Uma Mahadevan, MD: Prioritizing Gastric Health in Gestational Patients

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The investigator discusses the unique interplay between conditions like IBD and gestational risks—and how specialists need to improve communication.

The findings from a new single-center study at the University of California, San Francisco (UCSF) highlighted the overall safety against inflammatory bowel disease (IBD) flares among pregnant patients taking low-dose aspirin to prevent their risk of preeclampsia.

But perhaps more greatly, the findings from the UCSF team shine a greater light on the historical discrepancies in gastric and gestational health prioritization across the 2 specialties tasked with managing pregnant women with IBD.

In the second segment of an interview with HCPLive during the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting in Vancouver, BC, this week, study author Uma Mahadevan, MD, professor of clinical medicine at UCSF, discussed the need for collaborative care between GI specialists and obstetricians for pregnant women with IBD and other chronic conditions.

Speaking specifically to the risk of preeclampsia in such patients, Mahadevan stressed the importance of monitoring for suspicious signs or early symptoms.

“As many patients with inflammatory bowel disease are otherwise healthy, an obstetrician may look at them and say, 'You're at low risk' and not really follow them as closely,” Mahadevan said. “And that's why we have all of our (GI) patients with maternal fetal medicine specialists if they can be, or at least be monitored as high-risk patients because the fine things are subtle for preeclampsia. They may get high blood pressure, they may have protein in their urine, they may start not feeling well. And it's very easy to miss late in pregnancy.”

Mahadevan explained there’s a great deal of education and understanding of one another’s priorities in care that needs to be exchanged across GI and obstetricians.

“I think that as gastroenterologists, we may be afraid of the pregnancy, and the obstetricians are afraid of the disease,” Mahadevan said. “And so it's really important to have communication between the gastroenterologist and the obstetricians taking care of these patients, and that there's good communication.”

She said that her practice has had patients who were recommended to stop their medication for IBD going into their pregnancies by obstetricians, pediatricians, or other care providers. In most cases, Mahadevan explained, this is the wrong decision.

“Because the biggest risk to the pregnancy is actually active disease and not most of the medications we use,” Mahadevan said. “But for many patients in the community, there's a lack of OB providers, specialized GI providers, and then it becomes much more complex.”

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