Breastfeeding contraindications include maternal HIV infection, chemical dependency, and use of certain medications. īreastfeeding is the best feeding method for most infants. 2ĭetailed information is available online at. Lengthy trips are associated with increased risk of venous thrombosis. 17Ĭonsider the availability of medical resources at the destination. 8, 9Īir travel generally is safe for pregnant women until four weeks before the expected date of delivery. The guidelines discussed in both parts of this article are summarized in a memory aid, the Maternity Care Calendar and Guidelines, available online at. Part II 7 will focus on third-trimester care and prevention of infectious diseases. 4 – 6 Part I of this two-part article focuses on general prenatal care, counseling issues, nutrition, and screening for genetic conditions. 2 Reminder systems such as prenatal forms or checklists embedded in the process of care increase the likelihood that physicians will put clinical evidence into practice. A pregnant woman should understand what screening tests are meant to detect, how they are conducted, possible risks to her and her fetus, the type of results that will be reported (e.g., probability, risk), the likelihood of false-positive or false-negative results, and the choices she will face once results are obtained. Care ideally begins before conception and includes preventive care, counseling, and screening for risks to maternal and fetal health. 1 – 3 A systematic approach should integrate the best evidence into a model of informed, shared decision making. Pregnancy can be enhanced by a coordinated program of prenatal medical care and psychosocial support. There is limited evidence that routine use of other dietary supplements may improve outcomes for the mother and infant. Folic acid supplementation beginning in the preconception period reduces the incidence of neural tube defects. Counseling about the limitations and risks of these tests, as well as their psychologic implications, is necessary.
Women at increased risk for aneuploidy should be offered amniocentesis or chorionic villus sampling.
All women should be offered prenatal serum marker screening for neural tube defects and aneuploidy. Genetic counseling and testing should be offered to couples with a family history of genetic disorders, a previously affected fetus or child, or a history of recurrent miscarriage. Women should be offered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Routine fetal heart auscultation, urinalysis, and assessment of maternal weight, blood pressure, and fundal height generally are recommended, although the evidence for these interventions is variable. Structured educational programs to promote breastfeeding are effective. Pregnant women should be counseled about the risks of smoking and alcohol and drug use. Effective prenatal care should integrate the best available evidence into a model of shared decision making.
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