Chapter 13: Special Population: Pregnant Women

ANEMIA

Population

• –Pregnant women.

Recommendation

USPSTF 2015, AAFP 2014, ACOG 2008, CDC 1998.

• –Screen all women with hemoglobin or hematocrit at first prenatal visit.

Sources

• –USPSTF. https://www.uspreventiveservicestaskforce.org/

• –Ann Intern Med. 2015;163:529-536.

• –ACOG. Obstet Gynecol. 2008;112(1):201.

• –CDC. MMWR Morb Mortal Wkly Rep. 1998; 47(RR-3):1.

• –Am Fam Physician. 2014;89(3):199-208.

Comments

1. Insufficient evidence to recommend for or against routine screening for iron deficiency anemia (IDA) in pregnant women to prevent adverse maternal or birth outcomes. Insufficient evidence to recommend for or against use of iron supplements for non-anemic pregnant women. (USPSTF, 2015)

2. When acute stress or inflammatory disorders are not present, a serum ferritin level is the most accurate test for evaluating IDA. Among women of childbearing age, a cutoff of 30 ng/mL has sensitivity of 92%, specificity of 98%. (Blood. 1997;89:1052-1057)

3. Oral iron is first line therapy for IDA in pregnancy. IV iron is preferred choice (after 13th week) for those who have oral iron intolerance. Cobalamin and folate deficiency should be excluded. (Blood. 2017;129:940-949)

4. Decision to transfuse should be based on the hemoglobin, clinical context, and patient preferences. May be appropriate in severe anemia (<7 mg/dL according to WHO) in whom a 2-wk delay in Hb rise with oral iron may result in significant morbidity.

BACTERIAL VAGINOSIS

Population

• –Pregnant women at high risk^a for preterm delivery.

Recommendation

USPSTF 2008

• –Insufficient evidence to recommend for or against routine screening.

Population

• –Low-risk pregnant women.

Recommendation

USPSTF 2008

• –Do not screen routinely.

Source

• –USPSTF. Bacterial Vaginosis in Pregnancy to Prevent Preterm Delivery: Screening. 2008.

BACTERIURIA, ASYMPTOMATIC

Population

• –Pregnant women.

Recommendation

USPSTF 2008, AAFP 2006

• –Screen for bacteriuria at first prenatal visit or at 12–16 wk gestation.

• –Treat pregnant women who have asymptomatic bacteriuria with antimicrobial therapy for 3–7 d.

Sources

• –USPSTF. Asymptomatic Bacteriuria in Adults: Screening. 2008.

• –Am Fam Physician. 2006;74(6):985-990.

CHLAMYDIA AND GONORRHEA

Population

• –Pregnant women.

Recommendations

CDC 2015, AAFP 2012, AAP/ACOG 2012

• –Screen all women at first prenatal visit.

• –If infection detected, obtain test of cure 3–4 wk after treatment.

• –If chlamydia detected during 1st trimester, repeat within 3–6 mo or re-test in 3rd trimester.

Sources

• –CDC. ...