Disease States, Nutrition, Risk Indicators, Risk


Maternal serum alpha-feto-protein (MSFP)f 16-18 weeks gestation) Toxoplasmosis-if indicated

Group B Streptococus, and Cyomegalovirus (CMV) - if indicated

Group B Streptococus if indicated

Medical and General Risk Indicators include;

Infections:

  • Oral, teeth and gums
  • Gastro- Intestinal
  • Reproductive tract infections, e.g., bacterial vaginosis
  • Chronic infections, e.g., urinary tract infections
  • Sexually transmitted diseases (STDs)
  • Human Immunodeficiency Virus (HIV)
  • Tuberculosis

Disease States

  • Diabetes mellitus
  • Cardiovascular disease, e.g., hypertensive disorders, valvular heart disease
  • Pulmonary disease, e.g., asthma
  • Hepatic disease
  • Collagen disease
  • Metabolic disorders
  • Endocrine disorders
  • Convulsive/neurologic disorders
  • Isoimmune Thrombocytopenia
  • Hemoglobinopathies
  • Severe anemia
  • Sickle Cell Disease

Nutritional Disorders

  • Hyperemesis, anorexia
  • Bulemia
  • Inappropriate weight gain

Alternative Diets,

* Vegans (complete vegetarians) need B-12 supplements

Obstetric History - Risk Indicators

  • Poor obstetrical history
  • Multiple gestation
  • Infant with congenital anomalies
  • Low birth weight Infant.
  • Premature labor (< 37 weeks).
  • Rupture of membranes > 24 hours before the birth, regardless of gestational age
  • Bleeding after 20 weeks
  • Pregnancy induced hypertension
  • Uterine structural anomalies
  • Abnormal amniotic fluid volume
  • Intrauterine growth restriction
  • Fetal cardiac arrhythmias
  • Abnormal fetal lie
  • Isoimmunization
  • Chorioamnionitis

Socio-Economic Risk Indicators

  • Minority ethnic identity
  • Unemployment
  • Low income employment.
  • Household income < 150% federal poverty level.
  • Patient unable to make co-payments
  • Patient has no telephone
  • Homeless
  • Lives in shelter

Socio-Behavioral Risk Indicators

  • Social isolation/lack of social support
  • Maternal education < 12 years3
  • Unintended pregnancy.
  • Failure / inability to prepare for birth.
  • No prenatal care before 28 weeks
  • Single parent with no father identified
  • Mother < 17 years old at conception
  • One or more children < 2 years old
  • Conception interval < 6 mo.
  • Alcohol/drug use/abuse
  • Maternal smoking
  • Gestational depressive episodes
  • Inexperience in child care
  • Partner abuse/violence
  • Spouse/family member death
  • Occupation loss, patient/partner
  • Residential move
  • Multiple sex partners
  • Sex partner at high risk for HIV or IV drug use

Risk of Genetic Disease / Birth Defects

Genetic conditions are frequently associated with untoward outcomes of pregnancy. It is therefore essential that assessment that these diseases or defects are thoroughly investigated. Advances in medical research have provided mechanisms to identify and possibly to treat genetic diseases and birth defects prenatally. Perinatal care providers should be prepared to offer appropriate assessment, genetic counseling, or referral to a genetic consultant when there is significant risk of genetic disease or birth defect. Genetic risk factors include:

  • Advanced maternal age- 35 or older at Estimated Date of Delivery (EDD) (See pages for a chart on risk of abnormalities as a function of maternal age)
  • Repetitive spontaneous abortions or unexplained fetal deaths
  • Personal or family history of birth defect, chromosomal abnormality or genetic disease (e.g., congenital heart disease, Down's syndrome muscular dystrophy, cystic fibrosis, Autosomal recessive diseases, (e.g., Tay-Sachs disease, sickle and Thalassemia Hemoglobin types
  • Autosomal dominant diseases, e.g., Huntington's Chorea, gender or X-linked diseases, e.g., hemophilia) in either parent or in a previous offspring or other near relatives of either parent. Procedures available to detect genetic disease or defects, and most metabolic disorders include:
  • Ultrasound (U/S)
  • Amniocentesis with various analyses as indicated
  • Percutaneous Umbilical Blood Sampling (PUBS)
  • Chorionic Villus Sampling (CVS)