Late Spring 2006
Pregnancy Over Age 35: Beating the Stacked Deck

One evening in 2000, during the seventh month of her first pregnancy, while trying to read a recipe for sausage and peppers, Mary Catherine Santa lost her eyesight.

"Suddenly there were all these white spots clouding my vision," she says. The 35–year-old Huntington resident immediately called her obstetrician, Joseph Cuteri, MD. The sausage and peppers were left cooling on the stove while Mary Catherine and her husband, Ed, went straight to The Birthplace at Bridgeport Hospital.

Mary Catherine's temporary loss of vision was startling, but it was not the first indication of a troubled pregnancy. The Santas were braced for problems—and so was Dr. Cuteri, because when a woman has her first pregnancy at age 35 or older, the deck is somewhat stacked against her. Mary Catherine was at increased risk of miscarriage or having a baby with birth defects. In fact, early tests had already told Dr. Cuteri that he needed to watch her for signs of pre-eclampsia —a condition involving high blood pressure and other symptoms that can include swelling (edema) of the hands and feet, sudden weight gain (a pound a day or more), blurred vision, severe headaches, and dizziness. Dr. Cuteri specifically chose Bridgeport Hospital as the place where he wanted to deliver Mary Catherine's child, because he knew she would need the special perinatal expertise available in The Birthplace.

In The Birthplace that night, prompt treatment lowered Mary Catherine's blood pressure enough so that her sight returned—to her great relief. But she stayed on in The Birthplace for a week while doctors and nurses prepared her and her baby for an early cesarean delivery. "We can minimize the risk of problems by delivering the baby as soon as possible," explains Dr. Cuteri.

Mary Catherine was given medication to prevent seizures, special steroids designed to strengthen her baby's lungs, and frequent ultrasounds to monitor the baby's development. When the baby reached 32 weeks, and Mary Catherine's preeclampsia was still severe, Dr. Cuteri performed the cesarean for the safety of both mother and baby.

Baby Claire spent two weeks in Bridgeport Hospital's Level III (highest level) Newborn Intensive Care Unit, under the expert care of doctors and nurses trained to interpret each little breath and movement, making sure she received the support she needed to thrive.

That was five years ago. Claire, born at 3 lb. 6 oz., is now a bright and beautiful pre-kindergartner.

Mary Catherine's second pregnancy, sadly, did not have a happy ending. She lost that baby at an early stage. But in seeking reasons for the miscarriage, Dr. Cuteri sent the Santas to Gary Kleinman, MD, Director of Perinatal Genetics at Bridgeport Hospital. (Peri=around, natal=birth; a perinatologist specializes in highrisk pregnancies and births.) The tests Dr. Kleinman conducted showed that Mary Catherine had a genetic disorder: prothrombin gene mutation. This is a disorder that makes the blood more likely to clot. (A family medical history revealed that Mary Catherine's grandmother also carried the gene; she too had lost a child to pre-eclampsia.)

Blood clots can mean trouble to anyone at any time, because the clots can become lodged in veins or arteries, blocking blood flow and causing a stroke or heart attack. But during pregnancy, when the clotting factors in a woman's blood volume increase significantly, clotting becomes an even stickier problem. Clotting abnormalities might lead to pre-eclampsia (explaining Mary Catherine's difficult first pregnancy).

And, as happened to Mary Catherine, pre-eclampsia can lead to miscarriage.

For her third pregnancy, when she was 37 years old, Mary Catherine was forewarned. "Dr. Cuteri and Dr. Kleinman explained everything early and clearly, so I understood what was happening and what I had to do to control this pregnancy from my end," says Mary Catherine.

To combat clotting and keep her blood pressure down, she gave herself regular shots of blood thinning medication throughout her pregnancy. She had frequent ultrasounds in the Antenatal Testing Unit of The Birthplace to monitor the growth of the baby. Everything went well, and Cate, now three years old, was delivered at a ripe old nine months of pregnancy, weighing 6 lb., 11 oz.

"I thought I was through with my problems then," says Mary Catherine—but no.

In 2005, Mary Catherine, age 40, was delighted to learn that she was pregnant again. But even though her last pregnancy had gone well, and even though she was again giving herself shots of blood thinners, at 18 weeks, tests showed she was once more starting to develop high blood pressure, which later became pre-eclampsia. It was happening again.

"Everyone was so caring and supportive," Mary Catherine says. She particularly remembers one evening: "Dr. Kleinman had been doing woodwork at home when he cut his head. He came to Bridgeport Hospital for emergency care, and learned that I was in the Antenatal Testing Unit for another ultrasound." So, pulling scrubs over his jeans and tee shirt, and "with a bandage on my bald head," as Dr. Kleinman describes it, he first performed her ultrasound, and then went back to the Emergency Department for his own treatment.

Once again, Mary Catherine came to The Birthplace for the last week of her pregnancy. On February 22, 2006— six weeks before the due date, Dr. Cuteri delivered Charles Edward Santa, who weighed 4 lbs., 2 oz.

Charlie spent ten days in Bridgeport Hospital's Newborn Intensive Care Unit. Soon, he too was able to go home.

The Santas are grateful to the team of specialists whose expertise helped Mary Catherine through the most difficult times of her life: Dr. Cuteri, Dr. Kleinman and the staff of the Birthplace at Bridgeport Hospital. "They were," says Mary Catherine, "a blessing in our life."