dr. Fox: You inherited your Yankee gene. All right. 


Dr. Do: It just happens. 


Dr. Fox: Very nice. 


Dr. Do: So glad to be on the team in here. 


Dr. Fox: Great. Well, thanks for coming on the podcast. We’re gonna have you on many times again. It’s really great to hear your take on this. Thank you for listening to the “Healthful Woman,” podcast. To learn more about our podcasts, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L-W-O-M-A-N dot com. If you have any questions about this podcast or any other topics you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman,” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman,” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.