The Risks of Pregnancy: The Presence of Scleroderma and Hypothyroidism
The decision for a woman to become pregnant comes inherently with a number of health considerations which must first be taken. The presence of chronic, preexistent or medicated conditions may dictate complication or difficulty in conceiving, carrying to term or giving a healthy birth. This is why any such conditions must be carefully investigated if one has decided to become pregnant. So is this the case with the subject of this study. My sister, whose name will be the anonymous Jane Doe for the purposes or our discussion, agreed to an interview on the subject of her existing health conditions and their relationship to her desire to become pregnant. As an individual who suffers both from hypothyroidism and scleroderma, it is crucial for her to consider the relationship between these conditions and the practical medical concerns that these raise in reference to the condition of pregnancy.
The issue of her scleroderma does elicit some immediate cause for consideration. According to her own report, the condition is limited to her lungs and its severity is only modest. Additionally, as she was diagnosed with this condition well over five years ago, the likelihood of complication is much lower than it would be if she was just adjusting to the condition. As the source by Dunkin (2009) contends, “no woman with scleroderma should attempt to get pregnant within three years of diagnosis, because complications of that disease, including hypertension and kidney damage, are likely to show up within the first three years of the disease and could complicate a pregnancy.” (Dunkin, 1)
As Jane’s diagnosis was given over five years ago, all evidence is to suggest that no new complications are at this juncture to be expected. With respect to the nature of the condition itself, there is no indication that its presence would cause difficulty or danger in carrying a child to term. However, there are other aspects of the condition which do present a legitimate problem that my sister may soon encounter in her own pursuits. Namely, as is the case with most chronic medical conditions, her scelorderma is medicated as a way of treating the autoimmune deficiencies which are a typical part of the condition.
Jane has been using cyclophosphamide in treatment of the autoimmune aspects of her condition according to her own report. Further research denotes that this could pose a complication in the process of becoming pregnant. As the Dunkin source reports, “if fertility is a problem, drugs — rather than the disease itself — are likely to be responsible. The biggest offender is cyclophosphamide (Cytoxan), an immunosuppressive drug given for severe autoimmune disease.” (Dunkin, 1) For many women, this prompts the decision to be removed from the treatment of certain drugs while trying to become pregnant. However, this can come with its own side-effects, most particularly in the intensification of symptoms of the condition and in the vulnerability of the immune system during this most crucial time for both the mother and the unborn infant.
If in spite of these risks, Jane determines to follow through in the interest of becoming pregnant, she may have to accept a change in her medication routine, which can bring about some dramatic changes to the body. Already, Jane has begun to change other lifestyle habits in preparation for the effort to conceive. She indicates an awareness of many of the general health demands which enter into pregnancy consistent with our research findings. These command that “for any woman, the first trimester is a critical period when the baby’s vital organs are forming and when medications and lifestyle habits (such as smoking, drinking, diet and drug use) can affect that development.” (Dunkin, 1) This accounts for the fact that Jane has ceased smoking in preparation for the presence of an unborn child in her system. Such preparations are to be considered necessary even in the otherwise healthy individual.
For Jane, this effort will require further lifestyle and health habit changes though as a way of accommodating for pre-existent medical conditions. To the point, with the hypothyroidism which afflicts her, Jane must be prepared not just to undergo the regular doctor visits that are part of the pregnancy process. In addition, she must engage regular thyroid function checkups to ensure that the standard regimen of treatment for this condition remains effective. In this case, the hormone replacement therapy that is the traditional method of treatment is one which absolutely must be continued to the benefit and survival of the unborn child. As the article by Shomon (2006) indicates, “you must continue to take your thyroid hormone replacement (i.e., Synthroid, Levoxyl, Levothroid, Armour, Thyrolar) and it’s extremely important that you do, now and throughout the rest of your pregnancy. You are your baby’s only source of thyroid hormones at this point – your baby’s thyroid gland isn’t fully functional until after 12 weeks of pregnancy. If you don’t have sufficient thyroid hormones, you are at an increased risk of miscarriage, and your baby is at increased risk of developmental problems.” (Shomon, 1)
Jane indicated in her interview with me that she has established a fair amount of knowledge in the subject herself and that she believes in spite of some of the risks, there is significant precedent to suggest that her condition of hypothyroidism should not prevent her from procreating. Instead, her views were reinforced by present research which indicates that though non-producing thyroid glands can lead to developmental, intellectual and physiological abnormalities in the unborn child, the presence of continued and proper thyroid treatment tends to diminish if not eliminate these present dangers.
Without proper treatment though, evidence suggests that the risks are considerable. Indeed, Mathur (2005) reports that “there is a relationship between thyroid levels in the mother and brain development of her child. A large study reported in 1999 found that undetected or inadequately treated hypothyroidism in mothers was associated with IQ changes in the infants of these women.” (Mathur, 1) The danger of developmental delay for children who are not receiving the proper prenatal balance of iodine distributed by proper thyroid function is real. For my sister, this essentially means that her current treatment regimen must be continued and monitored. Evidence suggests that the dangers presented typically impact those in nations, regions or personal circumstances which have prevented proper treatment. With the presence of such, the risks are considerably diminished.
That said, we consider the relevance of the discussed conditions here to delivery itself. Returning to the issue of scleroderma, there are a few matters to be taken into consideration which, though non-threatening to the child or mother’s health, are still realities of concern. In our discussion, my sister indicated that in spite of her conditions, she would like to give birth naturally. However, indications are that “reduced flexibility of the neck of the womb or vagina, which may complicate the delivery, also needs to be taken into account.” (Walravens, 1) That means that she might have to prepare for the likelihood of C-Section in the event of unnecessary delivery difficulty. Beyond this, Walravens (2008) also reports that children born to mother’s with scleroderma are most typically delivered with low birth weight, but not to an extent that is health-jeopardizing.
The basic outcome of the interview and accumulated research is that Jane can safely attempt pregnancy provided she retains the following conditions. First and foremost, her smoking cessation must continue unabated. Additionally, as she prepares for conception, she must be prepared for the challenges produced by her scleroderma drug regimen, which could be an obstacle to pregnancy. Beyond this, continued attention to the thyroid and unabated commitment to hormone therapy should account for a smooth and healthy pregnancy.
Dunkin, M.A. (2009). Doctor Says Newly Diagnosed Scleroderma Patients Should Avoid Pregnancy For Three Years. Scleroderma Foundation. Online at http://www.scleroderma.org/medical/other_articles/Dunkin_2006.shtm
EHealthMD. (2004). Hypothyroidism and Pregnancy. Medical Illustrations Copyright.
Online at http://www.ehealthmd.com/library/hypothyroidism/HYO_pregnancy.html
Mathur, R. (2005). Hypothyroidism During Pregnancy. MedicineNet.com
Shomon, M. (2006). Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success. Thyroid-Info. Online at http://www.thyroid-info.com/articles/pregnancy.htm
Walravens, M. (2008). Scleroderma. Chronic Inflammatory Connective Tissue Diseases. Online at http://www.cibliga.com/en/index.html
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