Obstetric Internal Medicine (OBIM) aims to provide optimal, comprehensive medical care to women with preexisting or newly developed medical conditions in and around pregnancy. Obstetric Internal Medicine providers are generally trained in internal medicine, with additional training focused on care of pregnant patients with medical concerns or disease.
As childbearing is delayed and the burden of chronic disease increases across the population, rising numbers of women with existing medical conditions or significant risk factors are attempting to or becoming pregnant. Yet, internal medicine training in the United States rarely includes significant exposure to pregnant patients. While there has been significant improvement in maternal mortality due to obstetric causes – like hemorrhage, infection, preeclampsia, and eclampsia – in developed nations, there has been little change in the rates of maternal mortality from medical illness. The heath care needs of women of reproductive age – before, during, and after pregnancy – are unique. OBIM providers are specially trained to provide medical care to patients before, during, and after pregnancy.
Several international associations including ISOM, NASOM, MOMS, SOMANZ have developed in response to the need for internal medicine providers with expertise in the care of pregnant patients.
We know that for many conditions, preconception disease control and intervention is more effective in reducing pregnancy-related risk than prenatal disease control. Diabetes, obesity, hypertension, asthma, heart disease, epilepsy, thromboembolism, autoimmune disorders, and psychiatric illness represent just a handful of such conditions that would benefit from pre-pregnancy evaluation and management. OBIM providers are familiar with preconception targets for chronic disease control as well as safe and effective medications in pregnancy.
The physiology of pregnancy may alter chronic disease behavior and that certain conditions or complications may arise during pregnancy. OBIM physicians have the expertise to anticipate the changes of pregnancy and provide ongoing disease management.
While there are a host of symptoms that commonly affect pregnant women, and may be normal in pregnancy, they may also represent the first signs of an underlying medical condition unmasked by pregnancy. OBIM providers have experience with such concerns in pregnancy and can assist with detailed assessment by history, physical exam, and where necessary additional diagnostic testing and treatment.
Certain complications of pregnancy require more intensive postpartum management and have implications for risk of future cardiovascular disease (including hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and miscarriage). OBIM providers are familiar with the unique medical needs of postpartum patients in the near and long term.
In any of these circumstances, the Obstetric Internal Medicine Clinic is poised to offer patients evaluation and treatment. The clinic may be particularly helpful for patients who do not have a general internal medicine provider or medical subspecialty provider who is comfortable with medical management in the preconception, pregnant, or postpartum patient.
Brigham Medical Specialties Clinic
75 Francis Street
Boston, MA 02115
Fish Center for Women’s Health
850 Boylston Street, Suite 402
Chestnut Hill, MA 02467
We welcome referrals from obstetric care providers, primary care providers, infertility and reproductive physicians, and medical specialists.
Referring providers may choose to have their patient seen for a one-time consultation or to be followed throughout their pregnancy and postpartum period.
We maintain contact with the patient’s obstetrician and other health care providers throughout care to assure a smooth transition.
Common chronic conditions evaluated and managed in OBIM
Common acute symptoms evaluated and managed in OBIM