Screenings for Pregnant Women

Folic Acid Supplementation to Prevent Neural Tube Defects Population

Persons who plan to or could become pregnant

Folic Acid Supplementation to Prevent Neural Tube Defects Recommendation

All people planning to or could become pregnant should take a daily supplement of folic acid

Folic Acid Supplementation to Prevent Neural Tube Defects USPSTF Grade

A

Folic Acid Supplementation to Prevent Neural Tube Defects Folic Acid Dosing

take daily supplement of 0.4-0.8mg (400-800 mcg) folic acid

Folic Acid Supplementation Prevents:

neural tube defects: anencephaly, encephalocele, spina bifida

Hypertensive Disorders of Pregnancy Population

Asymptomatic pregnant persons

Hypertensive Disorders of Pregnancy Recommendations

Screen for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy

Hypertensive Disorders of Pregnancy USPSTF Grade

B

Hypertensive Disorders of Pregnancy cause:

hypertensive disorders of pregnancy are among the leading causes of maternal mortality and morbidity and adverse perinatal outcomes for the fetus and newborn

Hypertensive Disorders of Pregnancy effect which populations the most:

Black, Alaskan Native, and Native American

Hypertensive Disorders of Pregnancy screening

take blood pressure measurements during each prenatal care visit and repeat if elevated

Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality population

Pregnant persons at high risk for preeclampsia

Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality Recommendation

Use low dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in persons at high risk for preeclampsia

Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality USPSTF Grade

B

Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality High Risk

hx of preeclampsia, multifetal gestation, chronic HTN, pregestational T1D/T2D, renal disease, autoimmune disease

Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality Intervention

if patient is at high risk, prescribe low dose aspirin (81 mg/day) after 12 weeks of gestation once daily

Gestational Diabetes Population

Asymptomatic pregnant persons at/after 24 weeks of gestation

Gestational Diabetes Recommendations

Screen for gestational diabetes in asymptomatic pregnant persons at/after 24 weeks of gestation

Gestational Diabetes USPSTF Grade

B

Gestational Diabetes Tests

- 2 step process with oral glucose challenge test followed by oral glucose tolerance test

OR:

- oral glucose tolerance test

OR:

- fasting plasma glucose measuremen

Gestational Diabetes needs done:

once between 24-28 weeks, typically

Healthy Weight and Weight Gain in Pregnancy Population

Pregnant persons

Healthy Weight and Weight Gain in Pregnancy Recommendations

Offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain

Healthy Weight and Weight Gain in Pregnancy USPSTF Grade

B

Healthy Weight and Weight Gain in Pregnancy Interventions

effective behavioral counseling interventions with individual focus on nutrition, physical activity, or lifestyle and behavioral change

- individual or group counseling in person or by computer or internet

Healthy Weight and Weight Gain in Pregnancy Starts:

start at the end of first trimester or beginning of second and end prior to delivery

Asymptomatic Bacteriuria in Pregnant Persons Population

Pregnant persons

Asymptomatic Bacteriuria in Pregnant Persons Recommendations

Screen for asymptomatic bacteriuria using urine culture in pregnant persons

Asymptomatic Bacteriuria in Pregnant Persons USPSTF Grade

B

Asymptomatic Bacteriuria in Pregnant Persons Test

- use a midstream clean catch urine culture at first prenatal visit or 12-16 weeks, whichever is earlier

Asymptomatic Bacteriuria in Pregnant Persons Test needs treatment when:

- culture with >100,000 CFU/mL of a single uropathogen or >10,000 CFU/mL if pathogen is group B streptococcus

Pyelonephritis in pregnancy is associated with

negative maternal outcomes and treatment of screen-detected asymptomatic bacteriuria can reduce the incidence of pyelonephritis in pregnant persons

Syphilis in Pregnant Persons Population

Pregnant people

Syphilis in Pregnant Persons Recommendation

Early screening for syphilis infection in all pregnant people

Syphilis in Pregnant Persons USPSTF Grade

A

Syphilis in Pregnant Persons Test

- 2-step process: nontreponemal antibody test (venereal disease research laboratory (VDRL) test or rapid plasma reagin (RPR) test) followed by a confirmatory treponemal antibody detection test (fluorescent treponemal antibody absorption test)

- reverse sequence screening algorithm: automated treponemal antibody test (enzyme-linked chemiluminescence or multiplex flow immunoassay) followed by nontreponemal VDRL or RPR test

Syphilis in Pregnant Persons Treatment (IF POSITIVE)

treat with parenteral benzathine penicillin G

Hepatitis B in Pregnant Persons Population

Pregnant people

Hepatitis B in Pregnant Persons Recommendation

Screen for HBV infection in pregnant people at first prenatal visit

Hepatitis B in Pregnant Persons USPSTF Grade

A

Hepatitis B in Pregnant Persons Test

serologic identification of hepatitis B surface antigen (HBsAg) at first prenatal visit

Hepatitis B in Pregnant Persons - Screening for persons with unknown status or new/continuing risk factors

should be screened at time of admission to delivery setting

Chlamydia and Gonorrhea Population

Sexually active women, including pregnant people

Chlamydia and Gonorrhea Recommendation

Screen for chlamydia and gonorrhea in all sexually active women ≤24 y/o and those ≥25 y/o at increased risk of infection

Chlamydia and Gonorrhea USPSTF Grade

B

Chlamydia and Gonorrhea Test

Use a nucleic acid amplification test (NAAT)

HIV Population

Pregnant people

HIV Recommendation

Screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown

HIV USPSTF Grade

A

HIV Test

antigen/antibody immunoassay

Referring Pregnant and Postpartum Persons who are at increased risk of perinatal depression Population

Pregnant and postpartum persons

Referring Pregnant and Postpartum Persons who are at increased risk of perinatal depression Recommendation

Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions

Referring Pregnant and Postpartum Persons who are at increased risk of perinatal depression USPSTF Grade

B

Referring Pregnant and Postpartum Persons who are at increased risk of perinatal depression Treatment

CBT, interpersonal therapy

Referring Pregnant and Postpartum Persons who are at increased risk of perinatal depression Risk Factors

hx of depression, current depressive symptoms that do not meet diagnostic threshold, low SES, single parents, recent intimate partner violence, elevated anxiety symptoms, hx of significant negative life events

Breastfeeding Population

Pregnant people, new parents, and their children

Breastfeeding Recommendations

Provide interventions during pregnancy and after birth to support breastfeeding

Breastfeeding USPSTF Grade

B

Breastfeeding Interventions

promote the benefits of breastfeeding, provide practical advice and direct support on how to breastfeed, provide psychological support

Breastfeeding - Food for Thought as a provider

not all choose/want to breastfeed so respect the autonomy of people and their families to make decisions that fit their specific situation, values, and preferences

Rh(D) Blood Typing Populations:

- Pregnant people, during the first pregnancy-related visit

- Unsensitized Rh(D) negative pregnant people

Rh(D) Blood Typing First Pregnancy Recommendation

Rh(D) blood typing and antibody testing is completed for all pregnant people during their first visit for pregnancy-related care

Rh(D) Blood Typing Unsensitized Recommendation

Rh(D) blood typing and antibody testing is completed for all unsensitized Rh(D) negative pregnant people at 24-28 weeks gestation unless the biological father is known to be Rh(D) negative

Rh(D) Blood Typing First Pregnancy USPSTF Grade

A

Rh(D) Blood Typing Unsensitized USPSTF Grade

B

Rh(D) Blood Typing Test

complete Rh(D) blood typing and antibody testing

Rh(D) Blood Typing - High Risk

Rh(D) negative patients who give birth to an Rh(D) positive newborn or are otherwise exposed to Rh(D) positive RBCs are at risk of developing anti-D antibodies and fetuses are then at risk of developing hemolytic disease of the newborn/fetus

Tobacco Population

Pregnant persons

Tobacco Recommendations

Ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation

Tobacco USPSTF Grade

A

Tobacco Intervention

effective behavioral counseling including cognitive behavioral, motivational, and supportive therapy such as counseling, health education, feedback, financial incentives, and social support

First Prenatal Appointment

- BP (HTN, every prenatal appointment)

- Folic Acid (take all pregnancy)

-Bacteriauria (urine culture, first visits or at 12-16 weeks)

- Hep B (HbsAG)

- Syphilis, Chlamydia, Gonorrhea, HIV

- Depression

12 weeks of pregnancy

- assess blood pressure for high risk of preeclampsia

- prescribe low dose aspirin (81 mg/day)

24 weeks of pregnancy

- BP

- Aspirin

- Gestational diabetes (oral glucose testing)