Celebrated Physician: Sara Iqbal, MD

Who is Dr. Iqbal?

The joyful anticipation of childbirth can also be fraught with anxiety, particularly if the pregnancy is considered high-risk, or unexpected problems develop. That’s when mothers and their families need more than just a capable physician. They also need a counselor, and a friend.

Sara Naeem Iqbal, MD, makes sure they have all that, and more. As program director for MedStar Washington Hospital Center’s Maternal-Fetal Medicine program, Dr. Iqbal believes that while each pregnancy is unique, the goal is the same—to fully support the mother with the best possible care throughout a high-risk pregnancy, and the baby’s arrival.  

A voracious student of science while growing up in Pakistan, Dr. Iqbal pursued medicine as a profession because it allowed her to apply her interests toward helping people.  

“You get to make a difference in someone’s life,” she explains. “You ease the sufferings, cure the disease and are able to feel inner satisfaction and a sense of accomplishment.”

Why Maternal-Fetal Medicine?

Maternal-fetal medicine likewise provided the opportunity to not only care for a mother and baby, but also focus on what Dr. Iqbal calls “the un-routine” cases—women who encounter problems such as early labor, bleeding or high blood pressure.  

“It was the perfect combination for me—prenatal care, ultrasound, genetic counseling, continuity of care and delivery,” she says. “I believe, by providing specialized clinical care, I can personally impact and make a difference in women’s lives.”  

After completing medical school at Dow University of Health Sciences in Karachi, Pakistan, Dr. Iqbal joined her husband in the U.S. and completed her residency training in obstetrics and gynecology at Howard University Hospital. She focused on high-risk obstetrics during her fellowship in maternal-fetal medicine at the University of Maryland Medical Center in Baltimore.  

Dr. Iqbal’s interest in gaining and sharing knowledge has proliferated through her many research interests, including intrauterine growth restriction, intrahepatic cholestasis and the effects of diabetes and obesity on pregnancy. She works with ob/gyn residents and fellows at MedStar Washington Hospital Center and MedStar Georgetown University Hospital to help shape their own research pursuits, and leads the Hospital Center’s periodic conferences on high-risk obstetrics and morbidity and mortality.  

Outside the Hospital

Given such a busy, intense schedule, it’s no surprise that Dr. Iqbal enjoys spending as much time as possible with her husband and three daughters. And if she can help her patients achieve that same degree of serenity, it makes the long hours and hard work worthwhile.

 “I feel a sense of fulfillment when I help women,” Dr. Iqbal says, “and in turn give them and their child a healthy, happy life.”  

Thank you, Dr. Iqbal, for everything you do!

 

2 reasons we’re seeing more high-risk pregnancies in D.C.

We care for about 3,500 pregnant women every year. While that number has remained fairly steady over the past decade, the number of those women with high-risk pregnancies increases every year.  

Because “high-risk pregnancy” is a catch-all term that includes factors such as age and chronic health problems, it can be difficult to determine exactly how many of these women there are. But my colleagues and I can tell you that we’re treating more women who fall into this category than ever before.  

The most severe pregnancy complications – such as eclampsia, heart failure and hemorrhage – are referred to as severe maternal morbidity. The Centers for Disease Control and Prevention reports that the severe maternal morbidity rate has more than doubled from 2000 to 2010, and now affects 650,000 women in the United States every year.  

Many factors contribute to this increase, but the two we see most often in the District of Columbia are obesity and advanced maternal age. 

1. How obesity can complicate pregnancy  

Nearly one in four U.S. women was considered obese when they became pregnant in 2014. While the rate of pre-pregnancy obesity in D.C. was lower than the national average at about one in five women, we still feel the effects of this epidemic.

 Obesity is defined as having a body mass index greater than 29.9, and it can increase the risk of problems during pregnancy, including:

  • Birth defects
  • Gestational diabetes
  • Preeclampsia
  • Preterm birth or stillbirth  

Excess body fat also can make it difficult to analyze an ultrasound and monitor fetal heart rate.  

Obesity also increase a person’s risk for health problems such as diabetes, high blood pressure and heart conditions. Our patients are not nearly as healthy going into pregnancy as they once were. I commonly find myself caring for patients with a condition that requires me to collaborate with a specialist such as a cardiologist.  

The number one thing you can do to decrease the risk of obesity-related pregnancy complications is to lose weight before you become pregnant. Talk with your doctor about lifestyle changes you can make to reach a healthier weight.  

Also, talk to your Ob/Gyn or a maternal-fetal medicine specialist before you become pregnant about what to expect if you have a heart condition or another chronic health problem such as obesity. 

2. More D.C. women delaying pregnancy until 35 or older

Not even 15 years ago, I would have exclaimed, “Whoa! You have a 45-year-old patient who’s pregnant?” These days, we don’t blink an eye at a pregnant woman in her 40s.  

The District of Columbia is somewhat unique in that we have more professional women who delay having children until they are older.  

  • The birth rate for D.C. women age 35 to 39 was 72.7 births per 1,000 women in 2015, compared with 51.8 nationwide.
  • The birth rate for D.C. women age 40-44 was 21.8 births per 1,000 women in 2015, compared with 11 nationwide.
  • The birth rate for D.C. women age 45-49 was 2.5 births per 1,000 women in 2015, compared with 0.8 nationwide.  

It’s wonderful to have the option to wait to have children until you’re in your late 30s and early 40s. However, it does increase certain risks for mom and baby, including:

  • Birth defects
  • Gestational diabetes
  • High blood pressure  
  • Miscarriage
  • Premature birth  

We may recommend additional testing and screening if you are 35 and older to detect certain birth defects. The best thing you can do if you’re 35 or older and want to get pregnant is to talk with your Ob/Gyn about your specific risk factors and how to go into pregnancy as healthy as possible. 

Reduce and manage pregnancy risks

Obesity and advanced maternal age are just two factors for the increase in high-risk pregnancies. Thanks to advances in science, we’re also caring for more women who are having multiples (twins or more), have had organ transplants or are cancer survivors. We also see a number of pregnant women who have HIV.  

With proper preparation, we’re better able to manage the increased risks of these health factors. Request an appointment with an Ob/Gyn or maternal-fetal medicine specialist to discuss your unique challenges. The doctor can help you prepare for pregnancy and manage your and your baby’s health during pregnancy, labor and delivery.  

Don’t be afraid to ask your doctor questions. These can include:

  • How can I get healthier before I become pregnant?
  • What type of prenatal testing will be done?
  • Should I stop or adjust my medications?
  • Will I need extra ultrasounds to monitor my baby’s health?
  • Will I need additional prenatal appointments?  

We may care for high-risk pregnancies more often, but each pregnancy is different and comes with its own challenges. We want the same thing for every woman: to go home with a healthy baby.  

Testing Options for High-Risk Pregnancies

For pregnant women over the age of 35, extra monitoring and screening may be recommended to detect for chromosomal abnormalities in their pregnancies.  

In order to determine if there are extra or missing chromosomes, there are several testing options.

First, women can do a blood test. The one most recommended is called non-invasive prenatal testing. It is 99% accurate in screening for the most common chromosomal abnormalities.

A diagnostic option is called an amniocentesis. Through an amniocentesis, we can culture your baby’s cells to search for missing or additional chromosomal information. Finally, another test called a microarray looks even more in depth.

These screenings can be valuable, but also confusing at times.   Dr. Rachael Overcash, a maternal-fetal medicine specialist at MedStar Washington Hospital Center, has a unique explanation for how these tests search fetal DNA, looking for the missing chromosomes.

“I like to explain the testing options to my patients using the analogy of a set of encyclopedias, with 23 volumes representing the 23 pairs of chromosomes. The amniocentesis examines the set of encyclopedias for missing volumes or entire books. The microarray looks deep into the pages and can find missing or additional sections or paragraphs. And in the future, testing may be so advanced that we will be able to see if a single word or letter is missing.”

Ask your doctor or a maternal-fetal medicine specialist which screening options are best for you and your family.

Our specialists are experts in the care of high-risk pregnancies. For an appointment, call us at

202-759-0267

As heard on WTOP Radio:

Rachael Overcash, MD

Rachael Overcash, MD
MedStar Washington Hospital Center

For an appointment, call 202-759-0267.

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