unmeasured AI · how she's doing
Sarah is a 32-year-old G2P1 patient at 14 weeks gestation with continuous wearable monitoring since week 10.
Priority flag: TSH 3.8 mIU/L (trimester-specific target <2.5; drawn 3 wks ago), trending up from 2.4 at pre-conception — she developed postpartum thyroiditis after her first pregnancy.
HRV declined 18% over 2 weeks (Oura: 52ms → 43ms) with sleep efficiency 71% vs 84% baseline. Iron borderline: ferritin 18 ng/mL, saturation 22%. Currently on aspirin 81mg for preeclampsia prevention.
Clinical flags requiring attention
⚑TSH elevated — repeat recommended todayTSH 3.8 mIU/L (3 wks ago). Trimester-specific range: 0.1–2.5 mIU/L (ATA/ACOG). History of postpartum thyroiditis.
◈Iron borderline — supplementation reviewFerritin 18 ng/mL (ref ≥30), iron saturation 22% (ref 25–45%).
◈HRV declining — sleep quality degradedOura: HRV dropped 18% over 14 days (52ms → 43ms). Sleep efficiency 71% vs 84% baseline.
ℹGDM family history — screening protocolMother: GDM in 2nd pregnancy. Early glucose challenge at 14–16 wks may be considered.
✓PPD history documented — monitoring in placeEPDS 5/30 at 10 wks (non-concerning). Monthly check-ins via unmeasured.
Today's vitals (Oura Ring · Apple Health · Withings)
Resting HR
74bpm
↑ 4 vs baseline
Blood pressure
112/72
→ stable
Sleep efficiency
71%
↓ from 84%
Body temp
98.4°F
+0.3° vs pre-preg
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Good morning. I have Sarah's full clinical record loaded — 14 weeks G2P1, two active flags. The TSH elevation (3.8 mIU/L vs target <2.5 in T1) is the most time-sensitive item given her history of postpartum thyroiditis. I'd recommend ordering a repeat TSH + Free T4 before she leaves today.
I'm also tracking the 18% HRV decline over the past two weeks alongside the borderline iron studies — there may be a compounding fatigue picture worth discussing. What would you like to explore?
TSH management protocolPPD risk assessmentIron supplementationGDM screeningInterpret wearable dataDraft SOAP note
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Q
Thyroid management in pregnancy — TSH above 2.5 mIU/L
ACOG PB 223ATA Guidelines
ATA recommends trimester-specific TSH target of 0.1–2.5 mIU/L in T1. Sarah's 3.8 exceeds this. With postpartum thyroiditis history, initiating low-dose levothyroxine (25–50 mcg/day) is reasonable.
Evidence-based synthesisGrade B
Q
Iron deficiency in pregnancy — ferritin below 20 ng/mL
ACOG PB 233Cochrane 2015
Ferritin <30 ng/mL defines iron deficiency. ACOG recommends adding 160–200 mg elemental iron daily. Vitamin C co-administration increases absorption 30%.
Evidence-based synthesisGrade A
Q
PPD recurrence prevention in subsequent pregnancy
ACOG PB 92Cochrane 2020
25–50% recurrence risk. Preventive CBT/IPT reduces recurrence by 39%. Prophylactic sertraline at 34–36 weeks reduced PPD rates (12% vs 30%).
Evidence-based synthesisGrade A