In addition, she must engage regular thyroid function checkups to ensure that the standard regimen of treatment for this condition remains effective. In this case, the hormone replacement therapy that is the traditional method of treatment is one which absolutely must be continued to the benefit and survival of the unborn child. As the article by Shomon (2006) indicates, "you must continue to take your thyroid hormone replacement (i.e., Synthroid, Levoxyl, Levothroid, Armour, Thyrolar) and it's extremely important that you do, now and throughout the rest of your pregnancy. You are your baby's only source of thyroid hormones at this point - your baby's thyroid gland isn't fully functional until after 12 weeks of pregnancy. If you don't have sufficient thyroid hormones, you are at an increased risk of miscarriage, and your baby is at increased risk of developmental problems." (Shomon, 1) Jane indicated in her interview with me that she has established a fair amount of knowledge in the subject herself and that she believes in spite of some of the risks, there is significant precedent to suggest that her condition of hypothyroidism should not prevent her from procreating. Instead, her views were reinforced by present research which indicates that though non-producing thyroid glands can lead to developmental, intellectual and physiological abnormalities in the unborn child, the presence of continued and proper thyroid treatment tends to diminish if not eliminate these present dangers.

Without proper treatment though, evidence suggests that the risks are considerable. Indeed, Mathur (2005) reports that "there is a relationship between thyroid levels in the mother and brain development of her child. A large study reported in 1999 found that undetected or inadequately treated hypothyroidism in mothers was associated with IQ changes in the infants of these women." (Mathur, 1) The danger of developmental delay for children who are not receiving the proper prenatal balance of iodine distributed by proper thyroid function is real. For my sister, this essentially means that her current treatment regimen must be continued and monitored. Evidence suggests that the dangers presented typically impact those in nations, regions or personal circumstances which have prevented proper treatment....

With the presence of such, the risks are considerably diminished.
That said, we consider the relevance of the discussed conditions here to delivery itself. Returning to the issue of scleroderma, there are a few matters to be taken into consideration which, though non-threatening to the child or mother's health, are still realities of concern. In our discussion, my sister indicated that in spite of her conditions, she would like to give birth naturally. However, indications are that "reduced flexibility of the neck of the womb or vagina, which may complicate the delivery, also needs to be taken into account." (Walravens, 1) That means that she might have to prepare for the likelihood of C-Section in the event of unnecessary delivery difficulty. Beyond this, Walravens (2008) also reports that children born to mother's with scleroderma are most typically delivered with low birth weight, but not to an extent that is health-jeopardizing.

The basic outcome of the interview and accumulated research is that Jane can safely attempt pregnancy provided she retains the following conditions. First and foremost, her smoking cessation must continue unabated. Additionally, as she prepares for conception, she must be prepared for the challenges produced by her scleroderma drug regimen, which could be an obstacle to pregnancy. Beyond this, continued attention to the thyroid and unabated commitment to hormone therapy should account for a smooth and healthy pregnancy.

Works Cited:

Dunkin, M.A. (2009). Doctor Says Newly Diagnosed Scleroderma Patients Should Avoid Pregnancy For Three Years. Scleroderma Foundation. Online at http://www.scleroderma.org/medical/other_articles/Dunkin_2006.shtm

EHealthMD. (2004). Hypothyroidism and Pregnancy. Medical Illustrations Copyright.

Online at http://www.ehealthmd.com/library/hypothyroidism/HYO_pregnancy.html

Mathur, R. (2005). Hypothyroidism During Pregnancy. MedicineNet.com

Shomon, M. (2006). Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success. Thyroid-Info. Online at http://www.thyroid-info.com/articles/pregnancy.htm

Walravens, M. (2008). Scleroderma. Chronic Inflammatory Connective Tissue Diseases. Online at http://www.cibliga.com/en/index.html