Halie Reyes discovered she was pregnant in March of 2019. While she and her husband were excited, they couldn’t help but be a little anxious, too. A couple of months earlier, Halie and her husband experienced the pain of miscarriage. This, coupled with the fact that Halie had type 2 diabetes, made them particularly nervous.
Halie immediately set up an appointment to meet with diabetes educators at the Center for Maternal and Fetal Care at The Children’s Hospital of San Antonio. Prior to getting pregnant, Halie had Type 2 diabetes and knew this would put her at high risk for developing gestational diabetes during her pregnancy. The educators would help Halie regularly track her numbers and made sure she stayed on top of her monitoring each time she had a doctor’s appointment.
“I felt so blessed to be able to work alongside the doctors and educators at the Center for Maternal and Fetal Care. They did a really good job of helping me manage everything and stay on top of my logs. The team went the extra mile for me to ensure a safe and healthy pregnancy,” said Halie. “One of the first things they did was enroll my husband and me in a series of cooking classes so that we could develop healthier eating habits.”
The program, called Culinary Health Education for Families* (CHEF), was provided in the Teaching Kitchen at The Children’s Hospital of San Antonio. The program was aimed at teaching men, women and children how to grocery shop, prepare nutritious meals and establish healthier eating habits. Halie found the classes extremely helpful. A chef and dietitian showed Halie and her husband how to prepare various recipes and give them tips on using healthy substitutions.
“The food was amazing and we learned so much in each class. One of our favorites was the healthy version of a fish taco. It has now become a staple in our household,” said Halie.
In addition to helping her establish a healthier eating path, her care team also helped her properly manage her blood sugar and keep track of her glucose numbers. Initially, she was put on insulin and had to do finger pricks every day, but eventually, she was able to use a sensor, called the FreeStyle Libre to track her blood sugar. Halie found the device helpful and easy to use.
“Instead of pricking my fingers eight times a day, I was able to use the sensor that went on the back of my arm,” explains Halie. “It can sync up with either your phone or a tracking device and will give you your glucose levels. This device was a game changer for me.”
Doctors saw Halie every two weeks throughout her pregnancy to monitor the diabetes and as they got closer to her due date, her appointments were weekly. They were most concerned with Halie developing preeclampsia, a complication during pregnancy when blood pressure is too high, impacting the vital organs, most commonly the liver and kidneys. In addition to preeclampsia, they were also worried Halie would gain too much weight and that the baby would get too big during the pregnancy.
Doctors told Halie that she would not carry the baby to full-term due to the gestational diabetes because it could pose a greater risk to her and the baby. The plan was to induce her at 39 weeks. On Nov. 25, 2019, Halie had an excruciating headache and couldn’t sleep. At midnight, she went in for the induction, and Dr. Marisol Garcia-Hodge performed an emergency C-section because Halie’s blood pressure was too high and was not coming down.
Dr. Marisol Garcia-Hodge is an OB-GYN at CHRISTUS Central Women’s Health Care. She delivered Halie’s baby by emergency C-section at 39 weeks. Despite being diagnosed with gestational diabetes, Halie and her husband welcomed a healthy baby girl into the world in November 2019.
After controlling Halie’s blood pressure and managing her pain, they safely delivered her baby, a daughter she named Sarah.
“Due to the gestational diabetes during pregnancy, the doctors had to monitor Sarah’s blood sugar levels,” said Halie. “She had to spend a few days in the neonatal intensive care unit to make sure her body could learn to regulate itself.”
Today, Sarah is a healthy 22-month-old toddler.
Two years later, Halie said she would do it all over again, even though the experience was scary at times.
Halie praises the team at The Children’s Hospital that helped her give birth to a healthy baby girl in 2019.
For other mothers who have diabetes or develop gestational diabetes during pregnancy, Halie tells them it will get better and that they need to do what is necessary to care for themselves and their baby. She said a big part of this is finding the right care team to help you manage every aspect of your diabetes, including how to develop healthier eating habits.
“I will wholeheartedly recommend the care team at Children’s to anyone who will listen,” said Halie. “If any mom is looking for an obstetrician, I always tell them I know the best team!”
One you are diagnosed with gestational diabetes, how can you maintain a healthy pregnancy and reduce your risk of complications?
Q&A with Dr. Shad Deering, maternal fetal medicine specialist
Every year, 2 to 10 percent of pregnancies in the United States are affected by gestational diabetes. What exactly is it, and how can it be managed effectively? We recently sat down with Dr. Shad Deering to talk about gestational diabetes and what women need to know.
Q: Can you explain what gestational diabetes is and how and when it’s diagnosed?
A:Gestational diabetes is a type of diabetes that occurs during pregnancy.It’s usually diagnosed when a woman is between 24 to 28 weeks pregnant with a one-hour glucose tolerance test.
Q: What are some common risk factors associated with gestational diabetes?
A: There are certain risk factors the predispose a woman to develop gestational diabetes. First, if you had it before with another pregnancy and specifically if your baby weighed more than nine pounds, the likelihood of you developing gestational diabetes is greater. Also, if you have polycystic ovarian syndrome (PCOS), you are also at risk. Other risk factors include being Hispanic or Black, having a family member with diabetes, having hypertension, or having a body mass index (BMI) of over 25.
Dr. Shad Deering recommends a balanced diet, exercise routine and blood sugar monitoring to reduce the risks associated with gestational diabetes.
Q: If you have the above risk factors, what are some things you can do to manage gestational diabetes better?
A: You can take some steps to lower your risk profile, including being mindful of what you eat and being active. Getting 30 minutes of exercise – at least three to five times a week – will help. Making changes to your diet and cutting out simple carbohydrates like white bread, for example, also will help. You should aim for 40% complex carbs (multigrain bread and cereals, beans, and vegetables), 20% protein, and 40% fats. In short, a balanced diet and exercise routine coming into pregnancy will significantly decrease your risk.
Q: If a pregnant woman is diagnosed with gestational diabetes, what should she eat? What should she not eat? How should she manage her pregnancy cravings?
A: When women receive a diagnosis of gestational diabetes, they immediately think, “what can I eat” instead of “what should I stop eating,” which is the more important question. Reducing soda intake as well as processed baked goods like crackers and chips can be effective in lowering blood sugar levels. Making dietary changes can be difficult, especially when a woman is experiencing cravings. However, just like lifestyle changes are a big deal in managing diabetes outside of pregnancy, they also play a role in managing gestational diabetes as well.
Q: When a woman is first diagnosed with gestational diabetes, what happens next? What is done to help them so they have a healthy outcome?
A: When it’s determined that a woman has gestational diabetes, they are often only given a handout providing some limited information on what they should or should not eat. But, if we are asking women to make significant changes in their eating habits for the health of their pregnancy, we think they deserve more. When one of our patients receives this type of diagnosis, we take it a couple of steps further and immediately get them set up with one of our diabetic educators. The diabetic educator sits down with the patient, explains how to eat properly and what smart choices look like, and thoroughly answers a patient’s questions.
Q: Why is it important that a woman diagnosed with gestational diabetes take it seriously and follow the prescribed plan as set by either her physician or diabetic educator?
A: A diagnosis of gestational diabetes can cause multiple issues during pregnancy. One of them is having a large baby, which increases the likelihood of needing a C-section. Women with gestational diabetes are also prone to developing preeclampsia, a dangerous pregnancy complication which manifests with high blood pressure and can progress to eclampsia, or seizures. The risk of stillbirth also goes up substantially, especially if you’re not controlling your sugars. But, there is some good news. If you can control your blood sugars and get them within a specific range, then the risks of all of these things are much lower. It’s critical to keep in mind that what you’re dealing with is short-term and, in most cases, resolves after pregnancy.
Q: Besides diet and exercise, what are some other ways women can manage their gestational diabetes?
A:When it comes down to it, diet and exercise are key to managing gestational diabetes. Often, blood sugar levels will improve dramatically, and we won’t have to take any additional measures, like medication. However, if your blood sugars remain high, we’ll have to take further steps regardless of diet and exercise changes.
What is the typical medication for a pregnant woman with gestational diabetes? Is it different from what somebody would take if they have Type 2 diabetes and were pregnant?
A: The medication of choice for women with gestational diabetes is insulin. The recommendations have changed over the years. At first, it was insulin, and then we thought oral medications might be better, but we have come full circle and have settled on insulin as the optimal treatment, which is now recommended by The American College of Obstetricians and Gynecologists (ACOG). If, however, a woman is on Metformin already at the beginning of pregnancy, they might be asked to continue taking it. However, Metformin is used to treat pre-diabetes and not gestational diabetes, so it’s slightly different.
Q: How often does a woman with gestational diabetes need an insulin shot, and when?
A:It all depends on what time of day women are experiencing high blood sugars. Often women struggle first thing in the morning. In this case, they will take one dose of long-acting insulin before bed and hopefully, when they wake up, their levels will be in an acceptable range. On the other hand, if a woman experiences high blood sugar at dinner, one dose of short-acting insulin may be adequate. It is not only dependent on when a woman eats but what she eats as well. And all of this can change throughout pregnancy. You might start off not needing any insulin because the adjustments in your diet and exercise plan are working; however, you might need to start on a low dose the next trimester and even increase it later in pregnancy.
Q: Does a patient with gestational diabetes need to see her doctors more frequently?
A: If your diet is well controlled and you aren’t on medication, you will most likely be seeing your physician at almost the same intervals you would otherwise. Regardless, if you are on medication or not, you will need to track your blood sugar numbers and send them to your physician. This is especially important if you’re on medication because we’ll want to check those numbers weekly. After about 32 weeks, patients should plan on coming into the office so we can do fetal monitoring of the baby, which usually consists of an ultrasound where we are looking at fluid and movement and the size of the baby, or it can mean putting the patient on a monitor to watch the baby’s heart rate.
Q: So, throughout a woman’s pregnancy, can her gestational diabetes get worse? Why?
A:Yes, because the placenta makes hormones that predispose pregnant women to become diabetic. The human placental or lactogen HPL reduces the effectiveness of the insulin in your body when you are pregnant. As your pregnancy progresses, it’s not uncommon for women to require more insulin.
Q: What happens when a woman with gestational diabetes delivers? Does diabetes go away?
A: When you deliver, many things that would cause diabetes do go away. In other words, if you’re on insulin before having your baby, in many cases you won’t need it after you deliver. Your body will go back to a non-pregnant state. When this happens, you may not have gestational diabetes anymore, but you can still have diabetes. So, we highly recommend a two-hour 75-gram glucose test 4-12 weeks after you deliver to determine if you still have diabetes. If you have gestational diabetes, you have a 50 to 70 percent lifetime risk of developing Type 2 diabetes, which is why it’s so crucial for women to get checked and receive treatment if they need it.
Q: Is there a timeframe when a woman could develop Type 2 diabetes after having gestational diabetes? Is the risk higher right after she gives birth or later in life?
A:It depends a lot on the person because gestational diabetes has a lot to do with genetics and lifestyle. It’s a little hard to define an exact timeframe. The bottom line is if you have gestational diabetes, you should be checked for Type 2 diabetes regularly.
Q: Let’s say a woman leads a healthy lifestyle, exercises all the time, eats right, etc., and still develops gestational diabetes. What could be the reason?
A: It’s always a shock when women who don’t fit the profile are diagnosed with gestational diabetes. When someone comes in and their BMI is high, you’re going to expect some insulin resistance, but if they are the perfect picture of health, it’s a difficult pill to swallow. These women likely just have a genetic predisposition to developing gestational diabetes.
Q: Do you have any advice for women planning to get pregnant and how to avoid a diagnosis of gestational diabetes?
A: If you’re planning to get pregnant, there are some things you can start doing right away, like taking prenatal vitamins, folic acid, looking at your diet, and getting into an exercise routine. By the time you have that first appointment with your obstetrician, it’s too late. Your baby has already started forming, and you’re well into your pregnancy journey. So, making lifestyle adjustments before getting pregnant is my No. 1 piece of advice.
If you have received a diagnosis of gestational diabetes and would like to make an appointment with a maternal fetal medicine specialist at The Children’s Hospital of San Antonio, please contact us at one of our three Centers for Maternal and Fetal Care:
Research shows COVID vaccines do not affect one’s ability to have children.
With so much misinformation about COVID-19 vaccines, parents, especially of teenagers, find themselves confronted with some challenging questions that they may not know how to answer.
Among teenagers’ top concerns about the vaccines is whether or not they cause infertility later in life.
“It’s unfortunate this rumor is swirling around because there’s zero evidence of this occurring. It’s a theoretical risk that’s never been shown in any animal model to exist,” said Dr. Shad Deering, a maternal fetal medicine specialist at The Children’s Hospital of San Antonio.
This idea that the vaccines cause issues with fertility originated from a doctor who recognized something on the COVID-19 spike protein – on the virus itself, that was similar to a protein found in human placentas. The doctor thought that the vaccine might make antibodies against that protein and could affect placentas and pregnancies. But COVID-19 vaccines don’t even cause that protein to be produced, and there have been studies of placentas of women who received the vaccine and there are no differences between them and women who didn’t get the vaccine. According to Dr. Deering, unfortunate conclusions were quickly made, and soon after the information went viral and exploded on social media.
“There are inherent risks with anything we put in our bodies, from vitamin supplements to coffee and even chicken nuggets and we don’t know how those substances will affect us 10-20 years from now. In the case of the vaccine, the benefits of getting it greatly outweigh the risks,” said Deering.
Dr. Shad Deering, a maternal fetal medicine specialist at The Children’s Hospital of San Antonio, points to research showing there is no link between COVID-19 vaccines and one’s ability to have children afterward.
Teenagers may question the safety of the vaccines because of how quickly they were rolled out.
Deering said the mRNA technology isn’t new – it’s been around for years. In fact, Dr. Katalin Karikó, the scientist who was instrumental in developing ways to use it in medical treatments, has been working with mRNA since the 1990s. Additionally, the COVID vaccines now available were thoroughly tested before they were administered to the public and since they were introduced there has been ongoing research showing the vaccines are safe and effective.
“The process was sped up because we needed an answer to help curb the pandemic. I think most of us are used to hearing vaccines take four to eight years to develop, but if you think about it, does it really have to take that long? With this vaccine, all of the red tape that researchers usually face was taken away which sped this vaccine up significantly while still keeping all of the safety protocols in place,” said Deering.
While the connection between COVID-19 vaccines and infertility is unfounded, the risks associated with being pregnant and contracting the virus are, in fact, real, which is why the medical community is strongly encouraging pregnant women to get vaccinated.
“There are few things more difficult than seeing a pregnant woman, and sometimes her baby if it happens when too early in pregnancy, die from a disease that could have been prevented with a vaccine,” said Deering.
There is also a chance that seemingly healthy young people are at risk of developing severe issues after they contract COVID. For example, The Children’s Hospital of San Antonio has seen cases of adolescents and teenagers developing myocarditis (inflammation of the heart) after a COVID infection.
“What it comes down to is getting COVID-19 and the possibility of becoming severely ill and dealing with the long-term effects of the virus versus getting the vaccine which carries minimal short-term. While we know the vaccine doesn’t cause infertility, what hasn’t been studied are the long-term effects of actually getting COVID-19,” said Deering. “Parents, especially teens, need to take the time to arm themselves with trustworthy information sources so they can help debunk some of the myths.”
The Children’s Hospital of San Antonio offers the Pfizer vaccine free of charge to members of our community who are 12 and older. Sign up for an appointment at this link. Once arriving at this link, select specialty: COVID-19 Vaccination. Under COVID-19 Visit Type, select Onsite Pfizer Vaccination Dose 1. Then click on the blue bar with SEARCH in the middle to find available appointments. We provided COVID vaccines in the Goldsbury Center for Children & Families located at 333 North Santa Rosa St., first floor, San Antonio, Texas 78207.
Walk-ins are welcome on Tuesdays and Thursdays from 9:00 to 11:00 a.m. and 1:00 to 4:00 p.m. Experienced personnel provide the vaccines plus emergency attention is nearby in case of any immediate allergic reaction. If you have questions or concerns, please talk to your pediatrician about the vaccine.
After a series of miscarriages, a young couple finally has the family of their dreams.
Annabelle Pike’s journey to motherhood starts and ends with the heart – quite literally.
A mother of three, Annabelle has experienced more than her fair share of heartache along the way with several miscarriages, all of them leaving painful scars.
After announcing she and her husband, Rhyan, were pregnant with a baby boy in August of 2016, the pregnancy was going fine up until about 12 weeks when Annabelle had a placental abruption and lost the baby. During her DNC surgery, she learned she had a condition called bicornuate uterus which means her uterus was shaped like a heart instead of a pear.
“We had just announced the pregnancy to all of our friends and family,” said Annabelle. “We were devastated to learn the placenta had tried to grow around the area of the uterus called the horn where the dip in the heart is in the uterus leading to the placental abruption.”
The only silver lining is that she now had a diagnosis and could take this knowledge into future pregnancies.
“You either have the condition, or you don’t. And there’s no treatment for it,” said Annabelle. “The issue of having a bicornuate uterus is not getting pregnant, but staying pregnant, but it can lead to recurrent miscarriages and other pregnancy issues. So, if I wanted to continue to conceive, I would need to see a high-risk specialist.”
This was Annabelle and Rhyan’s third miscarriage in a short time. Determined to have the family they always wanted, Annabelle and Rhyan tried for another baby and got pregnant right away.
Fortunately for Annabelle, she stayed pregnant and carried her baby, Allison, now 4 years old, to term. A couple of years later, Annabelle was pregnant again with a little boy, Richard.
With both pregnancies, Annabelle and Rhyan were hesitant to become too excited for fear their excitement would turn to sadness with her history of miscarriages. They never wanted to share the news or plan too far in advance for fear their dreams would be shattered.
After Richard was born, Annabelle experienced heartache once more, losing yet another child. So, when she became pregnant with baby Eleanor, she decided to transfer her care to Dr. Emma Rodriguez, a maternal fetal medicine specialist at The Children’s Hospital of San Antonio.
Annabelle Pike praises Dr. Emma Rodriguez for providing compassionate care that helped relieve her anxiety and stress during a complicated pregnancy.
“There was something special about Dr. Rodriguez. Right from the start, she understood my anxiety, and I felt like she really listened to me,” said Annabelle. “I don’t ever feel like there was a time I went there and wasn’t completely heard or taken care of.”
Annabelle’s pregnancy started a bit rocky in that Eleanor had developed an echogenic bowel – a condition where the fetal intestines appear brighter than expected. When a baby has an echogenic bowel, they are at risk for bowel obstruction and other infections.
Dr. Rodriguez also discovered that Annabelle had a circumvallate placenta, with a fold or shelf in the placenta, leaving her at greater risk for placental abruption, a condition she was well aware of since she dealt with it before.
“The first 12 weeks of this pregnancy, I remember feeling really anxious and leaning on my family and friends. I concentrated on moving forward and reminded myself continuously that this was a new pregnancy that would have a different outcome,” said Annabelle. “And having Dr. Rodriguez by my side was so reassuring. She never made me feel like my emotions or questions were unwanted or unjustified.”
Annabelle got through her second and third trimesters, and thankfully Eleanor’s echogenic bowel cleared. Anabelle also concentrated on her own mental and physical healing, even participating in a 5K race in honor of the pregnancies she had lost.
While pregnant with Eleanor, Annbelle and her family participated in a 5K in memory of the children she lost due to miscarriages. She was joined by husband Rhyan, son Richard and daughter Allison.
Everything with this pregnancy seemed to be headed in the right direction. Annabelle breathed a sigh of relief.
This feeling went into the delivery day. Knowing that Annabelle was high-risk, Dr. Rodriguez, along with Dr. Mallory Thompson, her obstetrician at the Women’s Center at Westover Hills, decided it would be best to deliver her at Children’s in case there were any complications. Doctors performed an uneventful C-section, and Eleanor was born healthy, weighing 8 lbs. – which is incredible due to Annabelle’s bicornuate uterus.
Dr. Mallory Thompson holds newborn Eleanor moments after she was delivered via C-section at The Children’s Hospital of San Antonio.
About 12 hours after giving birth, just when she thought everything was right in her world, Annabelle’s journey took a scary turn.
Annabelle had just sent her husband and older children home after a joyful visit when a nurse noticed that Annabelle was hemorrhaging. Soon, a team of doctors and nurses at The Children’s Hospital of San Antonio gathered and started prepping her for surgery to stop the bleeding.
“I cannot tell you how thankful I am about how quickly all of them reacted,” said Annabelle. “They knew exactly what to do because they prepare for these types of scenarios all the time.”
Annabelle was in surgery for about two and a half hours. Because of the unique shape of her uterus, doctors had to physically fix the hemorrhage and then place a balloon in her uterus to stop the bleeding. After her surgery, she was on bed rest and anxious to get home to her family.
“Annabelle was in bad shape and the surgery was a complicated one,” remembers Dr. Rodriguez. “The good news is that she delivered at Children’s where we have a simulation center that practices for these exact types of situations which is why we were able to pull a team together so quickly and get Annabelle safely through the surgery.”
When she talks about her experience, Annabelle is extremely grateful to the entire team at Children’s for taking such great care of her.
“I definitely felt cared for by everyone there. Everyone on the team was incredibly supportive. If it weren’t for them, I don’t think I would have been able to safely deliver my daughter and be here today to enjoy my kids,” she said.
Eleanor is now 3 months old and loves seeing her siblings, smiling all the time and melting her mommy’s heart. Annabelle’s heart is full of love and life instead of fear and anxiety, thanks to Dr. Rodriguez, Dr. Thompson, and the team at The Children’s Hospital of San Antonio.
If you have a condition that puts you at risk for miscarriages, the maternal fetal medicine specialists at The Children’s Hospital of San Antonio are here for you every step of the way.
It was Halloween and Desirae and Christian Ruiz were sitting in the Walgreens parking lot dressed as cowboys and staring at a pregnancy test they had just taken. They were shocked when they saw it was positive! They were over the moon to learn they were pregnant for the first time, and so were their parents. After a challenging year dealing with the pandemic, the promise of a new baby brought everyone immense joy.
The family held a small gender reveal party and learned that Desirae and Christian were having a baby girl. It was a sweet experience and a special way to mark the impending arrival of baby Aria.
Desirae’s pregnancy got off to a rocky start.
“I had a lot of nausea, which I wasn’t used to, and I couldn’t hold anything down,” said Desirae. “It was miserable, and I felt awful the entire time.”
When Desirae was 20 weeks pregnant, she went in for her sonogram. What she thought would be a routine appointment to check on Aria’s progress turned out to be an anxiety-filled event. The technicians performing the scan told Desirae that she should not miss her next appointment with her obstetrician under no uncertain terms. But they did not tell her why.
“The whole situation gave me a lot of anxiety because the technician was not willing to further explain what she saw or what she thought she saw. I just remember getting into my car and just sobbing,” said Desirae.
A couple of weeks later when Desirae received a call from the clinic, she learned that her baby had what was known as gastroschisis. This is a condition where a hole develops in the umbilical cord, and the intestines leak out into the amniotic cavity. Aria would need one or more surgeries immediately after birth to place the intestines back inside.
“When I found out, I couldn’t breathe or talk. I was just crying. My world was turned upside down,” she said.
So, Desirae made an appointment at the high-risk clinic to learn more. Because it was during the height of the COVID-19 pandemic, her husband could not go with her. She was alone. She remembers feeling like she did something wrong and had a lot of guilt, but the doctors reassured her that gastroschisis is something that just happens, and there’s no good explanation for it.
Her obstetrician decided the best course of action would be for Desirae to deliver her baby at The Children’s Hospital of San Antonio and meet with Dr. Kathy Barsness, a pediatric surgeon who specializes in this type of surgery.
Dr. Kathy Barsness, pediatric surgeon, met with the Ruizes to help prepare them for what to expect when Aria was born with a condition called gastroschisis.
“When we went to go meet with Dr. Barsness, she was amazing. She told us at least half a dozen times that we were all going to be OK. She walked us through all possible scenarios and explained what life would be like after Aria was born. She was so accommodating and really eased our anxiety,” said Desirae.
Throughout the rest of her pregnancy, Desirae felt a myriad of emotions. Even though she’d been told that Aria’s condition was not her fault, she was still riddled with guilt. She had some depression, too. Together, she and Christian leaned on their faith and did a lot of praying. They started seeing the high-risk doctors once a week and her obstetrician every other week – it was a time full of worry and stress.
To help calm her fears, Desirae found a support group online called “Avery’s Angels.” The group was full of mothers whose babies had surgeries shortly after birth and grew up to lead healthy and productive lives.
“Finding that group was awesome for us. Being able to connect with other moms and chat with them brought me a lot of peace,” said Desirae.
Fast forward a few weeks later, Desirae went to one of her regularly scheduled appointments.
“I remember that morning being super hectic. We somehow overslept and were rushing to our appointment,” remembers Desirae. “When we got there, the nurses doing the sonogram realized that Aria hadn’t moved in 10 minutes. Next thing you know, they were telling me it was time to deliver Aria and that I needed to head to the hospital. I couldn’t believe it; I was going to be having my baby that day!”
Despite Desirae’s desire to have a vaginal birth, her team at Children’s thought it best for her and Aria if they performed a C-section. It was not what Desirae wanted for her first-born child, but she understood why it needed to be that way.
“So many things didn’t look like we wanted them to with this pregnancy,” said Desirae. “It was just another thing, but we knew that a C-section was the safest thing for our baby.”
At 4:34 p.m., Aria was born. It wasn’t until 1 a.m. the following day that Desirae was able to meet her baby girl in the neonatal intensive care unit (NICU) as she recovered from her C-section. Even though her intestines were outside of her body, Aria’s vital signs were good. Her heart was stable, and initially, she was on a breathing tube.
Looking back, Desirae says that meeting with Dr. Barsness and the talking with the moms in the support group really helped prepare them for what Aria would look like when she was born and helped to alleviate some of their fears. Desirae and Christian treasured the moments when they held Aria’s tiny hands and feet – the only contact they could have.
Soon after Aria was born, Dr. Barsness sat down with Desirae and Christian. She explained that Aria had an intestinal atresia, a type of blockage, which meant spending at least four to six months in the NICU. Both Desirae and Christian were devastated.
At that point, the goal was to get Aria’s intestines back in her body. They put her intestines in a clear bag and balanced them on a white bar above her body and then they used gravity to allow her intestines slowly back into their body. Every day, they would push the intestines deeper into her stomach and verify that the intestines were adequately oxygenated.
Because of Aria’s atresia, they were doubtful this would happen, but miraculously, it did. Once her intestines were back in her body, they X-rayed her and discovered air flowing from stomach all the way to her rectum. She no longer had a blockage. She experienced a lot of breathing issues because there was a lot of pressure on her lungs from her stomach and intestines. It was a matter of waiting for Aria to respond and for the intestines to decrease in size.
“We are sure that there was a lot of science to it, but we just felt like God had moved a mountain, that He had performed a miracle for us by removing that blockage,” said Desirae.
Now that the intestines were safely back in her body, the next big milestone for Aria would be for her to have a bowel movement. The whole family rallied around her and wished for poop. They even created a special hashtag: #prayforpoop.
Desirae remembers the timeline well. On June 23, her intestines were finally back inside her body, and they learned there was no blockage and two weeks later Aria had her first bowel movement. Afterward, they kept her on IV fluids to receive her nutrition and she also remained on supplemental formula. Shortly after, she was able to start regular feedings.
“I feel so blessed that Dr. Barsness came to The Children’s Hospital of San Antonio,” said Desirae. The way she did the suture-less closing was a huge benefit and saved our little Aria from a traditional surgery that normally happens for this condition. She benefited from it tremendously because another concern we had was the cosmetic scar left on gastroschisis kids across their tummies and we didn’t want that for her. Her belly button will look completely normal.”
Aria spent 36 days in the NICU. Gradually, she was able to increase her milk, and as of late, she eats between 75 to 90 milliliters every three hours. She was able to go home on July 23.
“We are overjoyed to have her home and she’s doing awesome. She poops four times a day and has urine output every time she eats which is exactly what our doctors want to see from her,” said Desirae.
Her doctors don’t anticipate Aria will need another surgery. Her intestines popped into place. She is currently underweight, but as long as she continues to gain at a steady pace, she will be OK.
Looking back at her daughter’s experience, Desirae is grateful to the entire NICU team for their unconditional care of Aria.
“They truly made this process so much easier and relieved our anxiety, especially as first-time parents,” said Desirae. “Leaving our baby overnight and for multiple hours a day while we worked was hard, but we knew she was in great hands and that they were intentional about everything they did for her.”
Desirae said she and Christian are particularly indebted to Dr. Maria Pierce in the NICU and to Dr. Barsness. They felt like both were rooting for Aria and always had her best interests at heart.
“I am appreciative for Dr. Pierce. You could really see that she was excited when Aria did well and that she really felt it when Aria had some setbacks,” said Desirae. “We felt cared for just at a deeper level.”
Aria did not have to undergo surgery for gastroschisis, but rather a less-invasive procedure was done to put her intestines back into your abdomen.
Desirae is also looking forward to her continued journey with Dr. Barsness who they will be seeing regularly throughout Aria’s life. “We are very excited for the relationship we’re going to continue to build and we’re so thankful and grateful that she is just so excellent in her craft and was able to give Aria a better quality of life.”
A specialist in maternal fetal medicine explains why some pregnant women with COVID-19 can be effectively treated with monoclonal antibody therapy.
James Hill, MD, Maternal Fetal Medicine Specialist, The Children’s Hospital of San Antonio
When the COVID-19 pandemic first emerged, there was no specific treatment for it. Fast forward a year and a half later, not only do we have safe and effective vaccines but also monoclonal antibodies for patients who develop mild to moderate coronavirus infections.
As the delta variant continues to circulate, we are hearing increasingly more about these monoclonal antibodies. But what are they, and who can benefit?
The monoclonal antibody is a Y-shaped protein that can protect the body from foreign invaders.
An antibody is a Y-shaped protein that serves like a lock-and-key to protect the body from foreign invaders, like the virus that causes COVID-19. Monoclonal antibodies are just like the ones you already have, except they are produced in a laboratory and are specifically designed to help your immune system detect and respond more effectively to the notorious spike protein of the coronavirus.
Data suggests that the sooner the monoclonal antibody treatment is given to individuals who test positive for COVID-19 and fall into specific high-risk categories, the better they may benefit by preventing progression of disease that would otherwise result in hospitalization. These high-risk groups include individuals who are overweight (body mass index over 30), diabetic, have high blood pressure, and/or cardiovascular/kidney disease.
Dr. James Hill points to evidence-based research that supports monoclonal antibody therapy for COVID positive pregnant women.
In July, the American College of Obstetricians and Gynecologists (ACOG) stated that doctors could consider monoclonal antibodies in non-hospitalized pregnant patients who fell into one of the above-mentioned high-risk groups. As recently reported by the Society of Maternal Medicine (SMFM), this guidance now applies to women who’ve recently given birth and are currently breastfeeding.
The use of monoclonal antibodies, specifically REGEN-COV (casirivimab and imdevimab), has been used primarily on non-pregnant/non-lactating women until now; however, there is evidence to support that breastfeeding and pregnant patients can benefit if they have a mild or moderate COVID-19 infection.
As of now, the Food and Drug Administration (FDA) has authorized the use of these medicines to treat COVID-19 for non-hospitalized adults and adolescents under what is referred to as an Emergency Use Authorization (EUA.) An EUA means the drugs have not undergone the same type of review as other FDA-approved products but meet certain criteria for safety, performance, and effectiveness in treating patients during the COVID-19 pandemic.
Both of these drugs are administered intravenously (through the vein) for at least an hour, and patients receive one dose of casirvimab and one dose of imdevimab. You will be monitored for 60 minutes after your infusion to monitor for side effects.
Like any drug, these two medicines have potential risks, so it’s essential to discuss their use with your physician, especially if you are pregnant or breastfeeding.
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