Ep. 107: Reproductive Immunology & Pregnancy Loss, with Dr. Cynthia Mangubat

Pregnancy loss is devastating, and not having answers for why it happens makes a heartbreaking reality even more painful. Dr. Mangubat joins us to share the different categories of miscarriage and more information on one of the less discussed areas: reproductive immunology. Dr. Mangubat studied at Rosalind Franklin University RI clinic under Dr. Kwak Kim, and shares how our immunological system could cause miscarriages, and who may be at risk.

NOTE: This episode does discuss the topic of pregnancy loss.

SHOW NOTES:
Ep. 26: Miscarriage 101 - Common Causes
Ep. 36: Advocating in the Dr.'s Office: Asking Good Questions
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Transcript

Caitlin: 0:06

Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Back to the Woven Well podcast. I love it when I get to introduce you to doctors who specialize in NaProTechnology. We've talked a lot about NaProTechnology and its restorative approach to a woman's health and other episodes on the podcast, and I'll make sure to link a few of those in the show notes. But there's just something really helpful about hearing from these medical professionals directly. I find that they often have a different take on women's health issues as they're really focused on getting to the root cause of the issue and addressing it quickly and directly. A doctor with this type of focus is exactly who you want to work with when you're dealing with miscarriage, and that's our topic today. Unfortunately, miscarriage is as common as one in four pregnancies. So understanding what causes them and what can be done to prevent them as at least as many as possible is incredibly important. Today we're going to talk about this subject with Dr. Cynthia Mangubat. Dr. Mangubat graduated from the medical school at the University of the Philippines and completed her OBGYN residency at Sisters of Charity SUNY Buffalo. She currently serves as an OBGYN at St . Mary's in Galesburg, Illinois, and has completed her NaProTechnology Medical Consultant Training. Dr. Mangubat, welcome to the show today.

Dr. Cynthia Mangubat: 1:46

Glad to be here. Good morning.

Caitlin: 1:49

I am too. So why don't you tell us a little bit about yourself and your work.

Dr. Cynthia Mangubat: 1:55

So when I did , when I finished obstetrics of gynecology in the Philippines actually and was doing high risk perinatology subspecialty, we encountered this very issue, recurrent miscarriages. And so I had an opportunity to go to North Chicago actually to do research on reproductive immunology for about three years before I ventured into my own private practice.

Caitlin: 2:29

Okay. So you have had a long focus on recurrent pregnancy loss and miscarriage and finding out why those things happen. Well, I'm thrilled that you can be with us today and talk about that a little bit. I know you've been able to serve women in many contexts for many years, so can you talk us through what the most common causes of miscarriages are?

Dr. Cynthia Mangubat: 2:54

There could be anatomic causes. There's something wrong with the uterus , a malformation in the uterus. It can be genetic, something in the genes and chromosomes of the woman. And later I'll, I'll mention there's something about the compatibility of the couple as well that plays a role in the chromosome level. And there are endocrine issues like diabetes and thyroid. There they can be caused by infections as well. Viruses, they can be caused by a clotting mechanism. Some people are, have hereditary conditions where they are prone to clot more and this increased clotting decreases supply to the baby to the early baby and can cause miscarriage. There is a lot of unexplained causes and of course there is the immunologic cause.

Caitlin: 4:01

Okay. So there are a lot of reasons why a couple could be experiencing either a miscarriage or recurrent pregnancy loss, and that is incredibly difficult to walk through for a couple, especially if it is recurrent, if it is happening over and over again. But every single life is celebrated and every single life is important. So I know that we both agree that one loss is too many. And when we think about all the different categories that you just explained, and you did a great job of giving examples in each one of those , especially things like the endocrine system, you mentioned thyroid and glucose, blood sugar regulation. And I don't think that people focus on those very often as causes of miscarriage, but we should because they can directly influence the likelihood of having a pregnancy loss. So when we hear all of these different categories, it can feel overwhelming. Sounds like maybe I could have more than one of these, or maybe I don't know which one it is, and how do I move forward? How do I prevent a possible loss? Maybe we could talk about that. Are there things that we can do to reduce our chances of pregnancy loss? What tips do you have?

Dr. Cynthia Mangubat: 5:27

Having an active lifestyle, eating the right diet, nutrition; those are just the general things I mentioned. And anytime also that people encounter even just one miscarriage, I am on my toes about checking all the different possible causes. So , having a good gynecologist as well is one of them.

Caitlin: 5:56

Yeah. And I would imagine if someone has a history of some of the things that you mentioned, for instance, you said blood clotting. So if someone knows that they have a history of a blood clot, is that something that they could get looked into before they try to conceive?

Dr. Cynthia Mangubat: 6:14

Oh, definitely, definitely. In fact , because I was into this , actually my fourth pregnancy, I would just happened to be bleeding. I did the rundown of tests and I actually had, I was positive for an acquired thrombophilia for which I needed an anticoagulant and I had no history of losses before that. I had a , I actually had a miscarriage, but I was about 40 after that first one. So yep , there are various things to consider.

Caitlin: 6:54

So listeners, if you have a history of any of the things that she mentioned or maybe even a family history, then it may not be a horrible idea to have some of those tests done before you are at the point of actively trying to conceive, just so you can be aware of those things. Now one of the things you mentioned Dr. Mangubat was reproductive immunology and you said we would talk more about that because you knew I was going to ask you. I mean, that is one that I have told clients about and I will want more women to know about because it's not talked about as much, but it does affect a lot of women and a lot of couples. So , can you give us a brief explanation of what reproductive immunology is?

Dr. Cynthia Mangubat: 7:37

Immunology, it is the defense mechanism of the body. And the beauty about reproductive immunology is normally our body would attack infection, viruses, germs or even donor organs. But the beauty of how normal pregnancy comes about is the foreign baby is camouflaged. The immune system produces blocking antibodies that will protect this fetus and the placenta and cause it to grow and it will turn off those natural killer cells are the attack immune system. And however, there are instances where this normal camouflage does not occur. Normally there's a message from the male genes that will trigger the immune system of the mother to protect the pregnancy. But certain compatibilities and genes will not form adequate blocking antibodies to protect the pregnancy. And so what happens is the placental cells are attacked and rejected. So this is like the key thing in the reproductive immune cost of recurrent pregnancies. But that is the one class of immunologic cost of pregnancy loss. But there is also, there are five classes actually and that is the first class. The second cause is antibodies to phospholipids, which are essential gluing mechanisms in the placenta. And the treatment for that is anticoagulants or blood thinners like aspirin or heparin. And the third class is antibodies to nuclear components of the, of the fetus. This is similar to like lupus or rheumatoid arthritis where we detect a positive ANA or anti-nuclear antigen and, but they're negative for lupus and steroids is the mainstay for this, mainstay for treatment. And then there are other causes which are more specialized like antibodies to the sperm antigen. And the fifth class is antibodies to neurotransmitters. And one of the treatments is intravenous immunoglobulin, which is a protective antibody

Caitlin: 10:59

That is incredibly helpful to know that there are conditions where the body is responding negatively towards that fetus. It could be the fetus, it could be the sperm as you mentioned. It could be the hormones that are going on during that time, any of those things related to pregnancy, the body could get its signals crossed and begin to attack those pregnancy positive things. And so when that happens, you would not be able to sustain a pregnancy because the body's reacting so negatively to it. It's trying to help us <laugh>, it's trying to work on our behalf and protect us. It thinks maybe it's an illness or a virus like you mentioned, but obviously it's not. It's something that is very dear and precious and I appreciate you talking about the different approaches and what some, some of the treatments may be. I realize that if you are going to specifically address reproductive immunology then you probably need to work with someone who is a reproductive immunologist. Now this is different than a reproductive endocrinologist. These are two totally different things. And so you can work with your OBGYN and have a reproductive I immunologist who can help you with these things. So it's really helpful to hear that broad understanding of what that is. Now, are there certain women who should be looking into whether or not reproductive immunology could be an issue for them?

Dr. Cynthia Mangubat: 12:37

Well definitely , when you've had a second miscarriage probably, you know, a second or third miscarriage and you've had the treatment of let's say steroids or anticoagulants or progesterone therapy and still miscarrying, then that's a good option for consult.

Caitlin: 13:03

That's great. And as you mentioned earlier with if someone has a history of those things. So you mentioned lupus or rheumatoid arthritis. So for instance, if somebody has one of those or has some other type of immunological issue, would they be more likely to need reproductive immunology?

Dr. Cynthia Mangubat: 13:25

Definitely. Definitely.

Caitlin: 13:26

And I'm so glad we're talking about this because I imagine there are a lot of women out there who have immunological diagnoses and they're not told to look into this before they're ready to try to conceive. And I realize that it is a newer science; it's not as old as some of the others, but obviously it's really important, it makes such a difference. So how can listeners find a doctor who is willing to go that extra mile to prevent early pregnancy loss or any pregnancy loss? Do you have any guidance on that about what someone should be looking for in an OBGYN?

Dr. Cynthia Mangubat: 14:07

Well , there are not too many who are trained for this, but definitely the first is probably to get through your regular gynecologist , to be referred to a reproductive immunologist. And of course there's also the high risk perinatologist there is actually an American, Society of Reproductive Immunologists. So I guess you just Google and if you find someone, you request your gynecologist to refer you.

Caitlin: 14:45

Okay. Okay. What if someone doesn't need reproductive immunology? They are just a woman who has experienced a miscarriage, but it's not because of immunological issues. They still want someone who is going to search for like you mentioned, thyroid or anatomical reasons or you know, to investigate those causes. For instance, you mentioned after one loss, you are ready to look into all the possible ways. Is there, is there a way to find a doctor who's like that?

Dr. Cynthia Mangubat: 15:21

Usually, for me, after one miscarriage, I start certain basic things. Like I usually, after one miscarriage, I check their thyroid and their glucose because those are basic things. And then later on I might do antiphospholipid antibody or anticardiolipin or ANA. So I think you can request or talk to them about certain tests.

Caitlin: 15:53

Absolutely. I do think that doctors like yourself who are NaProTechnology trained are more likely to be curious about that underlying cause and want to pursue that and find that out as quickly as possible. So I do think NaProTechnology can be a good way to go. I mean, I know that's your background as well, and but then also what you mentioned about advocating for yourself. I completely agree. So if you're listening to episodes like this and you are gathering your resources, then you can be prepared when you walk into the doctor's office with what tests you would like to be run. And if you find that your doctor doesn't want to run those tests for you, then you can start looking for another doctor if you need to. But like you said, if you can work with your local doctor, then that may be ideal for you . So if we have listeners who are in Illinois and they would like to consider working with you, what would be the best way for them to get in touch with you?

Dr. Cynthia Mangubat: 16:51

Well , I will be working at the St . Mary's in Galesburg, which is under the order of St . Francis.

Caitlin: 17:02

Okay, fantastic.

Dr. Cynthia Mangubat: 17:04

There's, well, there's a reproductive immunology center actually in Rosalind Franklin University in North Chicago and that's where I did my research. And one of the pioneers in reproductive immunology is actually up there, Dr . Kwak-Kim.

Caitlin: 17:26

That is great. You never know when someone may need it, so that's great. I love that she's local to you and close by for all of your patients. That's great. Well, thank you so much for being on the show today, for giving us this great information and for teaching us a little bit about reproductive immunology.

Dr. Cynthia Mangubat: 17:44

Very glad to be of service

Caitlin: 17:46

Listeners. I hope you've enjoyed hearing from someone who has invested all of this time and energy in becoming trained on your behalf, wanting to care deeply for you and every pregnancy that you experience as a certified fertility care practitioner, I know that we could not serve women and couples the way that we do without their education, compassion, and care. We absolutely need this kind of healthy partnership with OBGYNs. And here on our Woven Well podcast, we bring you resources like this on a regular basis. In fact, on a weekly basis, we provide education and a sense of community that empowers women to make informed fertility decisions while honoring the deep connection between fertility and faith. So if you find this helpful and valuable, maybe you'd like to support the show through a gift of $3, you can check out the show notes where we have the opportunity to do that. There you can also sign up for our newsletter. It's a great way to learn about all that we're doing at Woven Natural Fertility Care. As always, thanks so much for listening as we continue to explore together what it means to be woven well.