Providing care to Hawaii’s Filipino Women

By Dr. Elenita V Alvarez

I have been taking care of Hawaii’s women and delivering their babies for the past 42 years. In fact, I’ve been taking care of four generations of women. I’m originally from the Philippines and went to University of Santo Tomas Medical School but did majority of my Obstetrics and Gynecology training in many hospitals in New York.

Filipinos make up about 80% of my practice. Most of my older patients, who have been with me since child-bearing age, and some of my younger patients in my practice are immigrants from the Philippines. In my experience, Filipino women are at higher risk of some pregnancy-related issues.

Partly because of limited access to healthcare and being unable or willing to take time off work, Filipinos often don’t go to the doctor. When they do, they already may have underlying health problems like diabetes, high blood pressure, or high cholesterol. Interestingly, if a Filipino woman is not yet diabetic, they still have a higher risk of gestational diabetes, which is a development of diabetes during pregnancy. Most of the time, the gestational diabetes resolves after childbirth. However, these women have a higher risk of developing diabetes in 10 to 15 years.

When mothers have hypertension or pregnancy-induced hypertension called pre-eclampsia, there is a risk of low birth weight babies. The mother’s high blood pressure causes poor circulation of blood to the uterus and baby which is why babies don’t grow as big. High blood pressure can be from poor eating choices. Salty foods common in a Filipino diet like spam, fried fish, and sausages, retain water and contribute to high blood pressure and weight gain. Because of this, it is not uncommon in the Philippines to have low birth weight babies because of their diet.

Even with smaller birth weights of babies in the Philippines, there is a higher rate of cesarean births because of the short body stature and small pelvis of Filipino women. When these women migrate to the United States, not only are they still eating high salt foods, but now also eating more meaty and high fat diets, now resulting in bigger babies, who are likely delivered by C-section.

Although generally rare in the world, the Philippines has one of world’s highest incidence of hydatidiform mole or molar pregnancy. This hydatidiform mole is an abnormal growth inside of the womb in the beginning of pregnancy. There is abnormal fertilization of the egg which results in growth of the placenta, but minimal or no growth of fetal tissue. A diet low in Vitamin A and folic acid is a risk factor for molar pregnancy, as well as other developmental disorders. These vitamins are found in leafy greens and fruits, some in which have seasonal growth.

Genetically, Filipinos are at risk of anemia due to a higher incidence of alpha thalassemia trait. Thalassemia is an inherited blood disorder that causes you to have malformed blood cells that are unable to carry oxygen resulting in anemia or low blood count and can cause fatigue. A mild form is not a problem for someone who has this blood disorder, but when both parents have this gene, there is potential to pass it down to the baby, causing severe genetic problems. The Bart’s hemoglobinopathy causes circulation problems starting in utero resulting in “blue babies”, pre-eclampsia of the mother, and even fetal hydrops in which the baby is so anemic that they don’t survive to birth. This trait is checked on prenatal work-up for anemia.

Another observation I have is that depression is common with many of my migrant patients. Depression is more common with new environments with the culture or the transplant shock. Women have to make many adjustments since they left their family behind in the Philippines. There’s also stress from financial problems. This can result in menstrual disorders, which are common within the first 6 months of migration. 

The Filipino community is flourishing here in Hawaii with generations with roots in the islands and the continued migration of individuals from the Philippines. We still have to take into consideration the social and lifestyle changes of our local and migrant women.

I advocate that our women and children need to be up to date with their vaccines and screening tests. One of the new vaccines is for HPV, given from age 9 for prevention of general warts and cervical cancer. Cervical cancer screening tests should be considered from age 18 or within 6 months of starting sexual activities. The recent recommendation is that Pap smears are every three years unless abnormal and stop at age 65 unless there are problems. Breast cancer is the most common cancer affecting all women. Screening mammograms start at 40 years old. All women should do a breast self-exam mid-cycle. Males and females should get a screening colonoscopy at 50 years old.

To have a healthy baby, mothers should have a healthy mind and body. It’s important to have a well-rounded diet that is low in sugar, salts, and fats especially during the prenatal period. Avoid negative vices including smoking, drinking, and drugs during pregnancy. Everything the mom does, the baby does too.

I would like mothers to consider cord blood donation at birth. There are stem cells in the umbilical cord which can help with treatments for lymphoma and leukemia. These stem cells, like blood, have to be matched with donor to recipient. There is shortage of stem cells available to match patients of Asian, Hispanic, Black, and Pacific Islander decent. This is a gift that can help our kababayans.   

Lastly, consider being more open with your doctors by talking about all your medical concerns. Be proactive and ask questions about your issues, testing, and laboratory reports. Don’t ignore abnormal signs and seek doctor help sooner than later. Be proactive about your health. Language should not be a problem, bring your interpreter, family member or see a Filipino provider–we speak your language and understand you.

DR. ELENITA V ALVAREZ is an Ob/Gyn physician with a private practice in Kuakini and deliveries babies at Kapiolani Hospital for Women and Children. She is an active member of the Philippine Medical Association of Hawaii.