The first 12 weeks of pregnancy are a time of organogenesis and heightened fetal vulnerability to teratogens; counseling about risk behaviors is appropriate. Issues to be discussed in early pregnancy are outlined in A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. Recommendation statement: screening and behavioral counseling interventions in primary care to reduce alcohol misuse.
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.
Women should be offered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Screening women and elderly adults for family and intimate partner violence: a review of the evidence for the U.
Accurate dating is important for timing screening tests and interventions, and for optimal management of complications.
Some research indicates that early ultrasonography is more accurate than LMP at determining gestational age, and that it should be used routinely to determine EDD and reduce the need for labor induction.216 This approach should be considered if there is uncertainty about the LMP.
Pregnant women should be counseled about the risks of smoking and alcohol and drug use. Feldhaus KM, Koziol-Mc Lain J, Amsbury HL, Norton IM, Lowenstein SR, Abbott JT.
Structured educational programs to promote breastfeeding are effective. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department.
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. Saftlas A, Wang W, Risch H, Woolson R, Hsu C, Bracken M. Schieve LA, Cogswell ME, Scanlon KS, Perry G, Ferre C, Blackmore-Prince C, et al.
All women should be offered prenatal serum marker screening for neural tube defects and aneuploidy. Lindhard A, Nielsen PV, Mouritsen LA, Zachariassen A, Sorensen HU, Roseno H. Pre-pregnancy body mass index and gestational weight gain as risk factors for preeclampsia and transient hypertension. Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery.
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.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.46 Part I of this two-part article focuses on general prenatal care, counseling issues, nutrition, and screening for genetic conditions.
Part II7 will focus on third-trimester care and prevention of infectious diseases.
See page 1245 for more information A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. United States Public Health Service Expert Panel on the Content of Prenatal Care.