prenatal care
Jump to navigation
Jump to search
[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]
Introduction
Institute of Medicine in 1999 recommends universal HIV screening during prenatal care. HIV testing is now incorporated into the routine battery of prenatal testing in some practices. Patients can still refuse testing.
Laboratory
- HIV1 serology
- hepatitis B serology
- syphilis serology (VDRL)[6]
- varicella, rubella, measles, mumps serology if immunization status unknown[27]
- urinalysis for bacteriuria[6][13]
- serum glucose, glucose tolerance test
- carrier screening for
- complete blood count to quantify the risks for thalassemias & hemoglobinopathies[17]
- serum TSH
- offspring of women with elevated serum TSH with excess risk for prematurity & neonatal respiratory distress syndrome[38]
- see ARUP consult[8]
Management
- also see pregnancy
- pregnant women should have at least 8 prenatal care visits
- routine screening for diabetes mellitus on 1st prenatal visit
- ferrous sulfate 325 mg (30-60 mg Fe+2)/day during pregnancy [10][16] (WHO recommendation)
- folic acid
- folic acid 0.4 mg or more QD begun 3 months before conception can reduce risk of neural tube defects by 70%[2]
- multivitamin or folic acid supplements before or during pregnancy may reduce risk of autism in offspring[28]
- vitamin D supplementation
- little effect on maternal or neonatal outcomes[19][33]
- vitamin D (1000 IU QD) beginning at 14-17 weeks gestation may increase bone mineral content among infants born in winter months[20]
- maternal serum 25-hydroxy vitamin D declines from 14-34 weeks gestation in women who deliver in winter & spring unless supplemented with vitamin D[20]
- maternal vitamin D deficiency duing pregnancy associated with increased risk of multiple sclerosis in offspring[29][31]
- 1000-2000 IU vitamin D daily for women with immediate family member with multiple sclerosis & serum 25-OH vitamin D < 20 ng/mL[31]
- vitamin D supplementation during pregnancy is associated with improved neonatal outcomes[32]
- calcium supplementation for prevention of pre-eclampsia in populations where calcium intake is low [NGC, WHO]
- vaccinations[27]
- Tdap after 20 weeks gestation (all pregnancies)[16][22][25]; 27-36 weeks of gestation[26]
- influenza vaccine can be given any trimester[23]
- influenza vaccination between 20 & 36 weeks' gestation reduces influenza in mothers & their infants (2-4% both)[24]
- TdaP & influenza vaccine during pregnancy not associated with infant hospitalization or mortality[30]
- measles/mumps/rubella vaccine (MMR) & varicella vaccine immediately postpartum in pregnant nonimmune women[27]
- prenatal vitamins should contain 150-200 ug of iodine/day[9]
- ultrasound before 24 weeks' gestation is recommended to help determine gestational age & identify fetal anomalies & multiple gestation[16]
- greater depth of prenatal ultrasound may be associated with increased autism risk for autism[29]
- NIH panel recommends 300 mg/day of DHA during pregnancy[5]
- increase levothyroxine dose in women with hypothyroidism 30-50% prior to conception or when pregnancy discovered if unplanned[13]
- prenatal screening for hypothyroidism is not recommended[7]
- USPSTF recommends screening all pregnant women for syphilis[6][34]
- USPSTF recommends screening all pregnant women for hepatitis B[37]
- screening for pre-eclampsia with blood-pressure at every prenatal visit[15]
- USPSTF recommends against screening for bacterial vaginosis[39]
- counsel women about risks associated with overweight & obesity#
- set targets for gestational weight gain informed by from pre-pregnancy body mass index[14]
- use antidepressants with caution during pregnancy
- may be associated with a 'discontinuation' syndrome* manifested by neonatal respiratory distress ...[3]
- fluoxetine may be associated with low birth weight[4]
- prenatal docosahexaenoic acid (DHA) supplementation does not lead to improved IQ in school-aged children[18]
- maternal or infant probiotic supplementation reduces risk for eczema in children ages <=4 years (RR=0.78)[31]
- fish oil supplementation during pregnancy & lactation reduces risk for allergic sensitization to egg at 1 year (RR=0.69)[31]
* use of tricyclic antidepressant or SSRI during late pregnancy
# infant mortality is double in obese women[14]
Notes
- 1/2 of pregnant women received influenza vaccine 2017-2018[35]
- 1/2 of pregant women receive Tdap[35]
More general terms
Additional terms
- planned parenthood; preconception planning; preconception risk assessment
- pregnancy (gestation)
- prenatal diagnosis
References
- ↑ Journal Watch 22(2):15, 2002
- ↑ 2.0 2.1 Journal Watch 24(10):82, 2004 Cleves MA, Hobbs CA, Collins HB, Andrews N, Smith LN, Robbins JM. Folic acid use by women receiving routine gynecologic care. Obstet Gynecol. 2004 Apr;103(4):746-53. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15051568
- ↑ 3.0 3.1 Journal Watch 24(10):82, 2004 a) Kallen B. Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch Pediatr Adolesc Med. 2004 Apr;158(4):312-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15066868
Koren G. Discontinuation syndrome following late pregnancy exposure to antidepressants. Arch Pediatr Adolesc Med. 2004 Apr;158(4):307-8. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15066865 - ↑ 4.0 4.1 Hendrick V, Smith LM, Suri R, Hwang S, Haynes D, Altshuler L. Birth outcomes after prenatal exposure to antidepressant medication. Am J Obstet Gynecol. 2003 Mar;188(3):812-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12634662
- ↑ 5.0 5.1 Prescriber's Letter 13(8): 2006 DHA Supplementation During Pregnancy and Lactation Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220810&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 6.2 6.3 U.S. Preventive Services Task Force (USPSTF) Screening for Syphilis Infection in Pregnancy: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement Annals of Internal Medicine 2009, 150:705 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19451577 <Internet> http://www.annals.org/content/150/10/705.full
Wolff T et al Screening for Syphilis Infection in Pregnant Women: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement Annals of Internal Medicine 2009, 150:710 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19451578 <Internet> http://www.annals.org/content/150/10/710.full
U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement. Feb 2018 Syphilis Infection in Pregnant Women: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/syphilis-infection-in-pregnancy-screening1
U.S. Preventive Services Task Force (USPSTF) Draft Evidence Review. Feb 2018 Draft Evidence Review for Syphilis Infection in Pregnant Women: Screening https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/syphilis-infection-in-pregnancy-screening1 - ↑ 7.0 7.1 Lazarus JH et al Antenatal Thyroid Screening and Childhood Cognitive Function N Engl J Med 2012; 366:493-501February 9, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22316443 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1106104
Brent GA The Debate over Thyroid-Function Screening in Pregnancy N Engl J Med 2012; 366:562-563February 9, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22316450 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1112591 - ↑ 8.0 8.1 ARUP Consult: Prenatal Screening and Diagnosis The Physician's Guide to Laboratory Test Selection & Interpretation https://arupconsult.com/content/prenatal-screening-and-diagnosis
Prenatal Screening and Diagnosis for Chromosomal Abnormalities and Neural Tube Defects Algorithm. https://arupconsult.com/algorithm/prenatal-screening-and-diagnosis-algorithm - ↑ 9.0 9.1 De Groot L et al Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab August 1, 2012 97(8):2543 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22869843 <Internet> http://jcem.endojournals.org/content/97/8/2543.abstract (corresponding NGC guideline withdrawn Feb 2018)
Stagnaro-Green A Optimal Care of the Pregnant Woman with Thyroid Disease J Clin Endocrinol Metab August 1, 2012 97(8):2619 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22869845 <Internet> http://jcem.endojournals.org/content/97/8/2619.full - ↑ 10.0 10.1 Young K. Physician's First Watch. Massachusetts Medical Society David G. Fairchild, MD, MPH, Editor-in-Chief http://www.jwatch.org
Haider BA et al Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013;346:f3443 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23794316 <Internet> http://www.bmj.com/content/346/bmj.f3443 - ↑ Pena-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004736 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19821332
- ↑ Blumer I et al Diabetes and Pregnancy: An Endocrine Society Clinical Practice Guideline. Endocrinology & Metabolism. Nov 1, 2013, 98(11):4227-4249 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24194617 <Internet> http://jcem.endojournals.org/content/98/11/4227.abstract
- ↑ 13.0 13.1 13.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 19 American College of Physicians, Philadelphia 2012, 2022
- ↑ 14.0 14.1 14.2 Johansson S et al Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden. BMJ 2014;349:g6572 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25467170 <Internet> http://www.bmj.com/content/349/bmj.g6572
Owe KM Weight in early pregnancy and outcomes in early infancy. BMJ 2014;349:g6850 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25467941 <Internet> http://www.bmj.com/content/349/bmj.g6850 - ↑ 15.0 15.1 U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement. Preeclampsia: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement167/preeclampsia-screening1
- ↑ 16.0 16.1 16.2 16.3 16.4 Word Health Organization (WHO) Pregnant women must be able to access the right care at the right time, says WHO. News Release. Nov 7, 2016 http://www.who.int/mediacentre/news/releases/2016/antenatal-care-guidelines/en/
- ↑ 17.0 17.1 17.2 American Congress of Obstetrics & Gynecologists Carrier Screening in the Age of Genomic Medicine. Committee Opinion Number 690, March 2017 http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Genetics/Carrier-Screening-in-the-Age-of-Genomic-Medicine
American Congress of Obstetrics & Gynecologists Carrier Screening for Genetic Conditions. Committee Opinion Number 691, March 2017 http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Genetics/Carrier-Screening-for-Genetic-Conditions - ↑ 18.0 18.1 Gould JF, Treyvaud K, Yelland et al. Seven-year follow-up of children born to women in a randomized trial of prenatal DHA supplementation. JAMA 2017 Mar 21; 317:1173 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28324081 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2612605
- ↑ 19.0 19.1 Roth DE, Leung M, Mesfin E et al Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomised trials. BMJ 2017;359:j5237 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29187358 <Internet> http://www.bmj.com/content/359/bmj.j5237
- ↑ 20.0 20.1 20.2 Cooper C, Harvey NC, Bishop NJ et al Maternal gestational vitamin D supplementation and offspring bone health (MAVIDOS): a multicentre, double-blind, randomised placebo-controlled trial. The Lancet Diabetes & Endocrinology. March 1, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26944421 Free Article <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2816%2900044-9/abstract
Reid IR Towards a trial-based definition of vitamin D deficiency. The Lancet Diabetes & Endocrinology. March 1, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26944420 Free Article <Internet> http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2816%2900079-6/abstract - ↑ Nielsen NM, Munger KL, Koch-Henriksen N et al Neonatal vitamin D status and risk of multiple sclerosis. A population-based case-control study. Neurology. Nov 30, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27903815 <Internet> http://www.neurology.org/content/early/2016/11/30/WNL.0000000000003454
Marrie RA, Daumer M. A gestational dose of vitamin D per day keeps the MS doctor away. Neurology. Nov 30, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27903816 <Internet> http://www.neurology.org/content/early/2016/11/30/WNL.0000000000003469
Munger KL, Aivo J, Hongell K et al Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort. JAMA Neurol. Published online March 07, 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26953778 <Internet> http://archneur.jamanetwork.com/article.aspx?articleid=2499458 - ↑ 22.0 22.1 Centers for Disease Control and Prevention Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women Advisory Committee on Immunization Practices (ACIP), 2012 MMWR. Feb 22, 2013 / 62(07);131-135 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm
- ↑ 23.0 23.1 23.2 Prescriber's Letter 18(12): 2011 Use of Influenza and Pertussis Vaccines in Pregnancy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271205&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 24.0 24.1 24.2 Madhi SA et al Influenza Vaccination of Pregnant Women and Protection of Their Infants. N Engl J Med 2014; 371:918-931. September 4, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25184864 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1401480
- ↑ 25.0 25.1 Ahluwalia IB et al Tetanus, Diphtheria, Pertussis Vaccination Coverage Before, During, and After Pregnancy - 16 States and New York City, 2011 MMWR. May 22, 2015 / 64(19);522-526 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6419a4.htm
Centers for Disease Control and Prevention (CDC) Pregnancy and Whooping Cough http://www.cdc.gov/pertussis/pregnant/HCP/ - ↑ 26.0 26.1 Winter K et al. Effectiveness of prenatal versus postpartum Tdap vaccination in preventing infant pertussis. Clin Infect Dis 2016 Sep 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27624956
- ↑ 27.0 27.1 27.2 27.3 Swamy GK and Heine RP. Vaccinations for pregnant women. Obstet Gynecol 2015 Jan; 125:212. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25560127
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 762 summary: prepregnancy counseling. Obstet Gynecol. 2019;133:228-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30575672 - ↑ 28.0 28.1 Levine SZ, Kodesh A, Viktorin A et al Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring. JAMA Psychiatry. Published online January 3, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29299606 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2667432
- ↑ 29.0 29.1 29.2 Rosman NP, Vassar R, Doros G et al Association of Prenatal Ultrasonography and Autism Spectrum Disorder. JAMA Pediatr. Published online Feb 12, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29435580 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2672728
- ↑ 30.0 30.1 Sukumaran L, McCarthy NL, Kharbanda EO et al Infant Hospitalizations and Mortality After Maternal Vaccination. Pediatrics. February 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29463582 <Internet> http://pediatrics.aappublications.org/content/early/2018/02/16/peds.2017-3310
- ↑ 31.0 31.1 31.2 31.3 31.4 Garcia-Larsen V, Ierodiakonou D, Jarrold K et al Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLOS Medicine. February 28, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29489823 <Internet> http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002507
- ↑ 32.0 32.1 Bi WG, Nuyt AM, Weiler H et al Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and MortalityA Systematic Review and Meta-analysis. JAMA Pediatr. Published online May 29, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29813153 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2681636
Rosendahl J, Valkama S, Holmlund-Suila E et al Effect of Higher vs Standard Dosage of Vitamin D3 Supplementation on Bone Strength and Infection in Healthy Infants. A Randomized Clinical Trial. JAMA Pediatr. Published online May 29, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29813149 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2681637
Chawes B, Bonnelykke K, Bisgaard H. Prenatal Vitamin D Supplementation to Improve Health in Offspring. JAMA Pediatr. Published online May 29, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29813164 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2681631 - ↑ 33.0 33.1 Roth DE, Morris SK, Zlotkin S et al Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth. N Engl J Med 2018; 379:535-546 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30089075 https://www.nejm.org/doi/full/10.1056/NEJMoa1800927
- ↑ 34.0 34.1 US Preventive Services Task Force Screening for Syphilis Infection in Pregnant Women. US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2018;320(9):911-917. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193283 https://jamanetwork.com/journals/jama/fullarticle/2698933
Lin JS, Eder ML, Bean SI Screening for Syphilis Infection in Pregnant Women. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320(9):918-925 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193282 https://jamanetwork.com/journals/jama/fullarticle/2698932 - ↑ 35.0 35.1 35.2 Kahn KE, Black CL, Ding H, et al. Influenza and Tdap Vaccination Coverage Among Pregnant Women - United States, April 2018. MMWR Morb Mortal Wkly Rep 2018;67:1055-1059 https://www.cdc.gov/mmwr/volumes/67/wr/mm6738a3.htm
- ↑ 36.0 36.1 New S, Winter K, Boyte R, et al. Barriers to Receipt of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Among Mothers of Infants Aged < 4 Months with Pertussis California, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1068-1071 https://www.cdc.gov/mmwr/volumes/67/wr/mm6738a6.htm
- ↑ 37.0 37.1 U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement Hepatitis B Virus Infection in Pregnant Women: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-b-virus-infection-in-pregnant-women-screening
- ↑ 38.0 38.1 Lee SY, Cabral HJ, Aschengrau A, Pearce EN. Associations between maternal thyroid function in pregnancy and obstetric and perinatal outcomes. J Clin Endocrinol Metab 2019 Dec 15; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31838502 https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgz275/5678077?redirectedFrom=fulltext
- ↑ 39.0 39.1 US Preventive Services Task Force Recommendation Statement Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery JAMA. 2020;323(13):1286-1292 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32259236 https://jamanetwork.com/journals/jama/fullarticle/2764189