Pregnancy is a time of excitement and joy for most women. It’s also a period of great physical, mental and emotional upheaval, which is why doctors have cautioned women for years about the dangers of postpartum depression.

Now, an increasing number of Ob/Gyns are advising pregnant women to be on the lookout for similar symptoms before the baby comes.

“Most new moms are vigilant about looking for postpartum depression, but not as many watch for antepartum depression, which is a mood disorder that occurs during pregnancy,” says David Jaspan, DO, chair of the Department of Obstetrics and Gynecology, Einstein Healthcare Network. “Fortunately, we’re starting to better understand, diagnose and raise awareness about it.”

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PERSPECTIVES: Tell us about your vision for women's healthcare at Einstein.

DR. JASPAN: The time has come for a major paradigm shift in gynecologic care. In the past, gynecologists have significantly impacted public health through our vigilant use of the Pap smear. Today, we have the opportunity to lead the charge in cardiovascular prevention, genetics screenings for cancer risk, lifestyle intervention to fight obesity, and more.

PERSPECTIVES: How is Einstein approaching this vision?

DR. JASPAN: We're taking groundbreaking steps to reinvent gynecology—addressing women's healthcare overall. One such example is cardiology. Cardiovascular disease is the leading cause of death in women. Recent data tells us there are obstetrical factors that are harbingers of future cardiovascular disease, such as pre-term labor, high blood pressure during pregnancy and placental abruption. As such, we're able to identify risk factors early, and perform preventative screenings accordingly.

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"We refer to pelvic prolapse and incontinence as 'the silent epidemic,' because women are embarrassed by it, they don't realize how common it is and, as such, they tend not to talk about it," explains obstetrician/gynecologist Donald J. DeBrakeleer, DO, FACOG. "The fact is, one out of every three women over the age of 45 has some type of urinary incontinence, and one out of two suffers from some type of pelvic prolapse.

With ordinary incontinence, commonly known as bladder leakage, women can experience "urge incontinence"—the overwhelming need to go, even if they just went to the bathroom, and/or being unable to hold it long enough to reach a bathroom. Or, they can experience "stress incontinence"—leaking during exercise, coughing, sneezing, laughing or other body movements that put pressure on the bladder. Some women experience both.

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It is estimated that one in four women will develop uterine fibroids in her lifetime, most commonly during the childbearing years. A uterine fibroid is a smooth, rubbery mass that grows in the muscular tissue that makes up the wall of the uterus.

Many women who have fibroids never have symptoms, although those who do may experience heavy or irregular bleeding, pelvic pain, backaches, bloating, urinary frequency and trouble conceiving.

"It's so important for women who are having irregularities or discomfort with their periods to seek out gynecologic care sooner rather than later," explains obstetrician/gynecologist Dominick M. Giuffrida, Jr., DO, FACOG. "The earlier fibroids are detected, the easier they are to treat. Small fibroids can often be treated hormonally. If that proves ineffective, we can perform a hysteroscopic resection of the fibroad, which basically means we shave down the fibroid.

"If undiagnosed or untreated, fibroids grow larger, and can become a much greater threat," adds Dr. Giuffrida. "They can lead to infertility, or create preterm labor or other problems with pregnancy. Some women are unable to deliver naturally and require a C-section. In some cases, fibroids may lead to a hysterectomy."

In fact, uterine fibroid tumors are responsible for more than 200,000 hysterectomies a year in the United States.

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Several risk factors can increase a woman's risk of developing cervical cancer.

The most significant risk factor—found in more than 95 percent of cervical cancer cases—in an infection with certain strains of human papilloma virus (HPV).

Screening for cervical cancer with a pap smear should begin when a woman turns 21, and be repeated every three years until age 30. After age 30, if all Pap smears have been normal, women should have a Pap and HPV test HPV test every five years.

"Most women will be exposed to HPV as young adults," says obstetrician/gynecologist Mary E. Fleming, MD, MPH. "For a lot of women, the body will clear the virus on its own over time. But for those who don't, HPV can cause changes to cervical cells that can lead to cervical cancer."

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