What is the approach to counseling a patient about prenatal and postnatal care?

From the Guidelines

Counseling a patient about perinatal care should prioritize a comprehensive and continuous approach, focusing on accurate, evidence-based information and shared decision-making, as emphasized by the Society for Maternal-Fetal Medicine consult series #55 1.

Key Components of Counseling

• Before pregnancy, women should be informed about maternal and fetal health risks and strategies to prevent or reduce these risks, including discussions on contraception options and management of preexisting health conditions 1.
• During pregnancy, counseling should cover the potential risks and benefits of pregnancy continuation and termination, as well as postpartum health, contraception, and future pregnancy risks 1.
• The counseling process should be tailored to the individual's reproductive life plan, addressing factors such as preexisting health conditions, personal and family history, and social determinants of health 1.
• Healthcare practitioners should utilize strategies that reduce barriers to informative, unbiased communication, prioritize patient values, and empower patients to make the best reproductive health choices for them 1.

Addressing Specific Needs

• Women at increased risk of pregnancy complications should receive counseling on the management of their condition during pregnancy and the interpregnancy period, including strategies to mitigate risks in future pregnancies 1.
• Counseling should also address postpartum care, including signs and symptoms of life-threatening conditions, common physical changes, and mental health concerns such as postpartum depression and anxiety 1.
• The importance of continuity of care and access to services, including telemedicine and community resources, should be emphasized to support women throughout their reproductive life course 1.

Implementing Effective Counseling

• Healthcare practitioners should be prepared to provide counseling or referrals for contraception, abortion, and pregnancy management, and should receive training on how to address these topics effectively 1.
• Changes to healthcare policies and norms around collaboration with non-physician community members may be necessary to optimize care for women at increased risk of maternal morbidity and mortality 1.
• By prioritizing patient-centered care and evidence-based counseling, healthcare practitioners can help women make informed decisions about their reproductive health and reduce the risk of adverse outcomes 1.

From the Research

Counseling Patients About Perinatal Care

To counsel a patient about perinatal care, several key points should be considered:

• The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by optimizing health, addressing modifiable risk factors, and providing education about healthy pregnancy 2.
• Prepregnancy counseling should occur several times during a woman's reproductive lifespan, increasing her opportunity for education and potentially maximizing her reproductive and pregnancy outcomes 2.
• Counseling patients about optimal intervals between pregnancies may be helpful to reduce future complications 2.

Nutrition and Supplementation

Nutrition and supplementation play a crucial role in perinatal care:

• The blood levels of most vitamins decrease during pregnancy if un-supplemented, including vitamins A, C, D, K, B1, B3, B5, B6, folate, biotin, and B12 3.
• Sub-optimal intake of vitamins from preconception through pregnancy increases the risk of many pregnancy complications and infant health problems 3.
• Folic acid supplementation (400 to 800 mcg daily) decreases the risk of neural tube defects 4.

Screening and Testing

Screening and testing are essential components of perinatal care:

• All pregnant patients should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella 4.
• Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection 4.
• Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients 4.

Social Determinants of Health

Social determinants of health can significantly impact perinatal outcomes:

• Universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy 4.
• Care initiated at 10 weeks or earlier improves outcomes, and identification and treatment of periodontal disease decreases preterm delivery risk 4.

Dietary Supplements

Dietary supplements can help fill the gap between food-based intake and estimated requirements of pregnancy:

• Most pregnant women in the United States are at risk of inadequate intake of key nutrients during pregnancy from foods alone 5.
• Almost no US dietary supplements provide key nutrients in the doses needed for pregnant women, and affordable and convenient products that fill this gap are needed 5.