Prenatal visits should be structured to reflect the dynamic nature of risk assessment during pregnancy. Prenatal cell-free DNA screening, also known as noninvasive prenatal screening, is a method to screen for certain specific chromosomal abnormalities. Patients must be at least 10 weeks gestation and have adequate counseling regarding the options, benefits, and limits of first-and second-trimester screening. Measurement of crown–rump length of fetus between 7 and 12 weeks gestation for dating information. Stress has been suggested as a potential contributor to preterm birth and physical complications of pregnancy such as prolonged labor. Advise pregnant individuals to continue exercising as this is generally safe. Pregnancy requires only modest increases in calories (350–450 a day on average). This chapter discusses ongoing prenatal care. It also discusses interim history, physical examination, diagnostic examinations, ultrasound examination (second and third trimester), pregnancy management, modifiable risk factors, pregnancy discomforts, second-trimester education, and third-trimester education.

Pregnancy is characterized by insulin resistance and hyperinsulinemia and thus may predispose some individuals to diabetes. These metabolic changes stem from the placental hormones that ensure that the fetus has an abundant and continuous supply of nutrients: growth hormone, cortisol, placental lactogen, prolactin and progesterone. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The condition is associated with increased maternal, fetal, and neonatal risks. GDM is associated with increased risks for the fetus and the newborn, including macrosomia, shoulder dystocia, birth injuries, hyperbilirubinemia, hypoglycemia, respiratory distress syndrome, hypocalcemia, polycythemia, and childhood obesity. Maternal risks include preeclampsia, polyhydramnios, gestational hypertension, cesarean delivery, and diabetes occurring later in life. This chapter discusses screening, risk factors, differential diagnosis, management, and patient education of gestational diabetes mellitus during pregnancy.

The purpose of preconception care is to deliver risk screening, health promotion, and effective interventions as a part of routine health care. Preconception health care is essential, because the lifestyle behaviors and exposures that occur before prenatal care is initiated may affect fetal development and subsequent maternal and perinatal outcomes. This chapter discusses 10 recommendations for improving preconception and inter-conception care as part of a strategic plan to improve the health of individuals, their children, and their families. Nurse Practitioners (NPs) provide healthcare for patients before, during and in between pregnancies in a variety of settings. The care NPs provide seats them at the forefront to assess for and address known risk factors for maternal complications prior to pregnancy and tailor a care plan for each patient’s individual needs to mitigate risks and foster the best patient outcomes.

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG; 2007) describe prenatal care as “A comprehensive antepartum care program involving a coordinated approach to medical care and psychosocial support that optimally begins before conception and extends throughout the antepartum period ”. Comprehensive prenatal care is composed of the following elements: (a) preconceptional care, (b) prompt diagnosis of pregnancy, (c) initial prenatal evaluation, and (d) follow-up prenatal visits. Ongoing maternal–fetal assessment, education and support for the pregnant individual, preparation for parenting, and promotion of a positive physical and emotional family experience are all part of quality prenatal care. This chapter discusses the screening tools, physical examination, diagnostic and laboratory examination for the first prenatal visit, common discomforts in the first trimester, and first-trimester education/anticipatory guidance.

Asymptomatic bacteriuria (AB) is a microbiologic diagnosis that indicates the presence of a positive urine culture in an asymptomatic person. In the literature, bacteriuria may be defined as a single organism identified in the urine in any amount, but more specifically at a colony count of equal to or greater than 105 (100,000) colony forming units per milliliter. Urinary tract infection is defined as either a lower tract (acute cystitis) or upper tract infection. Cystitis is bacteriuria in the presence of urinary symptoms. Screening should be performed at the first prenatal visit or at 12 to 16 weeks gestation. Generally, penicillins and cephalosporins are safe in pregnancy. However, drugs with very high protein binding, such as ceftriaxone, may be inappropriate the day before parturition because of the possibility of bilirubin displacement and subsequent kernicterus. Suppressive therapy may be appropriate with bacteriuria that persists after two or more courses of therapy.

This chapter discusses disaster planning for pregnant and postpartum individuals and their infants, and provides guidelines for care whether evacuating or sheltering in place. Because injuries are common during disasters, it provides guidelines for assessment and management of minor trauma. More attention has been given to the need for disaster preparedness as a result of terrorist attacks and natural calamities, such as devastating hurricanes, tornadoes, wild-fires, tsunamis, and earthquakes, in various parts of the world. Despite these incidents, the public is still not adequately prepared to respond to a major disaster. Obstetric and Neonatal Nursing (AWHONN) position statement encourages nurses to participate in all phases of disaster planning. Obstetric, neonatal, and women’s health care providers can serve a vital role in addressing the many health needs of pregnant individuals, new mothers, and infants and reduce risk and morbidities.

Anemia is a common medical disorder of pregnancy. Two of the most common causes of anemia during pregnancy are iron deficiency and physiologic anemia caused by blood volume expansion greater than the red blood cell mass. However, other inherited and acquired causes of anemia should not be overlooked. Iron requirements increase significantly during pregnancy and, unfortunately, many individuals start pregnancy without sufficient stores to meet the increased demands. Health care providers need to educate individuals about the importance of taking an iron supplement during pregnancy and dietary sources of iron. This chapter addresses assessment of anemia during pregnancy, management, and patient education. Anemia may be characterized several ways such as by the causative mechanism, whether inherited or acquired, by a reduction in the number of red blood cells (RBCs) or the RBC size (mean corpuscular volume–MCV), which results in decreased ability to carry oxygen to tissues.

Thyroid disorders are second to diabetes mellitus as the most common endocrine disorders occurring in reproductive age women. Common pregnancy symptoms often mirror symptoms of thyroid dysfunction creating challenges for identification. During pregnancy poorly managed thyroid disorders are associated with adverse outcomes. This chapter discusses untreated thyroid disease during pregnancy that has been associated with increased risk of miscarriage, hypertensive disorders, fetal growth restriction and placental abruption. Thus, diagnosis and treatment are essential components of prenatal care to safeguard maternal and fetal well-being. The impact of pregnancy on maternal thyroid physiology is significant to meet the increased metabolic demands during a normal pregnancy. The major changes in thyroid function during pregnancy include a slight enlargement of thyroid gland due to hyperplasia and increased vascularity, but not enough for true goiter or significant thyromegaly. The chapter reviews physiologic changes with normal and abnormal thyroid function during pregnancy.

Pregnant individuals and the nurse practitioners who care for them are often concerned about the effects of medication on the developing embryo and fetus. Medication use has increased during the past 30 years. Birth defects are common; for example, the Centers for Disease Control and Prevention estimates that 3% of births in the United States result in major birth defects. Birth defects are the leading cause of infant mortality in developed countries. The most significant adverse effects of medications may occur early in pregnancy, before many individuals even realize that they are pregnant. The risks that medical conditions can pose to both the mother and fetus must be balanced against the risks that many medications pose to a fetus. Cardiovascular, poorly controlled diabetes, renal, and thyroid disease all have potentially adverse effects on fetus. This chapter discusses common medication to avoid during pregnancy and safe medications to take during pregnancy.

Acute upper respiratory infections (URIs) and asthma commonly affect pregnant women. URIs are the most common acute illnesses in adults. Nasopharyngitis, or common cold, is typically mild and self-limiting. Person-to-person spread of viruses accounts for the majority of URIs. Either airborne droplets are inhaled or direct contact of secretions occurs by touching an infected person or contaminated surface. Viruses are introduced by touching one’s eyes or nose. The incubation period is approximately 1 to 5 days. Hormonal changes during pregnancy produce hyperemia of the nasal and sinus mucosa and an increase in nasal secretions. These changes may increase the risk of URIs and the intensity of symptoms. This chapter reviews assessment and management of common cold, influenza, and asthma during pregnancy. It addresses strategies for prevention of illness and patient education.