A Vanderbilt Health expert explains why you might need to see a maternal-fetal medicine specialist, and what these specialists do to keep your pregnancy as healthy as possible.
If your obstetrician or midwife refers you to a maternal-fetal medicine specialist, you may feel fearful or anxious about what this may mean for you, your pregnancy and your baby. Does it mean your pregnancy is considered high-risk? Will your existing provider be able to deliver your baby, or does your birth plan need to shift?
It’s understandable to have fears and concerns, which is why we asked Dr. Matt Grace with the Fetal Center at Vanderbilt to answer some common questions about what to expect during a visit with a maternal-fetal medicine specialist.
“A maternal-fetal medicine physician is an obstetrician-gynecologist who has completed additional education, research and training in medical, surgical, obstetrical, fetal and genetic complications of pregnancy,” Grace said. “We are often called ‘high-risk pregnancy’ specialists.” Read on for Grace’s overview on what you can expect when referred to these physicians for prenatal care.
What kinds of pregnancy problems or complications does a maternal-fetal medicine specialist treat?
“We care for women who have experienced complicated pregnancies in the past, have chronic medical conditions, or have developed unexpected or fetal complications during their pregnancy,” Grace said. “These conditions or complications generally fall into the following four categories.”
Maternal chronic conditions:
- Heart disease
- High blood pressure
- Lupus or other rheumatologic diseases
- Thyroid disease
- Asthma or other lung diseases
- Diabetes
- Obesity
- Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
- Bleeding or clotting disorders
- Kidney disease
- Seizure disorders
- Chronic infections, such as hepatitis or HIV
- Cancer
Complications in prior pregnancies:
- Pregnancy loss (miscarriage)
- Preterm (premature) delivery
- Stillbirth
Unexpected complications:
- An abnormal result on a genetic test
- New diagnosis of a genetic syndrome or birth defect
- Infections that may affect the pregnancy or fetus
Fetal complications:
- Twins, triples, quadruplets or more multiple fetuses
- Fetal growth problems (fetal growth restriction)
- Certain fetal conditions for which fetal treatment or surgery can be performed inside the uterus, before delivery
Why was I referred to a maternal-fetal medicine doctor?
There are generally six reasons your obstetrician or midwife may refer you to a maternal-fetal medicine specialist, Grace said, identifying the following:
- A preconception consultation: “We meet with women before they become pregnant to discuss any medical conditions they have or complications they had in prior pregnancies. This is an opportunity to review any possible risks in a future pregnancy and to outline a plan for how those risks can be minimized in a future pregnancy.”
- Ultrasound: “Maternal-fetal medicine specialists perform detailed ultrasounds to screen the fetus for birth defects or genetic syndromes. You may be referred if your provider saw something concerning during an ultrasound in their office or if they want a detailed evaluation of your baby’s anatomy.”
- Genetic screening or testing: “We often work with genetic counselors to help you understand whether your pregnancy is at increased risk for being affected by a genetic condition (Down syndrome, for example). We can discuss the different testing options and, if you decide that you want testing, we can perform those tests and help you understand the results.”
- Consultation: “Patients are often referred to maternal-fetal medicine for consultation due to a medical condition that may complicate their pregnancy. Often, patients referred for consultation continue their prenatal care with their doctor or midwife. The maternal-fetal medicine specialist provides a detailed list of recommendations to your doctor for how to manage that condition during the pregnancy and at the time of delivery. You may return for one or two follow-up visits with the specialist during your pregnancy but will continue prenatal care and have your baby delivered by your doctor or midwife.”
- Co-management: “Your doctor or midwife may ask a maternal-fetal medicine specialist to co-manage a medical condition during your pregnancy. Diabetes, high blood pressure, thyroid disease or a history of premature delivery in prior pregnancies are common conditions that a maternal-fetal medicine specialist is asked to co-manage during pregnancy. You will continue to see your doctor or midwife for prenatal care but will see the specialist regularly to check bloodwork or adjust medication to keep you and your pregnancy healthy.”
- Transfer of care: “Sometimes pregnancies are so complicated or high-risk that your prenatal care and delivery are all performed by a maternal-fetal medicine expert. If needed, the maternal-fetal medicine specialists work with other medical specialists to keep you and your pregnancy as healthy as possible.”
Does a referral to a maternal-fetal medicine doctor mean my pregnancy is “high-risk”?
“Being referred to a maternal-fetal medicine specialist does not necessarily mean that your pregnancy is ‘high-risk,’” Grace said. “In many cases, we can provide guidance and recommendations to you and your prenatal care provider, but you can continue your care with your provider and they can deliver your baby. Our goal is to work with you and your provider to help you understand if your pregnancy is at an increased risk of complications and, if so, outline a plan to minimize those risks so that you and your baby are as healthy as possible.”
What can I expect during my visit?
“Your experience will depend on why you were referred,” Grace said. “It is common to have an ultrasound in our office before you meet with the maternal-fetal medicine specialist. During your visit, the specialist will ask detailed questions about your medical history, family history and any complications in prior pregnancies. The doctor may recommend follow-up visits, additional ultrasounds, additional testing or visits with other medical specialists.”
Who else might I meet with during my visit?
“Depending on your pregnancy’s needs, you may meet with various supporting members of our staff during your appointments, including sonographers, genetic counselors, nurse practitioners, pediatric specialists, and educators,” Grace said. “Together, we work as a team to support you and your pregnancy.”
The Fetal Center at Vanderbilt
The team of maternal-fetal medicine, neonatal and pediatric surgery specialists at the Reed Family Maternal Fetal Clinic at Vanderbilt develop personalized care plans tailored to each patient. They work together with other Vanderbilt experts to provide highly specialized care.
