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When High Risk Is Normal

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LEXINGTON A college basketball coach once said, “I don’t want a player who can make the easy look difficult, I want a player who can make the difficult look easy.” While bringing mother and baby successfully through a high-risk pregnancy is far more serious than a basketball game, the analogy is fitting for the work of Kristine Lain, MD, MS, director of Maternal-Fetal Medicine at KentuckyOne Health, Saint Joseph Hospital East. When asked to describe her work as succinctly as possible she says, “My goal is to make a high-risk pregnancy as normal as possible from the first confirmation of pregnancy through delivery of a healthy baby.” A simple statement, right? Not exactly. With Kentucky’s high incidence of obesity, smoking, diabetes, and hypertension, there can be treacherous times in pregnancies where the mother has one or more of these conditions, even times when the life of the mother or the fetus or both are in serious jeopardy. This is the medical world Lain lives in – to diagnose, treat, and comfort the woman, the fetus, and the family.

From biomedical Engineering to Maternal-Fetal Medicine

Lain graduated from Southern Methodist University in Dallas Texas in electrical engineering with a focus on biomedical engineering. She attended medical school at the University of Chicago, followed by a residency in obstetrics and gynecology at the University of Pittsburgh, where she spent a total of 11 years, including a three-year fellowship in maternal-fetal medicine and four years on faculty at the Magee Women’s Hospital. Highlights of these years include the opportunity to work with James Roberts, MD, a renowned researcher in pre-eclampsia, one of the most frequent complications of pregnancy. Steve Caritis, MD, recruited Lain into clinical research and multi-center trials coordinated by the National Institute of Child Health and Development (NICHD) Maternal-Fetal Medicine Units Network, the largest cooperative of clinical research for high-risk pregnancy and fetal health.

After her time on faculty at the University of Pittsburgh, Lain was attracted to the University of Kentucky Medical Center (UK) because the systems were in place to support young physician-scientists. Plus, living in Lexington brought her family closer to their extended families. After five years on faculty at UK, she had the opportunity to work with a large maternal-fetal medicine group at Norton Healthcare in Louisville, which allowed her to expand her clinical expertise.

At Norton, Lain used telemedicine to pursue her passion for providing care for maternal-fetal patients statewide from Paducah to Ashland. Telemedicine remains a very important part of Lain’s practice at KentuckyOne Health. While working in Louisville, Lain lived with her family in Lexington. She ended the daily commuting in 2015 when an opportunity arose to practice maternal-fetal medicine at KentuckyOne Health in Lexington. Lain says she never envisioned a solo practice, but her experiences at UK and Norton prepared her very well for this role.

Lain now has in place an experienced team of nurses, ultrasonographers, and counselors to support a robust practice at Saint Joseph East. With this team, she can diagnose and treat conditions early and refer appropriate patients to centers that implement the many innovative techniques for treating a fetus in utero, such as placental laser to treat twin-to-twin transfusion or endoscopic surgery on spine defects.

Lain points out that these advances are the result of innovations in ultrasound over the last 30 years. Ultrasound is now one of the most widely used procedures in obstetric care for women with a medical indication. Ultrasound not only guides the procedures noted above, it is used to diagnose fetal conditions such as slow or arrested fetal growth, too much or too little amniotic fluid, ectopic or tubal pregnancy, unsuspected twins, triplets, or other multiples, and many more less-common conditions. Lain emphasizes that some of the behavioral issues contributing to a high-risk pregnancy, such as obesity and smoking, cannot be aggressively addressed in nine months of pregnancy. Lain counsels her patients regarding behaviors that are risk factors to their pregnancy, but she does not suggest that an overweight patient lose 60 pounds during the pregnancy. Behavior modifications can be tackled aggressively, but the emphasis is often on things that can be controlled, such as hypertension, blood sugars, and seizure disorders.

Being part of a team or network is of utmost importance in providing comprehensive care. Lain has access to three neonatologists at Saint Joseph East, which has a level-two neonatal intensive care unit. Cardiac defects are the most common fetal conditions requiring transfer to a specialized center. Lain works closely with the surgeons and pediatric cardiologists at the neonatal cardiac center at the University of Louisville and Kosair Children’s Hospital. Other conditions that will not affect the timing of delivery but will require immediate surgical attention include gastroschisis and renal abnormalities. Lain determines the appropriate medical facility for each family to receive the best care. Sometimes that location will be Saint Joseph East, and other times it is Louisville or Cincinnati.

A common misconception of high-risk obstetrics and Lain’s practice is the “importance of prevention.” By this, she means identifying risk factors during one pregnancy that can be modified before the next pregnancy. A frequent example is high glucose or glucose intolerance during pregnancy in an overweight patient. Extreme weight loss during pregnancy is not realistic, but exercise and diet modification can result in weight loss before the next pregnancy so that glucose intolerance does not put that pregnancy in the high-risk category. This is a team approach involving a dietician and a primary care physician. With counselling, the patient will understand how obesity puts her and her baby at risk and will therefore have a strong motivator to lose weight. A similar case could involve smoking or non-prescription drug use.

As a final reinforcement of her overarching concern Lain says, “I want to manage this high-risk situation in a way that makes the pregnancy and delivery as normal as possible for each family.” Bringing a child into the world is one of the great joys of parenthood. Lain wants to move the issues of high-risk care out of the way of that experience.


Kentuckyone Health High Risk Obstetrics Associates Kristine Lain, MD 170 N. Eagle Creek Drive, Suite 110 Lexington, KY 40509 P 859.263.0141 F 859.263.8669