What pregnancy screenings and interventions are recommended for pregnant individuals?

From the Guidelines

Pregnant individuals should undergo universal screening for gestational diabetes at 24 to 28 weeks of gestation, and those with risk factors for diabetes should be tested for undiagnosed prediabetes and diabetes at the first prenatal visit. This recommendation is based on the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1. The American Diabetes Association (ADA) recommends that all pregnant women with risk factors for diabetes should be tested for undiagnosed prediabetes and diabetes at the first prenatal visit using standard diagnostic criteria. Additionally, all pregnant women not previously known to have diabetes should be evaluated for gestational diabetes at 24 to 28 weeks of gestation.

Some key screenings and interventions that are recommended for pregnant individuals include:

• Blood tests for blood type, Rh factor, complete blood count, infectious diseases (HIV, hepatitis B, syphilis), and immunity status for rubella and varicella in the first trimester
• Genetic screening options, such as cell-free DNA testing, first trimester combined screening (ultrasound and blood tests), and carrier screening for conditions like cystic fibrosis and spinal muscular atrophy
• Prenatal vitamins containing 400-800 mcg of folic acid daily, starting ideally before conception and continuing throughout pregnancy to prevent neural tube defects
• Quad screen blood test (15-20 weeks), anatomy ultrasound (18-22 weeks), and glucose tolerance testing (24-28 weeks) in the second trimester
• Group B streptococcus testing at 36-37 weeks, with antibiotics during labor if positive to prevent newborn infection
• Blood pressure monitoring at every prenatal visit to detect preeclampsia, as recommended by the USPSTF 1
• Rh immunoglobulin (RhoGAM) at 28 weeks for Rh-negative women, influenza and Tdap vaccines, and regular monitoring of fetal movement and growth

It is essential to note that women with specific risk factors may require additional specialized screenings or more frequent monitoring throughout pregnancy. The ADA and other organizations recommend that women with risk factors for type 2 diabetes should be screened for diabetes using standard diagnostic criteria at the first prenatal visit 1. The USPSTF also recommends screening for preeclampsia with blood pressure measurements throughout pregnancy, with a grade B recommendation 1.

From the FDA Drug Label

Pregnancy Teratogenic Effects Pregnancy Category A Folic acid is usually indicated in the treatment of megaloblastic anemias of pregnancy. Folic acid requirements are markedly increased during pregnancy, and deficiency will result in fetal damage Studies in pregnant women have not shown that folic acid increases the risk of fetal abnormalities if administered during pregnancy. If the drug is used during pregnancy, the possibility of fetal harm appears remote.

The recommended pregnancy screening is to check for folic acid deficiency, as it may result in fetal damage.

• Folic acid requirements are increased during pregnancy.
• Folic acid supplementation may be needed in certain cases, such as low-birth-weight infants or mothers with folic acid deficiency. No specific interventions are mentioned in the drug label other than folic acid supplementation. 2

From the Research

Pregnancy Screenings

Pregnancy screenings are essential for identifying potential complications and ensuring the best possible outcomes for both mother and baby. Some recommended screenings include:

• First-trimester screening for Down's syndrome, which can be done through a combination of maternal serum markers and fetal ultrasound measurements, such as nuchal translucency (NT) 3, 4
• Second-trimester screening for Down's syndrome, which can be done through a combination of maternal serum markers, such as alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotropin (hCG), and inhibin A 5, 6
• Screening for neural tube defects (NTDs) and maternal gestational diabetes, which can be done through folic acid and inositol supplementation 7

Interventions

Some recommended interventions include:

• Folic acid supplementation to prevent NTDs 7
• Inositol supplementation to prevent maternal gestational diabetes 7
• Chorionic villus sampling or amniocentesis for women with a high risk of Down's syndrome or other chromosomal abnormalities 3, 5

Factors to Consider

When interpreting screening results, several factors should be considered, including:

• Maternal age, as the risk of Down's syndrome and other chromosomal abnormalities increases with age 3, 5, 6
• Maternal weight, as this can affect the accuracy of screening results 5
• Presence of insulin-dependent diabetes mellitus, multiple pregnancy, ethnic origin, and previous Down's syndrome pregnancy, as these can also affect screening results 5