Science
Pregnancy With Lupus Is Risky. Would She Be Able to Carry Her Baby to Term?
Fatimah Shepherd knew she was not supposed to get pregnant — not now, while her illness was acting up, and maybe never.
Lupus, an autoimmune disease, was gnawing away at her kidneys, and doctors had warned her that pregnancy could tip her into full-blown kidney failure.
But in December 2023, there it was, a positive pregnancy test: two bold lines on the test strip, bright pink and indisputable.
“I almost passed out,” said Ms. Shepherd, 41, a New York City Fire Department dispatcher who lives in Brooklyn and had always wanted a child. “All I was thinking was, ‘What am I going to do?’”
For much of the 20th century, doctors instructed patients with lupus — a disease that strikes women during their prime childbearing years and that disproportionately affects Black, Hispanic and Asian women — to avoid pregnancy at any cost. The miscarriage rate was high, and pregnancy appeared to aggravate the disease.
That advice has changed in recent decades, as treatments have improved. But pregnancy can still be a precarious enterprise, and women with lupus that attacks the kidneys are advised to become pregnant during periods when their disease is stable and has been in remission for six months.
Ms. Shepherd’s disease was far from stable. Her kidney function was so compromised that she had started the process of getting on a waiting list for a donor kidney. A nervous Ms. Shepherd called her nephrologist, Dr. Mala Sachdeva, a professor of medicine with Northwell Health in Great Neck, N.Y.
But Ms. Shepherd recalled: “When I told her my news, she said, ‘Wow! Congratulations!’ And the way she said it, I could finally breathe.”
The doctor told her that pregnancy posed serious health risks, but that she had cared for other women who had done well and given birth to healthy babies. She told Ms. Shepherd, “We’re going to get through this.”
“It was a thing she said over and over again, throughout my pregnancy, every time I saw her: ‘We’re going to get through this,’” Ms. Shepherd recalled.
‘A lot to wrap your head around’
The team of doctors managing Ms. Shepherd’s care at Northwell Health — all women, most of them mothers themselves — met with Ms. Shepherd early in the pregnancy. They described in detail the risks that pregnancy entailed for both her and the fetus, and urged her to think carefully about whether to proceed.
The stress of pregnancy would almost certainly push her into kidney failure, and it could be permanent. Her high blood pressure could escalate out of control, which could restrict the baby’s growth. And she was at high risk for developing pre-eclampsia, a life-threatening condition that might force her doctors to deliver the baby prematurely.
“If her blood had clotting issues, if she had a seizure, then we would be delivering her to save her life,” said Dr. Hima Tam Tam, director of obstetrical medicine at North Shore University Hospital and Long Island Jewish Medical Center
A premature baby also would face risks. “There’s a risk of cerebral palsy; there’s a risk of blindness; there’s a risk the baby might have difficulty with ambulation,” said Dr. Dawnette Lewis, the director of the Northwell Center for Maternal Health.
There was also a risk the baby would not make it at all.
The doctors had several conversations with Ms. Shepherd because they wanted to give her time to process the information. “It’s a lot to wrap your head around,” Dr. Tam Tam said.
But they told her they would support any decision she made.
“And she definitely knew what she wanted,” Dr. Tam Tam said. “I knew that from the minute I saw her. I just wanted to make sure that she knew how long this journey was going to be.”
A room with a view
In January, Ms. Shepherd went on a planned vacation to the Bahamas. But a month later, when she came in for a checkup, the doctors were alarmed. Her potassium levels had spiked, which could cause cardiac arrest. Her blood acid levels were also high, putting the fetus at risk. She needed to start dialysis immediately.
Most kidney failure patients undergo dialysis three times a week. But pregnant women are recommended to have four-hour sessions, six days a week, in order to minimize fluid fluctuations that can restrict blood flow to the fetus. The fetal heart rate is monitored before, during and after dialysis.
Dialysis is exhausting, and Ms. Shepherd would be commuting from Brooklyn to Long Island for her care. All the doctors agreed: The safest thing at that point was to admit her to the hospital.
“We all kind of felt we wanted to just pack her up and take her home with us,” Dr. Tam Tam said.
But Ms. Shepherd had just come for a doctor’s visit; she didn’t even have a change of clothes with her. Still, she trusted the team. “It was their suggestion, but it was my choice,” she said. “And I said, OK, I’m going to do it. If you’re saying this is going to better for my child, I’ll stay here.”
She would remain at Katz Women’s Hospital at North Shore University Hospital in Manhasset for the next five months.
Ms. Shepherd was given a room with a view: on a corner, with large windows looking out over the parking lot on one side, where she could see the hospital staff’s comings and goings, and a small waterfall nestled in a grove of trees on the other.
She decided to make the best of it. She did her hair every morning and got dressed — no hospital gowns for her — and she took up painting. She had dialysis in the afternoons, and spent the mornings walking the halls of the hospital to maintain good circulation in her legs. Darnell Wilson, the baby’s father, came every Friday and spent the weekend with her; family members visited, and her colleagues from the Fire Department set up a rotating schedule of visits, so she was never alone.
When Ms. Shepherd was in her sixth month of pregnancy, she had a gender reveal party in her hospital room. She was having a boy, and she painted her nails blue in celebration. In May, she hired a professional photographer to do a pregnancy photo shoot of her.
“I kept myself busy,” she said. “I would take nice walks around the hospital and socialize with everybody. And I prayed every night and throughout the day. I had to keep a positive mind-set.”
Her doctors were checking her labs daily, constantly making adjustments in her medications and monitoring for any signs of pre-eclampsia. It was tricky, because lupus flare-ups during pregnancy can look like the condition, and when blood pressure spikes, it is not always clear whether it is from hypertension or pre-eclampsia. “You don’t want to deliver someone early because of a wrong diagnosis,” Dr. Lewis said.
“We were scared,” Dr. Tam Tam said, then corrected herself: “We were terrified.”
Ms. Shepherd’s official due date was Aug. 3, but her medical team planned to induce her on July 8, if she made it that far. But at 3:30 a.m. on July 5, Ms. Shepherd went into spontaneous labor, and Baby Oakari was delivered a couple of hours later via cesarean section.
Oakari was a healthy little boy who weighed five pounds at birth. Ms. Shepherd had carried him just short of 36 weeks. It was an incredible outcome: Most women with lupus whose disease inflames the kidneys develop complications and are forced to deliver much earlier, by about 33 weeks.
“She really beat the odds,” Dr. Lewis said.
But she wasn’t quite out of the woods yet.
The fourth trimester
As soon as Ms. Shepherd and her partner, Mr. Wilson, got their hands on an infant car seat, they took Oakari home. Mr. Wilson was on a few weeks of paternity leave, and Ms. Shepherd continued her dialysis treatments, now three times a week instead of six.
But in late August, Ms. Shepherd started having chest pain and shortness of breath. She went to the nearest emergency room, where she was diagnosed with cardiomyopathy, a disease of the heart muscle that develops in rare cases after childbirth, during the period known as the fourth trimester, which is fraught with risk for new mothers.
Ms. Shepherd was hospitalized for a few days, and then referred to Dr. Evelina Grayver, director of women’s heart health at Katz Women’s Hospital for a follow-up. But when she arrived on Long Island for her appointment in early October, Oakari in tow, she was breathing rapidly and gasping for air.
“My nurse, Paula, ran into my office and said, ‘There’s a new patient, and she doesn’t look good — she’s huffing and puffing,’” Dr. Grayver said.
Oakari had started crying, so Dr. Grayver scooped him up and held him while she examined Ms. Shepherd, who was struggling to breathe, and gave her oxygen.
“She told me she thought she just needed to go to dialysis, but I told her, ‘I think you’re going into heart failure,’” Dr. Grayver said.
Dr. Grayver called the transport services to take Ms. Shepherd to the emergency department, while Ms. Shepherd tried to reach her partner. But Mr. Wilson was on a job several hours away, and Ms. Shepherd’s sister could not get to the hospital right away.
“I was worried she would have to go on a ventilator, but the only thing she was worried about was the baby,” Dr. Grayver said.
Dr. Grayver went down to the emergency department, still holding Oakari. He was fussy, so the emergency nurses warmed a bottle for him, and Dr. Grayver sat herself in a corner and fed the infant.
“Fatimah was in such distress, and she saw the baby took to me, and said, ‘You’re so good with him,’” Dr. Grayver recalled. “So I said, ‘Do you want him to stay with me?’”
And that’s what they did. Ms. Shepherd got started on a nitroglycerin drip, and while a bed was prepared for her in the cardiac intensive care unit, she gave permission for Dr. Grayver to watch the baby until a family member could pick him up.
Dr. Grayver kept Oakari with her all afternoon, and her nurse practitioner took him whenever a patient came in. Dr. Grayver was preparing to take him home with her when Ms. Shepherd’s sister came to pick him up. “Just between us, I was secretly quite disappointed,” Dr. Grayver said. “He is such a cutie.”
Ms. Shepherd was fortunate. About one-third of patients with postpartum cardiomyopathy get worse, about one-third stay the same and about one-third improve. Ms. Shepherd improved. “I am beyond happy,” Dr. Grayver said.
Oakari is almost 2 now. He is walking — well, when he’s not running — and loves soccer and picture books and other children.
But Ms. Shepherd’s kidney function did not recover after the delivery. For a while, she hoped that a live donor would come forth to give her a kidney. Organs from living donors last longer, and the waiting time for a kidney can be up to five years.
But on Sunday, at 6:40 a.m., Ms. Shepherd got a call from North Shore University Hospital: A kidney from a deceased donor was available, and it was a good match for her. Could she get to the hospital in an hour?
She did, and by Sunday afternoon, she had a new healthy kidney. It was the ultimate happy ending.
Now she is looking forward to a taking Oakari to swim lessons, and to the many other things she could not do while on dialysis. Most of all, she said, “I want to get my energy back. and play with my son like a normal mom.”
The Los Angeles County Department of Public Health is investigating a confirmed measles case in a resident who recently traveled internationally, the agency said in a release Saturday.
This is the fifth measles case identified by the county this year as outbreaks increase across the U.S. and globally.
The infected resident arrived at the Los Angeles International Airport on Thursday on Alaska Airlines Flight 1354. Other travelers at Tom Bradley International Terminal B that day between 6 a.m. and 8 a.m. may have been exposed to the virus, officials said.
Public health officials are advising residents to check their immunization status and watch for symptoms if exposed. The measles-mumps-rubella vaccine is the most effective protection from measles, according to the public health department.
“As measles cases increase, it is important that residents take steps to make sure they are fully protected,” L.A. County Health Officer Muntu Davis said in a statement. “The MMR vaccine is the safest and most reliable way to prevent measles and protect yourself, your family, and your community.”
In coordination with the federal Centers for Disease Control and Prevention, L.A. County Public Health will notify travelers seated near the infected person on the flight.
Affected travelers are at risk of developing measles from seven to 21 days after exposure to the virus. Symptoms include rash, fever, cough and red, watery eyes.
Measles can lead to complications including pneumonia, brain swelling and even death. Those with symptoms should notify their healthcare facility before visiting, officials said.
So far this year, 1,814 measles cases have been confirmed nationwide, including 48 in California.
In January, health officials recorded the most amount of cases since the U.S. achieved elimination of the virus in 2000.
Archaeologists working in Egypt have discovered a remarkable combination of Homeric epic and Egyptian ritual: a 2,000-year-old mummy with a papyrus fragment of the “Iliad” sealed in a clay packet outside its wrappings.
It is the first time a literary work has been found playing a functional, spiritual role in the mummification process. And it suggests that for a Roman-era Egyptian, the “Iliad” — specifically some lines from Book 2’s “Catalogue of Ships” — was perhaps as crucial for navigating the afterlife as a magical spell.
“The find is incredibly significant, primarily for the discovery of such a papyrus with Greek literary text in its original context,” said Foy Scalf, an Egyptologist at the University of Chicago. “We have evidence that such Greek literary texts could be used as magical amulets and that Homer was frequently cited in such amulets, as well as in the large handbooks now known as ‘The Greco-Egyptian Formularies.’ The new find directly supports that indirect knowledge.”
The mummy, a nonroyal male, was unearthed by the Mission of the University of Barcelona at a burial site known as Oxyrhynchus, as part of a project directed by Ignasi-Xavier Adiego of the university’s Institute of Ancient Near East. Leah Mascia, a specialist in the written and material culture of Greco-Roman and Late Antique Egypt at the Free University of Berlin, coordinated the collaborative breakthrough that finally brought the damaged text to light.
Recognizing that the heavily degraded papyrus required careful analysis, Dr. Mascia worked with a conservator, Margalida Munar, to stabilize the artifact, and Dr. Adiego, an authority on the Carian language, to study the text. Together, their combined expertise in preservation and linguistics allowed them to identify and read the document.
After six years of painstakingly reconstructing tomb fragments, Dr. Mascia uncovered a rare moment of cultural alchemy: Roman Egypt, where foreign and local customs merged. Her analysis, which identified embalmer seals and folding patterns of the papyrus packet, suggests that classical Greek epics were not merely read but physically repurposed.
Traditionally, mummified bodies were buried with sepulchral texts like the “Book of the Dead” and “The Book of Breathing,” formulaic manuals intended to protect and guide the deceased through the underworld. Yet, by the early Roman period, a major shift emerged: the introduction of sealed papyrus packets placed upon the dead.
These new packets contained a surprising mix of texts, including Greco-Egyptian magic, documentary records and even literary works like the “Iliad,” indicating a personalized, alternative funerary practice.
Out of the dumps
The Oxyrhynchus necropolis, located near the modern village of El-Bahnasa about 120 miles south of Cairo, is not just a burial site but an archaeological mother lode. Located on the banks of the Bahr Yussef canal, the area is speckled with ancient garbage dumps that managed to preserve everything from wedding invitations and tax records to horoscopes and early Christian gospels.
The ruins of Oxyrhynchus were initially documented by Vivant Denon, a scholar during Napoleon’s 1798 Egyptian campaign. But they held a secret that remained buried for an additional century, until 1896, when British archaeologists dug up more than 400,000 fragments of papyri from the ancient trash heaps. The discoveries ultimately included lost masterworks by poets and playwrights like Sappho and Euripides, transforming millenniums-old refuse into a cornerstone of classical literature.
In the 1990s, the Mission of the University of Barcelona and the University of Cairo began a joint project largely funded by the Spanish Ministry of Culture and the Egyptian Ministry of Tourism and Antiquities. This ongoing mission, directed by Maite Mascort i Roca and Esther Pons Mellado and staffed by archaeologists, epigraphists and papyrologists, focuses on various sectors of the necropolis, including No. 22, where experts are reconstructing the elaborate social and religious life of residents during the transition from the Ptolemaic to the Roman era.
Researchers exploring the multichambered burial site have exhumed a remarkable trove of treasures, among them mummies adorned with golden tongues — gold foil placed over the mouth — and at least one with copper, ritualistic additions that may have ensured that the dead could confidently speak their case to Osiris, the god of death and resurrection, before judgment.
A separate, distinct area of the necropolis — Sector 42 — has yielded large jars containing cremated remains. One vessel held the bones of an adult, an infant and a feline, along with fabric fragments. While these individuals most likely date to a slightly different period from the “Iliad” mummy, the immense complexity of these rites implies a wealthy, status-conscious class, providing fresh insight into the spiritual anxieties of the Roman-era community.
A cultural passport
Recovered in December from Tomb 65, the fragmentary papyrus packet contains a passage from the 2,800-year-old “Iliad” that functions as a detailed inventory of the Achaean army’s naval strength and regional origins, describing the forces arrayed against Troy to retrieve Helen. The text mentions specific commanders, such as Guneus, who arrived with “two and twenty ships from Cyphus,” and Tlepolemus, a “son of Hercules” who brought nine ships from Rhodes.
Dr. Mascia’s findings reveal a deliberate, intimate act: a document prepared in a mummification workshop and placed directly upon the body of the deceased. “These sealed papyrus packets may have been regarded as part of an alternative funerary procedure,” she said, adding that further studies were essential to prove this hypothesis.
This spiritual first-aid follows a long tradition. Dr. Scalf noted that “The Greco-Egyptian Formularies” even suggests the “Iliad” doubled as a literal medical kit. For a bed-bound patient shivering with malaria, the prescription was simple: Brace your head against a papyrus scroll of Book 4 to break the fever.
For residents navigating the complex, vibrant crossroads of Roman Egypt, Greek literary papyri may have functioned as a crucial cultural passport, said Anna Dolganov, a historian at the Austrian Archaeological Institute. In Egypt, being Hellenic connoted an exclusive social status and financial privilege — and had to be meticulously documented through genealogies going back across several centuries.
Buried with the dead, the “Iliad” perhaps served as a cheat code for a more comfortable afterlife. Dr. Dolganov wonders if carrying the epic poem was a deliberate strategy to secure entry into the Greek underworld, effectively sidestepping the torturous trials of Egyptian mythology. For these individuals, a Hellenic identity wasn’t just for this world — it was an eternal upgrade, offering a smoother path and higher status in the great beyond.
Science
Ten times worse than benzene — California updates its science on two chemicals in everyday air
Two toxic contaminants present in California’s ambient air appear to be much stronger carcinogens than previously known, state environmental health officials announced Thursday.
The draft finding from the state’s Office of Environmental Health Hazard Assessment finds that acrolein and ethylene oxide may pose an estimated cancer risk more than 10 times higher than benzene, a serious carcinogen linked to leukemia and other cancers.
It is the first step in a review process before final risk values are adopted, and it arrives at a time federal air-quality regulations are being reined in.
“If the early air monitoring results bear out, and if the draft cancer values developed are close to what eventually becomes final, then each air contaminant poses an unacceptable cancer risk,” said Kris Thayer, OEHHA’s director.
The update reflects the state’s evolving understanding of its most dangerous pollutants, which has shifted over the decades from visible pollutants, such as smog, to more invisible ones that cause cancer, heart disease and other health harms.
It comes only two months after the Trump administration’s Environmental Protection Agency moved to roll back standards on ethylene oxide, or EtO, in an effort to save millions of dollars in compliance costs for facilities that use the chemical for medical sterilization. The administration said it acted to “safeguard the supply of essential medical equipment,” but experts said the move will also expose more people to health risks.
It also follows a new national report from the American Lung Assn. that found 82% of Californians live in counties with unhealthful air, nearly double the national average.
“This is an important step to better understanding the harms of pollutants impacting Californians’ health,” said Will Barrett, assistant vice president for nationwide clean air policy at the American Lung Assn., who reviewed the state’s findings for The Times. “Following the latest available health science to determine risk is crucial to protecting health.”
Ethylene oxide is a colorless gas often used in the sterilization of medical devices, particularly those that can’t be cleaned using steam or radiation.
Acrolein can be formed when materials burn, such as cigarettes, e-cigarettes and vapes, wood, plastics and gasoline for cars, trucks, ships and aircraft. It can also be released by cooking fats and oils at high temperatures, and has been found in water produced by oil and gas operations and is an ingredient in some pesticides used in irrigation canals.
People can take steps to protect themselves from acrolein exposure in everyday life by avoiding smoking tobacco or using e-cigarettes and vaping products, avoiding smoke from fires or exhaust from diesel and gasoline vehicles and equipment — much of which can also help reduce exposure to ethylene oxide, officials said. When cooking with oils or fats, people should avoid very high temperatures and use a range hood fan when possible.
While both chemicals have been present in the state’s air for years, the new assessments from OEHHA are based on the latest science on health risks, officials said. Both acrolein and ethylene oxide were found to pose an estimated cancer risk exceeding 800 in 1 million — on par with the cancer risk that diesel exhaust was estimated to pose when it first emerged as a major public health concern in the 1990s, the agency said.
In response to the findings, Gov. Gavin Newsom’s May budget revision, released Thursday, includes $2.5 million in funding for the California Air Resources Board and OEHHA in support of research to help reduce people’s exposure to acrolein and ethylene oxide. The funding will help the state identify and track major sources of the chemicals and turn the findings into public health policy outcomes, officials said.
OEHHA’s assessment provides the first cancer risk value for acrolein since it was classified as probably cancer-causing to humans by the International Agency for Research on Cancer in 2020. Ethylene oxide was already identified as a carcinogen by the state, but the new assessment updates its risk levels based on the new research. The risk calculations are based on air monitoring data, which vary across the state depending on location, nearby sources and other factors.
Officials said the findings underscore the state’s efforts to strengthen environmental protection measures for residents at a moment when federal officials seek to loosen them.
“Especially in light of some of the national rollbacks we’re seeing on protections for public health, it really underscores how important the work that we’re doing here in California is,” said Courtney Smith, principal deputy executive officer with the Air Resources Board. “Not only for protecting the health of Californians, but also to ensure that there is rigorous, solid science available to other entities as well who may want to pursue additional protections.”
Short-term exposure to EtO by inhalation can cause headaches, dizziness, nausea, fatigue respiratory irritation and other adverse health effects, according to the federal Agency for Toxic Substances and Disease Registry. Longer-term exposure increases the risk of cancers of the white blood cells, such as non-Hodgkin’s lymphoma, as well as breast cancer.
Inhaling acrolein can cause nose and throat irritation and a decreased breathing rate. Chronic exposure, such as through cigarette smoke, has been linked to the development of asthma, chronic obstructive pulmonary disease and respiratory cancers.
The findings also come as California continues to receive poor grades on air quality. The American Lung Assn. annual State of the Air report found that the five U.S. counties with the worst smog pollution are all in California. Bakersfield was the metropolitan area with the worst level of year-round particle pollution for the seventh year in a row, while Los Angeles was the city with the worst ozone pollution, as it has been for 26 of the last 27 years.
“Californians face the most significant smog and soot challenges in the nation, but our air agencies have followed the science to build policies and programs to make real headway,” Barrett said. The state’s latest assessment “speaks to the need for ongoing local efforts while the federal government ignores the science and opens the door for more pollution. California must continue to invest in things like cleaning up truck fleets, broader public education and the underlying science to guide policies to protect health.”
Thursday’s announcement kicks off a 45-day public comment period, after which the draft assessments may be revised before undergoing additional public comment, peer review by the state’s Scientific Review Panel on Toxic Air Contaminants, and eventual adoption.
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