From the Research
When counseling a patient about perinatal care in Canada, I recommend following a comprehensive approach that prioritizes routine testing and potential treatments to minimize morbidity, mortality, and improve quality of life, as supported by the most recent evidence from 1.
Key Components of Perinatal Care
- First-trimester screening: dating ultrasound, complete blood count, blood type and antibody screen, rubella immunity, hepatitis B, HIV, and syphilis testing.
- Genetic screening options: non-invasive prenatal testing (NIPT) or maternal serum screening for chromosomal abnormalities.
- Second-trimester care: anatomy ultrasound at 18-22 weeks and glucose challenge test at 24-28 weeks (with 50g glucose load, followed by a 75g oral glucose tolerance test if indicated).
- Ongoing monitoring: blood pressure, weight, fundal height, and fetal heart rate at each visit.
- Rh-negative mothers: administer RhIg at 28 weeks and after delivery if the baby is Rh-positive.
- Group B Streptococcus screening: perform at 35-37 weeks.
Treatment Recommendations
- Iron supplementation: 27mg daily for all pregnant women.
- Folic acid: 0.4-1mg daily, taken preconceptually and continued through the first trimester.
- Gestational diabetes management: dietary modifications, blood glucose monitoring, and insulin therapy if targets aren't met.
- Hypertensive disorders: medications like labetalol (100-400mg twice daily) or nifedipine (10-20mg three to four times daily) may be required.
Importance of Early Prenatal Care
Early initiation of prenatal care is crucial for improving maternal health outcomes and health behaviors, as highlighted in 2 and 3. Care initiated at 10 weeks or earlier improves outcomes, and identification and treatment of periodontal disease decreases preterm delivery risk, as noted in 1.
Additional Considerations
- Universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy, as emphasized in 1.
- Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients, with potential treatment options including dietary modifications and insulin therapy.
- People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks, as suggested in 1.