Prenatal care is an important aspect of pregnancy and can result in positive outcomes for both mother and infant. Low-risk pregnancies have different recommendations for prenatal care than high-risk pregnancies. Low risk pregnancies begin with medical checkups that include screening tests. This will help the mother know if the baby is healthy and if she is healthy while pregnant. Prenatal care also involves some aspect of counseling as well as education on how to handle various facets of pregnancy. Patient education could involve topics like healthy eating, any additional screening tests needed, and level of physical activity. They may also include as part of prenatal care, what to expect during labor plus after delivery.
The first trimester for a low-risk pregnancy as previously stated, involves tests, labs, and screenings. The first thing they do is determine the expectant mother’s blood type and Rh factor and to look for signs of immunity to chicken pox and rubella. They also focus on screening for any STDs. This means testing for Hepatitis B, Gonorrhea, Chlamydia, and HIV antibody testing. There is also an antibody screening, urine testing, and if appropriate, cervical cytology. Along with these tests/screenings, the doctor may also consider additional testing. Such tests may include Vitamin D, PPD, early glucose challenge, varicella antibody test, and genetic screening. This is due to some patients potentially have genetic problems that could be passed down to their children.
Procedures possibly done during the first trimester is a dating ultrasound if the expectant mother does not know when her last period was, and to check for size-dates discrepancy. From 11-13 weeks an additional ultrasound and maternal serum screening may be performed. From 16-18 weeks, the obstetrician may recommend a maternal serum alpha fetal protein and/or a quadruple marker serum screening for any potential chromosomal abnormalities. From 18-20 weeks a fetal anatomy ultrasound may be recommended. This makes up the second trimester in a low-risk pregnancy.
The third trimester from 28 weeks to 41 weeks, involves additional tests and screenings. For example, there may be additional antibody testing, CC, syphilis screening, and glucose challenge test. Prenatal care may also include during this period administration of anti-D immune globulin if the expectant mother requires it. After 36+ weeks, there is determination of fetal presentation and screening for Group B. Streptococcus. Should the pregnancy last for more tha 41 weeks, there is an offer available for induction of labor.
While high risk pregnancies essentially include all of this, high-risk pregnancies may require additional rescreening in the 3rd trimester. But what is a high-risk pregnancy? High risk-pregnancies are any pregnancies that have a higher risk for complications. Although high-risk pregnancies may mean an increased chance for complications, the labor and delivery may transpire without any problems.
Those that are considered high-risk pregnancies are the very young, women over the age of 35, women underweight or overweight, previous problematic pregnancies, any pre-existing health conditions such as diabetes, high blood pressure, HIV, and cancer. Although cancer is rare during pregnancy, it can happen. “The diagnosis of cancer during pregnancy is uncommon. It is estimated that 1 in every 1000 pregnant women is diagnosed with cancer. Breast, melanoma and cervical cancers are those most commonly diagnosed during pregnancy, followed by haematological malignancies” (Peccatori et al., 2013, p. vi1160). Some women may develop conditions during pregnancy that could make them high-risk such as preeclampsia. High-risk pregnancies require additional prenatal care and may mean receiving care from a specialist like a maternal-fetal medicine specialist. They also may require additional and repeat testing and ultrasounds. Some have needed to remain in the hospital in order to deliver the baby.
In high-risk pregnancies they may check risk for delivery such as assessment of fetal lung maturity or percutaneous umbilical blood sampling. They may also ask for the expectant mother to come for health checkups more regularly where they check blood pressure and perform additional glucose testing. They may also do a pap smear and retest for STDs.
As mentioned before, patient education and counseling is an important and crucial aspect of prenatal care. Low-risk pregnancies from a primary care perspective advise expectant mothers to eat a balanced and healthy diet in order for both the mother and the infant to receive the nutrition they need to remain healthy. High-risk pregnancies may include an eating plan should the expectant mother be underweight or overweight. If the expectant mother is overweight, the doctor may recommend not gaining any additional weight and to eat more whole foods and less sugar and processed foods with little nutritional value. An underweight expectant mother may be advised to gain some weight and eat more carbohydrates, fats, and proteins from clean whole food sources.
Gestational diabetes is a problem that can easily be remedied or alleviated with proper healthy eating. Doctors should advise patients on what foods to avoid in order to improve health outcomes. Simply eliminating processed food and eating more fruits and vegetables can help many expectant mothers prevent such a complication. “Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus (GDM). We compared the effect of a low — glycemic index (GI) versus a conventional high-fiber (HF) diet on pregnancy outcomes, birth weight z score” (Markovic et al., 2015, p. 31).
Physical activity is also a key aspect of patient education. Low-risk pregnancies may involve the doctor advising on moderate activity with light weights. High-risk pregnancies, especially concerning high blood pressure, or previous pregnancy problems, may involve advising for bed rest. Preeclampsia can be deadly for both the baby and the mother and mothers that acquire the condition often must remain in bed until delivery. “Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. Preeclampsia/eclampsia is associated with substantial maternal complications, both acute and long-term. Clear protocols for early detection and management of hypertension in pregnancy” (Ghulmiyyah & Sibai, 2012, p. 56).
High risk-pregnancy may also involve the use of genetic testing, although this can be used in low-risk pregnancies. Genetic abnormalities can be passed down to a child and may result in a problem pregnancy, labor, and delivery. Genetic screenings, and testing and patient education on such procedure could help prevent some confusion and/or problems after the baby is delivered. Little people that have genetic abnormalities that stunt their growth, often have genetic testing, especially when a double dominant situation may arise, leading to a potential stillborn birth.
Certain procedures help reduce the need for other, more costly procedures such as NIPT.
NIPT detected 28% and 43% more T21 cases compared to INT and FTS, respectively, while reducing invasive procedures by >95% and reducing euploid fetal losses by >99%. NIPT leads to improved T21 detection and reduction in euploid fetal loss at lower total healthcare expenditures (Song, Musci, & Caughey, 2013, p. 1180.)
Overall, prenatal care is meant to serve as preventative measures to ensure the health and safety of the mother and infant. Whether a pregnancy is high-risk or low-risk, sound eating habits, some physical activity, and screenings and testing is essential for a good labor and delivery.
References
Ghulmiyyah, L. & Sibai, B. (2012). Maternal Mortality From Preeclampsia/Eclampsia. Seminars In Perinatology, 36(1), 56-59. http://dx.doi.org/10.1053/j.semperi.2011.09.011
Markovic, T., Muirhead, R., Overs, S., Ross, G., Louie, J., & Kizirian, N. et al. (2015). Randomized Controlled Trial Investigating the Effects of a Low — Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study. Diabetes Care,39(1), 31-38. http://dx.doi.org/10.2337/dc15-0572
Peccatori, F., Azim, H., Orecchia, R., Hoekstra, H., Pavlidis, N., Kesic, V., & Pentheroudakis, G. (2013). Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals Of Oncology, 24(suppl 6), vi160-vi170. http://dx.doi.org/10.1093/annonc/mdt199
Song, K., Musci, T., & Caughey, A. (2013). Clinical utility and cost of non-invasive prenatal testing with cfDNA analysis in high-risk women based on a U.S. population. The Journal Of Maternal-Fetal & Neonatal Medicine, 26(12), 1180-1185. http://dx.doi.org/10.3109/14767058.2013.770464
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