In commemoration of World Birth Defects Day on March 3, Dr. Men-Jean Lee of University Health Partners of Hawaii’s (UHP) Women’s Health Specialists spoke with us about how expectant moms can do their best to assure their babies are born healthy, especially during the global health crisis.

Dr. Lee is the Division Chief for Maternal Fetal Medicine at UHP, and Medical Director for the Fetal Diagnostic Center at Kapiolani Medical Center for Women and Children in Honolulu, where she and her team provide prenatal diagnosis, ultrasound, genetic counseling and diabetes counseling for women who have complications during pregnancy.

One might think during this time of heightened health concerns that those complications have increased, but actually, Dr. Lee tells us, there has been very minimal effect of the current global health crisis infecting unborn babies. With respect to women who contract a virus during pregnancy, she said, “We can safely counsel them that we have not seen any birth defects associated with the mother getting sick.” She clearly differentiates between this particular virus and the Zika virus which has been known to cause severe birth defects.

Another surprise is that there has not been an increase in the birth rate or the rate of women becoming pregnant during this global health crisis. “Many thought that there would be a baby boom because so many people were staying home,” Dr. Lee said, “but that still hasn’t happened. The birth rate in Hawaii has been steadily decreasing over the past year as it has been doing over the past ten years.

“There is more social information coming out on women who are planning pregnancies. Perhaps with job losses and the bad economy, women are thinking carefully about whether or not they want to start a family at this time, especially if finances are tight.”

When asked about whether the vaccines currently available to combat the spread of the virus are safe for pregnant women to take, Dr. Lee said, “Although there hasn’t been much research about the new vaccines on pregnant women, this new class of mRNA vaccines do not contain any virus particles. They are quickly eliminated by the woman’s body so that they are unlikely to reach the fetus to cause a birth defect. Whatever antibodies the mother makes from the vaccine will likely cross the placenta to protect the fetus. Pregnant women should decide what is more important to them after speaking with their doctors.”

Addressing the issue of people being afraid to go to a clinic or hospital during the global health crisis, Dr. Lee was quick to mention the Midwifery Integrated Home Visitation (MI-Home) Program. Created by UHP with a generous grant from AlohaCare, the MI-Home Program provides the services of a traveling Certified Nurse Midwife who can “actually go to your home or shelter to provide prenatal and lactation support services there in the comfort and safety of your own home. And if the pregnant woman needs extra medical services because she has some high-risk issues, the midwife actually carries mobile telehealth equipment to telehealth back to one of the maternal fetal medicine doctors via the internet.”

Dr. Lee called this program, which has been in existence for about a year, “a lifesaver during the global health crisis when many pregnant women are too afraid to leave their houses or aren’t allowed to bring their children with them to the hospital for a doctor visit.”

Telehealth is another service that can also help women who are afraid to come in to see their doctors, or who live in more remote locations. “A lot can be done with maternal telehealth,” Dr. Lee said, including tele-ultrasounds to help detect fetal birth defects prior to birth. “Prior to the global health crisis, we learned that almost 5,000 women each year have to fly to Honolulu from the neighbor islands to get their prenatal ultrasounds. So at UHP, we’re looking at how we can bring tele-ultrasound to the neighbor islands, so that patients don’t have to fly to Oahu for healthcare or need to quarantine when they return home.”

During the past year, she said, she and her department have moved quickly to convert their in-person prenatal consultations to telehealth visits so that they could counsel women in the comfort of their own homes about how to reduce birth defects and improve maternal health. “We’ve been very fortunate to be able to convert over 50% of our prenatal visits to telehealth visits with video conferencing,” she said.
She also spoke about how UHP Maternal Fetal Medicine doctors are flying to the neighbor islands to do ultrasounds in person “for patients who are either too afraid to fly or don’t have the means to fly to Honolulu for pregnancy care.”

For prevention of birth defects, it is recommended that women get healthy and start taking prenatal vitamins before trying to conceive. “Too often people forget that in order to have a healthy baby, we have to take care of moms first. Most healthy babies start with a healthy mom.

“Folic acid is actually a great way to prevent birth defects,” Dr. Lee said. She also strongly advises women who are diabetic to “get their diabetes under control before they conceive. Women with poorly controlled diabetes are at high risk for carrying a baby with birth defects.”

Dr. Lee also talked about the role of genetic counselors who work closely with the Maternal-Fetal Medicine doctors to discuss genetic screening tests that assess each family’s risk of birth defects. “The information gained from the specialized testing goes beyond whether the pregnant woman is carrying a girl or a boy. In fact, some of these DNA tests can detect particular problems in advance so that the patient can optimize the birth outcome of her baby or even make a decision as to whether or not to move forward with the pregnancy.” This is particularly important for women who are 35-years old or older who are another group of women who are at high risk for carrying a fetus with birth defects.

Maternal-Fetal Medicine doctors have been the key to improving health care for pregnant women and their babies in Hawaii. However, according to Dr. Lee, “The Maternal-Fetal Medicine doctors are faced each day with having to give bad news to patients. We all want every pregnancy to be healthy and all women to have a positive birth experience, but sometimes bad things happen to good people,” she said, “That’s why the Maternal-Fetal Medicine doctors work closely with the pregnant woman’s primary obstetrics provider and the pediatric subspecialists to give the mother and baby the best possible outcome even in a bad situation.”

As the global health crisis has affected all of us in our daily lives, the work of the Maternal-Fetal Medicine doctors has also been made more difficult. One of those challenges comes from misunderstandings and resistance many providers are facing due to public health and hospital mandates that have been issued to keep patients and their families safe from spreading the infection.

“The reality of living through this global health crisis is unprecedented. The hospitals and public officials have been trying really hard to control the spread of the virus and keep everyone safe. Some of the decisions have not popular, but they are tough decisions that are working to keep our numbers low here in Hawaii.”

“We want to remain data-driven,” Dr. Lee added, and praised the governor, the lieutenant governor, the mayors, and the public health officials of Hawaii for making the hard, unpopular decisions that have led to Hawaii having one of the lowest rates of infection in the US. “No one can do this alone. We’re not going to win the fight unless everyone does their part.”