High-Risk Pregnancy

Specialized Care for Complicated Pregnancy

Every pregnancy deserves special treatment. But if your normal pregnancy becomes complicated or you have a medical issue and become pregnant, you need highly specialized care.

A Collaborative Relationship for the Best Possible Care

The providers in the Integrated Program for High-Risk Pregnancy work collaboratively with community obstetricians, medical providers, and nurse midwives to address medical, obstetric, fetal and genetic issues prior to, during and after pregnancy. This unique constellation of services offers unparalleled assurance that patients and their doctors can receive the state-of-the-art, interdisciplinary guidance that these special women and these tiniest patients so deserve.

Integration of Services Means Better Patient Outcomes

Our goal is to work with community-based obstetric providers to offer the highest level of care. The integration of high-risk pregnancy specialists in one program means that the best minds are working together for the best outcomes.

Contact Information:

Women & Infants Hospital Division of Maternal-Fetal Medicine
2 Dudley Street | 5th Floor
101 Plain Street | 6th Floor
Providence, RI 02905
P: (401) 274-1122, ext. 47452

Women & Infants Hospital Outpatient Nutrition Services
100 Dudley Street
3rd Floor
Providence, RI 02903
P: (401) 430-7314
F: (401) 453-7790

For further information about Women & Infants Hospital's Integrated Program for High-Risk Pregnancy, please call the Division of Maternal-Fetal Medicine at (401) 274-1122, ext. 47096 or the Division of Obstetric and Consultative Medicine at (401) 453-7950.

Please be advised that this location is a provider-based clinic and both a physician and facility fee will be assessed, which may result in a higher out-of-pocket expense.

Obstetric & Consultative Medicine

Women & Infants' Center for Obstetric and Consultative Medicine is recognized worldwide for our focus on caring for women with medical needs. 

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Maternal Fetal Medicine

We specialize in providing care to women who are at risk of delivering prematurely or who encounter a pregnancy-related complication that warrants close monitoring.

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Prenatal Testing

Specialized services and testing, comprehensive screening, fetal assessment and genetic counseling to help you and your physician better understand your pregnancy. 

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Genetic Counseling

Genetic counseling may be helpful to you if you have a known genetic disorder, take medication or if there are diseases that run in your family.

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Reproductive Genetics

Genetics in obstetrics can be complicated because the genetic make-up of three people – the mother, the father of the baby, and the unborn child – must be considered. 

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Fetal Assessment

Sometimes, we need to test the health of your unborn baby. The Prenatal Diagnosis Center offers this type of testing. 

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Diabetes in Pregnancy

We provide a wide variety of services for women who are pregnant and have diabetes.

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Obesity in Pregnancy

We offer an Obesity in Pregnancy Clinic as part of the hospital's Integrated Program for High-Risk Pregnancy. 

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Nutrition in Pregnancy

Being overweight and gaining too much weight in pregnancy increase a woman's risk of pregnancy complications.

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Fetal Surgery

Women & Infants, partnering with Hasbro Children’s Hospital, is the first and only site in New England to offer fetal surgery to fix TTTS.

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Antenatal Care

Women with high-risk pregnancies may need specialty help and observation in maintaining their pregnancy and give birth to babies that are closer to full-term. 

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Medical Problems in Pregnancy FAQ

If a woman is pregnant and has a medical problem as well, what should she do?

If a woman in our region is pregnant and has a medical problem – either one that she knew about before she became pregnant or one that came about during her pregnancy – she is in luck. Women & Infants is privileged to have a multidisciplinary team of practitioners who work with the community obstetricians to care for high-risk pregnant patients.

Our obstetric medicine specialists are medical doctors/internists with special training in medical problems in pregnancy and what these medical problems might mean for a woman’s health throughout life. We work closely with the team of maternal-fetal medicine specialists, obstetricians who specialize in the diagnosis, treatment, and ongoing care of expectant mothers and their unborn babies, either or both of whom may have medical or surgical problems during pregnancy. Both specialties bring a slightly different view that enhances the care of patients at Women & Infants, and together we work with our community obstetricians to assure the best possible outcomes. We are the only hospital in the region with such a team.

Is it important for a woman with a medical problem to speak with someone before becoming pregnant?

The quick answer to this is, “Yes!” There are a number of medical problems that can affect – and be affected by – a pregnancy, including:

  • Hypertension (high blood pressure)
  • Diabetes
  • Lupus
  • Heart disease
  • Thyroid disease
  • Blood clots (especially in the legs or lungs)
  • Kidney problems

Women with these medical disorders should definitely receive preconception counseling. But women who have a family history of these and other medical illnesses would also benefit from speaking with a specialist before becoming pregnant. And if you have had a prior pregnancy that was complicated by one of these issues, you should speak with a specialist before becoming pregnant again.

Through preconception counseling, health professionals can help any woman optimize her health and also help get her medical condition under control. This may involve medication management to ensure that the medication is both the most effective for the mother’s condition and has the best safety data for the baby, weight control, or smoking cessation. For some illnesses such as diabetes, having the disease in good control prior to conception can protect against birth defects a well as keep the mother healthy.

Can some of the issues that arise during pregnancy predict future medical problems?

Definitely. For instance, hypertension or preeclampsia in pregnancy has been associated with an increased risk of developing heart disease, as has the delivery of a very low birth weight baby. And many women with gestational diabetes will go on to develop type 2 diabetes in later years. Pregnancy and the postpartum period are wonderful opportunities to try to reduce the risk of these diseases before they occur. We also have cardiac risk reduction programs for women identified during pregnancy.

If you need services for a high-risk pregnancy, speak with your doctor or midwife. For the name of a doctor or midwife on Women & Infants’ staff, call the Health Line at 1-800-921-9299.

Maternal-Fetal Medicine Team

Nina Ayala, MD

Attending Physician, Maternal-Fetal Medicine, and Medical Director, Antenatal Care Unit, Division of Maternal-Fetal Medicine

Dr. Ayala specializes in high-risk pregnancies and is a clinician-researcher with primary interests in patient personality characteristics and pregnancy complications and making pregnancy safer and more patient-centered. She speaks both English and Spanish. 

Tanya L. Booker, MD

Tanya Booker, MD, is director of the Maternal-Fetal Medicine Clinic at Women & Infants and a clinical assistant professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University. 

Stephen R. Carr, MD

Stephen R. Carr, MD, is director of the Prenatal Diagnosis Center and Maternal–Fetal Medicine Diagnostic Imaging at Women & Infants, co-director of the Fetal Treatment Program, a cooperative effort of Women & Infants and Lifespan, and a professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University.

Matthew A. Esposito, MD

Matthew Esposito, MD, is a clinical assistant professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University. He received his bachelor's degree in biology summa cum laude from Williams College, and a medical degree from the University of Rochester.

Alexis Gimovsky, MD

Alexis Gimovsky, MD, is a member of the Division of Maternal-Fetal Medicine and an assistant professor of Obstetrics and Gynecology at The Warren Alpert Medical School of Brown University. Dr. Gimovsky attended medical school at Albert Einstein College of Medicine, New York. She completed her residency at George Washington University Hospital and fellowship at Thomas Jefferson University Hospital, PA.

Linda Hunter, CNM, EdD

Linda Hunter, CNM, EdD, FACNM, is an associate professor of obstetrics and gynecology (clinical) at The Warren Alpert Medical School of Brown University and a member of the academic midwifery service at Women & Infants Hospital. 

Adam Lewkowitz, MD

Adam Lewkowitz, MD, is a member of the Division of Maternal-Fetal Medicine and an assistant professor of Obstetrics and Gynecology at The Warren Alpert Medical School of Brown University. Dr. Lewkowitz obtained his medical degree at Mount Sinai School of Medicine in New York City. He completed a residency in Obstetrics and Gynecology at the University of California, San Francisco and a fellowship in Maternal-Fetal Medicine at Washington University in St. Louis.

Dwight J. Rouse, MD

Dwight J. Rouse, MD, MSPH, is the Brown/Women & Infants principal investigator for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Research Network, and professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University. 

Melissa L. Russo, MD

Melissa L. Russo, MD, is a maternal-fetal medicine and clinical genetics specialist in the Division of Maternal-Fetal Medicine. A magna cum laude graduate of Colgate University, Dr. Russo earned her medical degree from Georgetown University School of Medicine. 

Jami Star, MD

Dr. Star is a member of the Division of Maternal Fetal Medicine and an assistant professor of Obstetrics and Gynecology at The Warren Alpert Medical School of Brown University. She is the Medical Director of The Perinatal/Neonatal Quality Collaborative of Rhode Island, a fellowship wellness coach, and the quality liaison for Kent Hospital Obstetrics. 

Martha Kole-White, MD

Martha Kole-White, MD, is a member of the Division of Maternal-Fetal Medicine and an assistant professor of Obstetrics and Gynecology at The Warren Alpert Medical School of Brown University. She attended medical school at the University of Pennsylvania and completed her residency and fellowship training at Brown University.

Emily S. Miller, MD, MPH

Dr. Miller is an Associate Professor in Obstetrics & Gynecology at The Warren Alpert Medical School of Brown University. She is the Division Director of Maternal Fetal Medicine at Women & Infants Hospital of Rhode Island. Dr. Miller attended New York University School of Medicine. She completed her residency and fellowship at Northwestern University, Feinberg School of Medicine in Chicago.

Maureen S. Hamel, MD

Dr. Hamel is an Assistant Professor in Obstetrics & Gynecology at The Warren Alpert Medical School of Brown University.  She is the Medical Director of Labor and Delivery at Women & Infants Hospital of Rhode Island.  Dr. Hamel received her medical degree from Tufts University and completed her residency in Obstetrics and Gynecology and Fellowship in Maternal Fetal Medicine at Brown/Women & Infants Hospital. 

Obstetric Internists Team

Kenneth K. Chen, MD

Kenneth Chen, MD, is the director of the Division of Obstetric and Consultative Medicine at Women & Infants Hospital. Dr. Chen received a MBBS degree, the equivalent of a MD degree, at the University of Sydney in Australia after which he completed a residency in internal medicine at Westmead Hospital, University of Sydney.

Niharika Mehta, MD

Niharika Mehta, MD, is a board certified internal medicine specialist and attending physician at the Center for Obstetric and Consultative Medicine.

Srilakshmi Mitta, MD

Srilakshmi Mitta, MD, is a graduate of Brown University, obtaining her B.A. in history of art and architecture and her medical degree from The Warren Alpert Medical School of Brown University. She completed an internship and residency in internal medicine and pediatrics at The Mount Sinai School of Medicine where she earned the title of chief resident of internal medicine and pediatrics. 

Raymond O. Powrie, MD, FRCP(C), FACP

Raymond O. Powrie, MD, is the chief of medicine at Women & Infants and an attending physician in the Center for Obstetric and Consultative Medicine. Dr. Powrie earned his medical degree from the University of Alberta, Faculty of Medicine in Edmonton, Canada, where he also completed his residency in internal medicine. 

Erica J. Hardy, MD, MA, MMSc

Erica Hardy, MD, MA, MMSc, is associate director of the Infectious Disease Consult Service. A graduate of Mount Holyoke College, she received her medical degree at George Washington University School of Medicine. 

Gofran K. Tarabulsi, MD

Dr.Tarabulsi is a board certified internal medicine specialist and attending physician at the Center for Obstetric and Consultative Medicine. Dr.Tarabulsi received her medical degree from King Abdulaziz University in Jeddah, Saudi Arabia and completed her residency in internal medicine at West Virginia University in Morgantown, WV. She completed a fellowship in obstetric and consultative medicine at Women & Infants Hospital, The Warren Alpert Medical School of Brown University.