Pregnancy complicated by sickle cell disease is high-risk for both mother and fetus. Surveillance helps manage problems such as vaso-occlusive crises and alloimmunization. Maternal problems can arise from chronic underlying organ dysfunction such as renal disease or pulmonary hypertension, from acute complications of sickle cell disease such as vaso-occlusive crises and acute chest syndrome, and/or from pregnancy-related complications. Fetal problems include alloimmunization, opioid exposure, growth restriction, preterm delivery, and stillbirth. Couples should be counseled that a pregnancy with sickle cell disease is high risk for both fetus and mother and be made aware of the increased risks of adverse pregnancy outcome. Risks of adverse fetal outcomes are reduced but not eliminated with fetal surveillance. This review provides recommendations, screening and clinical management during prenatal and puerperium of patients with sickle cell disease. Genetic screening can identify couples at risk for offspring with sickle cell disease and other hemoglobinopathies and allow them to make informed decisions regarding reproduction and prenatal diagnosis.Read More

Identification of inherited thrombophilias has increased our understanding of one potential etiology for venous thromboembolism and of hypercoagulability in general. Over the past 10 years, some studies have suggested that inherited thrombophilia may be associated with preeclampsia and other adverse outcomes in pregnancy. There is limited evidence to guide screening for and management of these conditions in pregnancy. This document reviews common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy. The literature on fetal thrombophilia and its role in explaining some cases of perinatal stroke that lead, ultimately, to cerebral palsy are also discussed.Read More

This review focuses on the interrelationships between common psychiatric illnesses and the course of pregnancy, postpartum, and breastfeeding. Within the life cycle context, the impact of childbearing on existing disorders or vulnerabilities in the female patient is of primary interest, as well as episodes that are etiologically related to childbearing. Treatment considerations for psychiatric disorders during childbearing invoke special modifications of the risk-benefit decision-making process. Mental health is fundamental to health. For the pregnant woman, the capacity to function optimally, enjoy relationships, manage the pregnancy, and prepare for the infant’s birth is critical. Perinatal health can be conceptualized within a model that integrates the complex social, psychological, behavioral, environmental, and biologic forces that shape pregnancy. Unipolar and bipolar mood disorders, which are common in pregnant and postpartum women, deserve the attention of obstetric providers. Procedures to identify those at risk should begin in pregnancy if not in the preconceptional period.Read More

Even though pregnancy is a period of emotional well-being, in some women, when pregnant, experience their first depressive episode, whereas others, with a history of depression, are at risk for its recurrence, suggesting that pregnant women show the same risk for depression as other women of child-bearing age. The purpose of this document is to address the maternal and neonatal risks of both depression and antidepressant medication exposure. It focuses on periconceptional and antenatal management. For the pregnant woman, the capacity to function optimally, enjoy relationships, manage pregnancy, and prepare for the infant’s birth is critical. Perinatal health can be conceptualized within a model that integrates the complex social, psychological, behavioral, environmental and biologic forces that shape pregnancy. Antenatal depression affects the health and well-being of the mother, baby, and family. Early identification and management of depressive symptoms in pregnant women may improve their sense of well-being.Read More

The review evidence-based research and approaches for diagnosis and management of thyroid storm during pregnancy. Especially relevant is the intimate relationship between maternal and fetal thyroid function, particularly during the first half of pregnancy. Significant fetal brain development continues considerably beyond the first trimester, making thyroid hormone also important later in gestation. Importantly, although overt maternal thyroid failure during the first half of pregnancy has been associated with several pregnancy complications and intellectual impairment in offspring, it is currently less clear whether milder forms of thyroid dysfunction have similar effects on pregnancy and infant outcomesRead More

Parathyroid diseases are uncommon in pregnancy, may produce significant perinatal and maternal morbidity and mortality if not diagnosed and properly managed. It reviews calcium homeostasis, primary hyperparathyroidism, hypoparathyroidism, and osteoporosis during pregnancy. PTH promotes resorption of calcium from the bones. Thus, all events of PTH action are directed at increasing serum calcium levels. The successful treatment of maternal PHP may transiently improve some of the clinical findings of preeclampsia and preterm labor.Read More

Obesity is now epidemic in many developed countries secondary to decreased physical activity combined with an abundance of cheap, high-caloric foods. Maternal obesity increases the risk of multiple adverse pregnancy outcomes including congenital anomalies, miscarriage, preeclampsia, gestational diabetes (GDM), fetal macrosomia, and stillbirth. Obesity also is associated with multiple labor abnormalities, including an increased risk of induction of labor, post-dates pregnancy, prolonged labor, labor augmentation with oxytocin, excessive blood loss at delivery, and cesarean delivery. Obese women who are delivered by cesarean are at greater risk of complications such as longer operative times, excessive blood loss, wound infections, and post-operative endometritis. Not only are large numbers of women overweight or obese prior to pregnancy, but many women gain an excessive amount of weight during pregnancy, thus compounding their obstetrical risks and making them more likely to retain weight postpartum.Read More

The prevalence of gestational diabetes mellitus (GDM) continues to rise in the face of the obesity epidemic affecting up to 14% of the population. It is the most common clinical issues facing obstetricians and gynecologists and their patients. This document is to provide a comprehensive review of understanding of gestational diabetes mellitus (GDM) and provide management guidelines. Because the risk factors for GDM (particularly obesity) are independent risk factors for fetal macrosomia, the role of maternal hyperglycemia has been widely debated. Considerable controversy remains regarding the exact relationship of these complications to maternal hyperglycemia. Women with GDM are more likely to develop maternal and fetal complications. Whether the relationship with GDM is casual or not, clinicians should be aware of these risks. In addition, women with GDM have an increased risk of developing diabetes later in life.Read More

Diagnosis of gestational diabetes is typically made on the basis of an oral glucose tolerance test. A lack of consensus exists regarding the optimal testing protocol and threshold to identify women and infants with increased risk of complications. The majority of women with pregnancy complicated by diabetes have gestational diabetes (GDM). The American Diabetes Association defines GDM as any degree of glucose intolerance with onset or first recognition during pregnancy. Long-term risks of gestational diabetes include increased risk of recurrent GDM in subsequent pregnancies, risk of diabetes in the mother, and increased risk of childhood obesity, glucose intolerance and diabetes in the offspring.Read More

A cornerstone of blood glucose management of GDM is Medical Nutrition Therapy (MNT). The goal of MNT is to help the woman achieve normoglycemia without ketosis and optimal nutritional intake for maternal health and fetal growth. An estimated 50-75% of pregnancies complicated by GDM can be successfully managed with MNT alone. It is important to initiate such intervention as soon as possible after diagnosis. Referral to a Registered Dietitian (RD) should be made within 48 hours of diagnosis so that intervention can be initiated within one week after diagnosis.Read More