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!

 

Are D.C. residents at risk for Zika virus?

An April 2017 report from the Centers for Disease Control and Prevention (CDC) found that 1 in 10 pregnant women in the U.S. who contracted Zika virus in 2016 had a fetus or baby with Zika-related birth defects. News about this primarily mosquito-borne infection had died down some over the winter, but this report reminds us that the threat is not over.

Of the 5,238 Zika cases reported in the U.S. between Jan. 1, 2015, and April 19, 2017, 40 were in the District of Columbia. The vast majority of people picked up the infection during travel to an area with Zika, although a few cases were acquired through sexual transmission in the States. The virus made its way to the U.S. mainland in summer 2016, with infected mosquitoes found in Miami and Brownsville, Texas.

As the days get warmer and we once again begin shooing away mosquitoes, how concerned should D.C. residents be about Zika? While a local outbreak is not likely anytime soon, that doesn’t mean our community should ignore this serious infection. Let’s look at what we know, what we don’t, and how you can protect yourself, your partner and, potentially, your unborn child.

Zika-infected mosquitoes may not live in D.C., but we shouldn’t ignore the threat of #Zika virus. -Dr. Glenn Wortmann via @MedStarWHC

What we know about Zika

The Zika virus is primarily transmitted through the bite of an infected Aedes aegypti or Aedes albopictus mosquito. It can’t be spread through skin-to-skin or respiratory contact, such as a handshake or droplets from a sneeze, but it can be passed through unprotected sex.

The virus is not dangerous for most people. In fact, only one in five people infected will have symptoms, which can include:

  • Conjunctivitis (red eyes)
  • Fever
  • Headache
  • Muscle pain
  • Rash

Only 1 in 5 people with #Zika virus will have symptoms, but it can harm unborn babies. via @MedStarWHC

Zika poses the greatest danger to unborn children. When a pregnant woman is infected, Zika can cause birth defects such as microcephaly, in which a baby’s head and brain are unusually small. Microcephaly has been linked to problems such as seizures, developmental delays, hearing loss and vision problems. Zika also has been associated with miscarriage and stillbirth.

What we don’t know about Zika

While we’re learning more about Zika every day, we still don’t have firm answers to many questions.

So far, infected mosquitoes have been found only in small geographic areas of the U.S. While the potential range of Aedes aegypti and Aedes albopictus mosquitoes includes the D.C. area, it doesn’t mean that infected mosquitoes are guaranteed to come.

We know Zika can be spread through sex, but we aren’t exactly sure how long someone may be contagious. It appears that the virus can stay in semen longer than in other bodily fluids. Current guidance from the CDC for couples attempting to conceive is that women should wait at least eight weeks after the last possible exposure to Zika before trying to conceive, and that men should wait at least six months after the last possible exposure before trying to conceive. During this waiting period, couples should use condoms or not have sex.

It appears that Zika does the most harm to an unborn baby when contracted during the first trimester. But while it’s been shown that Zika can cause birth defects, we’re still learning about the range of birth defects it can cause. The effects of the virus may not be obvious at birth, or they may develop later. We’ll have to track these children over the years to learn exactly what damage this virus can cause.

There is no current treatment for Zika, but the good news is that researchers are working on a vaccine. Vaccine trials are underway, and I’m optimistic one will be approved in the next several years.

How to prevent Zika and other mosquito-borne infections

Right now, the best way D.C.-area residents can prevent contracting Zika is to avoid traveling to Zika-infected areas, especially if you are pregnant or planning to become pregnant. The CDC has a searchable map to check travel recommendations for Zika in a particular country. Find the map here.

Avoid travel to Zika-infected areas if you are pregnant or planning to become pregnant. via @MedStarWHC

If you must travel to one of these areas, talk to your healthcare provider. If you’re pregnant, the CDC recommends you be tested for Zika when you return, even if you don’t have symptoms.

Request an appointment to talk to a doctor about future travel or if you have returned from a trip to an area affected by Zika.

Because Zika can be passed through sex, if your partner has been to a Zika-infected area, protect yourself by using condoms or dental dams and not sharing sex toys. Again, the CDC recommends women wait at least eight weeks and men wait at least six months before trying to conceive after possible Zika exposure or after symptoms start.

Zika isn’t the only disease spread by mosquitoes – West Nile virus is one of the most common mosquito-borne infections. No matter whether you travel to a Zika-infected area or relax in your backyard, take precautions to avoid mosquito bites:

  •  Use insect repellents that contain DEET. Follow the instructions when applying it to children.
  • Wear long-sleeved shirts and long pants in the evening.
  • Dispose of standing water around your house where mosquitoes can breed.
  • Use screens on windows and doors, or sleep under a mosquito bed net if screens are not available.

Fortunately, Zika-infected mosquitoes have not been found in our community, nor are they expected to be soon. But that doesn’t mean we can let our guard down. By avoiding travel to affected areas and taking preventive measures if you or your partner must travel, we can keep our babies healthy and help slow the spread of this disease.

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.  

What to expect during pregnancy if you have a heart condition

Common tests during pregnancy include ultrasounds and blood sugar screenings. But heart tests – such as electrocardiograms (EKGs) – are also sometimes necessary.

Obstetricians discuss and evaluate their pregnant patients’ heart health to gain knowledge of a woman’s family history and risk factors. In cases of prior heart problems, we need to take special care to manage heart health during pregnancy.

As little as 15 years ago, a woman with a condition such as a congenital heart defect would have been advised to never get pregnant. We just didn’t think her heart could handle pregnancy, labor and delivery. But thanks to advances in medicine, growing expertise and doctors from multiple specialties – and facilities – working together, more and more of these women are able to safely give birth.

I’ve cared for a woman who had a heart valve replacement when she was 26. She became pregnant and delivered a healthy baby a year later. There’s no getting around it, such pre-existing conditions add complications to a pregnancy. But in many cases, the staff and resources are available to care for these high-risk patients and help them plan for safe, healthy pregnancies and deliveries.

The January 2017 guidelines issued by the American Heart Association agree, recommending that women with serious congenital heart defects work closely with their cardiologist and maternal-fetal medicine specialist before, during and after pregnancy. The guidelines also recommend giving birth at a larger medical center with specialists who have the necessary expertise to manage such a delivery.

Planning for pregnancy with a heart condition

Before you become pregnant, sit down for a discussion with a cardiologist and a maternal-fetal medicine specialist. It’s important that everyone is aware of your health history and the potential risks involved.

We’ll also want to evaluate:

  • Medications: Some medications can harm a baby during pregnancy, so we’ll want to discuss changing a medication or adjusting the dosage.
  • Potential procedures: Certain conditions should be fixed before pregnancy. This could include repairing a hole in your heart or opening a blocked valve.
  • Genetics testing: This can determine your baby’s risk of inheriting a congenital heart defect.

Your family doctor or general obstetrician may not have the expertise to plan for or manage such a complex pregnancy. It takes a unique understanding to optimize the care and outcomes for these women.

We’ll help connect you with an experienced team through our Special Moms/Special Babies program, which offers coordinated care for moms with congenital health problems. We also partner with Children’s National Health System, with whom we share a campus, to care for pregnant women in their adult heart clinics.

Learn more about our Special Moms/Special Babies program or call 844-333-DOCS.

There are still some circumstances in which we may advise you to not become pregnant. If this is the case, talk to your doctor about reliable birth control options.

Managing a heart condition during pregnancy

Every pregnancy causes the heart to work overtime. For example, the amount of blood it pumps can increase by as much as 50 percent to sustain a growing baby.

Physical changes during pregnancy affect which stressors the maternal heart faces. And when an underlying cardiac problem is in play, we become more worried about the potential for heart failure, heart attack and pulmonary hypertension, among other things.

Your care team likely will include a maternal-fetal medicine specialist, obstetrician, cardiologist, neonatologist and other specialists as needed.

Together, we’ll help you manage your heart health with medication, diet and exercise. You’ll likely need regular tests such as blood tests and EKGs to evaluate your heart function.

And, of course, we’ll keep an eye on your baby. For example, we know that if mom has an arrhythmia, the baby can develop it as well, so we’ll monitor for that.

Going into labor and delivery

Your team will collaborate with you on a plan for labor and delivery based on your health. This will include deciding whether certain specialists need to be present, in which case we may plan to induce labor.

We’ll monitor your and your baby’s hearts throughout the process. Pushing can put additional stress on the heart, so we might limit how long you push, or give you additional assistance using forceps or a vacuum extractor. In some cases, a cesarean section may be necessary.

If you decide you would like to have another baby, talk with your cardiologist and maternal-fetal medicine specialist before you get pregnant again. Your heart health may have changed since your first pregnancy. And even if it hasn’t, every pregnancy is different. We want to prepare for all possibilities.

With proper planning and precautions, more and more women who thought they could never give birth due to a heart condition are realizing their dreams and taking home healthy babies.

The Story of the Zika Virus Shouldn’t End with the Rio Olympics

As with many Olympiads of years’ past, the conversation leading up to the 2016 Summer Olympics in Rio de Janeiro, Brazil, has been laced with controversy. But in this case of this year’s global athletic event, health concerns have dominated the headlines, as news of the Zika virus spread across the world.

This led to public calls for athletes, in addition to attendees, to sit out the summer games this year, altogether. Their dream of Olympic glory was simply not worth the potential cost of their health. But with the end of the Olympics in Brazil, reports are becoming more positive, echoing the Center for Disease Control and Prevention’s July declaration that the Rio Olympics were “unlikely to spread” or accelerate the spread of the Zika virus.

After all, it is currently winter in Rio, and mosquitoes carrying the virus are less likely to be active this time of year.

Unfortunately, however, it has been reported that the Zika virus has made its way to America, with new cases reported in Florida and attributed to local mosquitoes. In light of this news, here is what you need to know about Zika to keep yourself safe at home or if you plan to travel abroad to impacted areas.

Zika Risk Factors and Symptoms

Following the original outbreak that began in northeast Brazil, Zika has since been linked to pediatric brain damage and microcephaly (when an infant is born with a smaller head). Adults are also at risk, as Guillain-Barré syndrome, a disorder where a body’s immune system attacks part of the nervous system, and acute disseminated encephalomyelitis, which is characterized by short, intense swelling in the spinal cord and brain, have been connected to the Zika virus.

Currently, there are two ways an individual can contract the Zika virus:

  • Primarily through bites of an infected Aedes mosquito; and
  • Unprotected sexual contact with someone who is infected.

According to the CDC, there is very low risk of transmission associated with blood transfusions, but that is subject to change, were the virus to spread further and become more commonplace.

Often many individuals do not present symptoms of the Zika virus, but some include fever, rash, joint pain or red eyes, as well as muscle pain and headache. These symptoms can last up to a week, and the virus itself is not fatal. But due to other healthcare issues that may evolve as a result of contracting the virus, you should contact your healthcare provider if you are experiencing these symptoms and have recently traveled to an impacted area. Your diagnosis can be confirmed with a blood or urine test.

Seeking Treatment for Zika

If you or someone you know has a positive Zika virus diagnosis, unfortunately, there is no current vaccine or medicine that treats it - you can only treat the symptoms. Keep hydrated with fluids, rest, and use pain or fever reducers like acetaminophen (Tylenol®).

You should not, however, take aspirin or other NSAIDS. If you are currently taking any other medication, consult your doctor before adding any additional medication to your regimen for treatment.

Ultimately, the Best Strategy for Zika Is Prevention

Since there is currently no treatment available for Zika, the best course for you and your loved ones is prevention - especially if you are currently (or plan on becoming) pregnant.

If you are at high-risk, do not travel to areas with reports of Zika. In addition to preventing mosquito bites with EPA-registered insect repellents and adequate coverage with clothing, you should use condoms or other barrier methods with sexual partners - especially those who have also recently traveled. Also, if you are looking to grow your family, it is recommended that you wait eight weeks before trying, if you have traveled to an area impacted or under warning of the Zika virus.

Finally, don’t be afraid to have a conversation with your healthcare provider. They can discuss your personal circumstances, as well as any questions or concerns you may have about the Zika virus.

Have questions?

If you're interested in learning more about the Zika Virus, or to schedule a consultation, call us at 202-877-3627.

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Healthy Habits for a Healthy Pregnancy

Managing Gestational Diabetes Yields Long-Term Benefits

Christine Leonard is the proud mother of three sons. With each child, she developed gestational diabetes during her pregnancy, which meant her blood sugar levels were too high. For Christine, she knew it was critical to eat right, exercise and carefully monitor her condition to have a healthy pregnancy.

“Each time, I was diagnosed early,” says Christine. “I was just very diligent about everything and made some lifestyle modifications."

Even after Christine delivered, it was important for her to maintain a healthy lifestyle, and here's why:  It is estimated that up to 10 percent of women with gestational diabetes are diagnosed with type 2 diabetes soon after delivery. Over 10 years, the risk can increase up to 50 percent.  But the risks can be mitigated if preventative screenings are scheduled. Yet, too many women are skipping the required postpartum glucose tolerance test, usually given to women six to 12 weeks after they’ve delivered. Recent studies show that up to 50 percent of patients do not show up for this important test.  The low compliance is likely because too many women are overwhelmed after bringing home a newborn baby and simply forget.

 Dr. Sara Iqbal, a high-risk obstetrician at MedStar Washington Hospital Center says, “Educating the patient and providing test reminders is essential in order to improve the rate of testing postpartum."

During her pregnancy, Christine followed the sound advice she received from Dr. Iqbal and to this day remains vigilant about her dietary changes.

“She was my model patient as she made the lifestyle changes that I asked,” says Dr. Iqbal. “This is very important because having gestational diabetes puts her at high-risk for developing type 2 diabetes later in life.”

Dr. Iqbal advises patients to:

  • Watch food portions and caloric intake
  • Avoid gaining too much weight as obesity is a major risk factor for type 2 diabetes
  • Continue to exercise
  • Follow up for the postpartum glucose tolerance test
  • Have your blood sugar levels tested every one to three years, depending on the glucose tolerance test results

“When I delivered my baby, the diabetes went away soon after, but I will be really aggressive about monitoring for the rest of my life,” says Christine.

From past experience, Christine knows that diabetes is easy to treat when caught early, before complications can occur, and most important, understands that type 2 diabetes can be prevented by simple, easily applicable lifestyle modifications. 

 

 

Have any questions?

We are here to help! If you have any questions about your pregnancy or would like to speak with a member of our Women's and Infants Services team call MedStar Washington Hospital Center at 202-877-3627.

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Varicose Veins: Signs, Symptoms and Treatments

Understanding Varicose Veins.

About 55 percent of American women suffer from some sort of venous disorder, with varicose veins topping the list. Varicose veins occur when damaged or weakened valves fail to do their job: keep blood flowing back to the heart. Healthy valves accomplish this task, even against gravity, by opening and closing tightly. But when valves aren’t working correctly, some blood leaks backward and pools in the legs, straining the walls of the veins. Results range from the merely unsightly to the uncomfortable, including feelings of pain, cramping, leg heaviness and fatigue.

In some cases, changes in the skin, and even leg ulcers, may develop. Family history, multiple pregnancies, occupations requiring long periods of standing, obesity and age can all contribute to the condition. While rarely a threat to your health, varicose veins will not go away by themselves and if left untreated, generally worsen over time. Fortunately, a variety of approaches  and therapies are available to get you back on your feet quickly. Chief among them, two outpatient procedures, called sclerotherapy and radiofrequency ablation (RFA) can relieve the pain safely and effectively and restore a healthier appearance, more quickly and easily than ever before.

 

Physician Profile

 As a vascular surgeon at MedStar Heart & Vascular Institute, Misaki Kiguchi, MD, MSc, MBA, specializes in the treatment of both arterial and venous diseases. Her training spans the spectrum of both diseases, including clinical expertise in aortic aneurysm repair, carotid artery disease management, peripheral arterial and venous disease management, which includes varicose veins. Dr. Kiguchi enjoys the long-term relationships she builds with her patients, but it is the technical aspects of vascular procedures that drew her to this specialty.

“Vascular disease is chronic, and patients rely on an ongoing relationship with me, their cardiologist, and primary care provider to keep their disease at bay,” says Dr. Kiguchi.

Caring for patients with life-threatening vascular conditions, and performing cosmetic surgical procedures are both equally satisfying for Dr. Kiguchi. 

"If I am able to improve a patient's quality of life because I'm able to help their cosmetic veins, then I am happy to provide the services, " she adds.

Read more about how the new, less invasive treatments helped one of Dr. Kiguchi's patients in this Center Scope article

Dr. Kiguchi has office hours in Washington, DC and Chevy Chase, MD.

Have any questions?

We are here to help! Contact us for more information about varicose veins or to schedule an appointment. Call us at 202-877-3627.

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