On December 2nd 2017 we attended the Lupus and Pregnancy conference at Stanford University. We met and spoke with Dr. Yashaar Chaichian, professor in Immunology and Rheumatology at Stanford School of Medicine, and Director of the Stanford Lupus Clinic. We were inspired by his presentation at the conference about the importance of preconception counseling, appropriate treatment during pregnancy as well as factors that contribute to adverse outcomes. We learned from Dr. Chaichian that most lupus patients of childbearing age had not received timely counseling regarding safe birth control, conception and control of disease. According to Dr. Chaichian, preconception is the most important phase for ensuring a good maternal outcome for a woman with lupus yet a key problem is lack of preconception education.
Angela is a 28 year old married African American woman living in San Francisco. She was diagnosed with lupus when she was 19. Her disease is under control but she still has symptom flareups.
Angela and her husband, Brian, would like to have children. They are concerned how her disease and the drugs she takes will affect the pregnancy, and meet with her physician, Dr. Matsuda, to talk about family planning with lupus.
Angela and Brian tell Dr. Masuda about their desire to have a child and share their fears about pregnancy and lupus. Angela wonders, “Will the drugs affect the pregnancy?”
Dr. Matsuda assures them that many women have healthy pregnancies with lupus. He also educates the couple on the potential risks. He shows them personalized infographics detailing the risks and prognosis for the pregnancy given Angela’s demographics, medical history and recent flare-up status.
Angela and Brian learn that it is very important that Angela’s flareups are under control before she tries to conceive. Frequent flareups before pregnancy are associated with poor maternal outcomes. The doctor refers to the infographic showing a 90% likelihood of Angela’s flare-ups being in control within the next six months.
Dr. Matsuda advises the couple not to attempt to conceive until her disease is more controlled. He tells them they will regularly monitor Angela’s flareups.
Based on the updated symptom history, The doctor gets revised forecasts that he uses in adjusting Angela's treatment as her symptom flareup risk changes. Six months later, a scheduled appointment verifies that the flare-ups are under control.
The couple is pleasantly surprised to conceive within the next month. They return to the physician to share the good news.
Matsuda reviews Angela’s chart and her predicted flareup pattern for the next year. He works with her Obstetrician and other specialists to create a plan for a healthy pregnancy, evaluating the frequency of her flareups and the results of her lab work over the last year. Both Angela and Brian feel relieved and excited to have a plan that will help to achieve a healthy pregnancy.
Dr. Matsuda is also pleased. Automatically scheduling an appointment for a patient on the brink of a flareup allows for early intervention and better outcomes by timely care for the lupus patient.
Angela’s symptoms continue to be monitored throughout her pregnancy. When a high flareup risk is detected Angela receives a notification in her messaging app requesting that she schedule an appointment. She is able to quickly and easily select a time from the list of open dates.
Dr. Matsuda, his colleagues and clinical staff have instituted walk in hours for patients like Angela optimizing clinical efficiency and improving outcomes.
At the appointment the doctor reviews Angela’s chart and her updated predicted flareup pattern for the rest of the pregnancy and beyond.
Angela has a very healthy pregnancy and delivers a healthy boy. Early detection of symptom flareups has improved the patient experience by more optimally scheduling appointments and reducing emergency room visits. It also improves maternal outcomes through early intervention.