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> There is no medical specialty dedicated to anyone who loses an infant or pregnancy There is. They’re medical geneticists. They’ve got relatively large depart

> There is no medical specialty dedicated to anyone who loses an infant or pregnancy There is. They’re medical geneticists. They’ve got relatively large departments at NYU, Brigham and Women’s, and NYP-Cornell. It’s not under-funded, it just usually goes under the radar as “genetics,” rather than a clinical specialty.

tathougies 9y ago
Why would genetics have anything to do with it? If a baby is genetically abnormal, then it's not a surprise that they died (although still sad!). All the babies I mentioned were genetically normal. Their hearts just stopped. We've seen the geneticists; they cannot explain why any of our children died, because none of it was genetic (believe us.. carrier screening was on the top of all of our lists to make sure it wasn't something we're passing on). Moreover, almost every study into the matter shows that the more pregnancy losses a couple has had, the less likely it is that any of them were due to aneuploidy, so again, genetics (while important for single miscarriages or stillbirchs) is an unlikely explanation for recurrent losses, unless a parent carries a balanced reciprocal or robertstonian translocation (which none of us do). The MFMs that we have spoken with have all suggested various blood issues and some auto-immune issues which we are now being tested for. I don't see how geneticists (who are usually not doctors themselves) could possibly have the level of expertise to handle these cases.
- arkades 9y ago
  Carrier testing is for known diseases only. For unknown genetic traits which give rise to non-viable offspring, well... they’re unknown. I’m sorry I wasn’t clear - I meant Medical Geneticists (MDs) not geneticists (phds). That said, their work on these issues tends to be oriented to the basic science side, so that it can be applied as screenings and other genetic tests for couples in the future. Most Medical Geneticists are part-clinical and part-bench scientists; I don’t know of any that are purely clinicians. Their clinical side tends to be pre-conception screenings and genetic counseling. It seems like what you’re saying you want is a medical specialty that deals in particular with individual couples that keep losing children, as though it’s a clinical problem. Admittedly, there are some exceptions (eg, anti-phospholipid syndrome), but that already has a relevant specialist: OBs are supposed to identify that a patient may have it, and the relevant specialist (rheumatologist, usually, for the autoimmune stuff) confirms and treats.
  - tathougies 9y ago
    While I agree any single incident is potentially due to an unknown genetic disease, I find it hardpressed that a woman who's had five stillbirths would fall on the shit side of luck. In general, mendelian inheritance is going to make it such that some number (at least 25%) is going to be viable, so it seems unlikely that someone could be unlucky that many times. Moreover, even in confirmed genetic diseases, there is a mechanism of death, for example metabolic disturbances in PKU or obvious malformation and anemia in hemoglobin barts thalassemia. Nevertheless, I think your focus on medical genetics is quite misguided. For example, we know several causes of recurrent stillbirth and infant death that are not genetic in nature. For example, NAIT certainly has a genetic predisposition, but the primary treatment is immune and hematologic in nature. There's no reason this would fall under a geneticists area of expertise, and given the rarity, it's not clear most OBs would know about it either. Several couples I've met in online support groups have had a lot of trouble finding a doctor knowledgeable enough in NAIT to properly treat their pregnancies (which are actually remarkably successful, when treatde). Given the importance that we ought to be giving to lives of young children, it seems that simply lumping known non-genetic causes with genetics is the wrong approach. A better approach -- in my admittedly biased opinion -- would be to have one specialty with a wide breadth of knowledge who could specialize in teasing out what may be causing any particular issue. For example, it seems somewhat ludicrous to believe that a woman who loses several babies consecutively in the third trimester due to premature labor while the baby is still alive is being affected by the same pathology that causes another woman's babies' hearts to just keep stopping. Unfortunately, these distinctions are rarely made in studies. And while OBs are the ones on the front-line of treatment, they're also mainly a surgical / low-risk specialty. There does need to be some specialized care for the higher-risk couples. Multiple studies in other countries (we're in America) have shown that simple supportive care (including heavy monitoring, constant reassurance, and dedicated clinics) increases the live birth rate in couples with recurrent stillbirth or other forms of pregnancy loss.
    - arkades 9y ago
      I feel like I’m in the awkward position of arguing with someone that’s recently had a terrible tragedy, sort of about that tragedy.(!)(?) I don’t want to do that.(?)(!) I’m just saying, bottom line, those specialties exist. You seem to think they don’t. Perhaps they don’t exist in your immediate area? They are, after all, fairly specialized tertiary care niches you’re only going to find in huge academic medical centers that bring in the sort of patient numbers to support tiny niche specialists.

tathougies 9y ago

Why would genetics have anything to do with it? If a baby is genetically abnormal, then it's not a surprise that they died (although still sad!). All the babies I mentioned were genetically normal. Their hearts just stopped. We've seen the geneticists; they cannot explain why any of our children died, because none of it was genetic (believe us.. carrier screening was on the top of all of our lists to make sure it wasn't something we're passing on). Moreover, almost every study into the matter shows that the more pregnancy losses a couple has had, the less likely it is that any of them were due to aneuploidy, so again, genetics (while important for single miscarriages or stillbirchs) is an unlikely explanation for recurrent losses, unless a parent carries a balanced reciprocal or robertstonian translocation (which none of us do). The MFMs that we have spoken with have all suggested various blood issues and some auto-immune issues which we are now being tested for. I don't see how geneticists (who are usually not doctors themselves) could possibly have the level of expertise to handle these cases.

arkades 9y ago
Carrier testing is for known diseases only. For unknown genetic traits which give rise to non-viable offspring, well... they’re unknown. I’m sorry I wasn’t clear - I meant Medical Geneticists (MDs) not geneticists (phds). That said, their work on these issues tends to be oriented to the basic science side, so that it can be applied as screenings and other genetic tests for couples in the future. Most Medical Geneticists are part-clinical and part-bench scientists; I don’t know of any that are purely clinicians. Their clinical side tends to be pre-conception screenings and genetic counseling. It seems like what you’re saying you want is a medical specialty that deals in particular with individual couples that keep losing children, as though it’s a clinical problem. Admittedly, there are some exceptions (eg, anti-phospholipid syndrome), but that already has a relevant specialist: OBs are supposed to identify that a patient may have it, and the relevant specialist (rheumatologist, usually, for the autoimmune stuff) confirms and treats.
- tathougies 9y ago
  While I agree any single incident is potentially due to an unknown genetic disease, I find it hardpressed that a woman who's had five stillbirths would fall on the shit side of luck. In general, mendelian inheritance is going to make it such that some number (at least 25%) is going to be viable, so it seems unlikely that someone could be unlucky that many times. Moreover, even in confirmed genetic diseases, there is a mechanism of death, for example metabolic disturbances in PKU or obvious malformation and anemia in hemoglobin barts thalassemia. Nevertheless, I think your focus on medical genetics is quite misguided. For example, we know several causes of recurrent stillbirth and infant death that are not genetic in nature. For example, NAIT certainly has a genetic predisposition, but the primary treatment is immune and hematologic in nature. There's no reason this would fall under a geneticists area of expertise, and given the rarity, it's not clear most OBs would know about it either. Several couples I've met in online support groups have had a lot of trouble finding a doctor knowledgeable enough in NAIT to properly treat their pregnancies (which are actually remarkably successful, when treatde). Given the importance that we ought to be giving to lives of young children, it seems that simply lumping known non-genetic causes with genetics is the wrong approach. A better approach -- in my admittedly biased opinion -- would be to have one specialty with a wide breadth of knowledge who could specialize in teasing out what may be causing any particular issue. For example, it seems somewhat ludicrous to believe that a woman who loses several babies consecutively in the third trimester due to premature labor while the baby is still alive is being affected by the same pathology that causes another woman's babies' hearts to just keep stopping. Unfortunately, these distinctions are rarely made in studies. And while OBs are the ones on the front-line of treatment, they're also mainly a surgical / low-risk specialty. There does need to be some specialized care for the higher-risk couples. Multiple studies in other countries (we're in America) have shown that simple supportive care (including heavy monitoring, constant reassurance, and dedicated clinics) increases the live birth rate in couples with recurrent stillbirth or other forms of pregnancy loss.
  - arkades 9y ago
    I feel like I’m in the awkward position of arguing with someone that’s recently had a terrible tragedy, sort of about that tragedy.(!)(?) I don’t want to do that.(?)(!) I’m just saying, bottom line, those specialties exist. You seem to think they don’t. Perhaps they don’t exist in your immediate area? They are, after all, fairly specialized tertiary care niches you’re only going to find in huge academic medical centers that bring in the sort of patient numbers to support tiny niche specialists.