Management of Pregnancy

Publication Date: August 1, 2023
Last Updated: August 15, 2023

Routine Care

Aneuploidy Screening

We recommend offering non-invasive prenatal testing as the prenatal screening test of choice for all patients with singleton pregnancies who choose aneuploidy screening. (Strong for)
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We suggest non-invasive prenatal testing for patients with twin pregnancies who choose aneuploidy screening. (Weak for)
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Lactation

We suggest assessing all patients for risk factors that impact initiation and continuation of lactation, includingobesity, depression, inappropriate gestational weight gain, and gestational diabetes mellitus. (Weak for)
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We suggest individual or group lactation education delivered via in-person, telemedicine, or multimedia modalities be provided for all pregnant and postpartum patients to improve the probability of initiating and continuing lactation. (Weak for)
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Pelvic Floor Health

We suggest all patients have an early prenatal evaluation of pelvic floor muscle function and receive pelvic floor muscle exercise instruction during pregnancy for the prevention of urinary incontinence in late pregnancy and up to 6 months postpartum. (Weak for)
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We suggest referral to pelvic health rehabilitation for patients with reported urinary incontinence in the postpartum period. (Weak for)
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Selected Conditions

We recommend offering scheduled delivery to patients who reach 41 weeks and 0/7 days undelivered. Antepartum fetal testing should begin at 41 weeks and 0/7 days if not delivered. (Strong for)
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We suggest that patients with uncomplicated pregnancies may continue a standard work schedule throughout their pregnancy. (Weak for)
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We suggest offering telemedicine as a complement to usual perinatal care. (Weak for)
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There is insufficient evidence to recommend for or against specific interventions that would diminish disparities in perinatal care access and maternal and childbirth outcomes. (Neither for or against)
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Complicated Obstetrics

Preterm Delivery

We recommend considering fetal fibronectin testing as a part of the evaluation strategy in patients between 24 0/7 and 34 6/7 weeks’ gestation with signs and symptoms of preterm labor, particularly in facilities where the result might affect management of delivery. (Strong for)
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We suggest vaginal progesterone or cerclage for singleton pregnancy with short cervix, history of spontaneous preterm birth, or both depending on patient characteristics and preferences. (Weak for)
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There is insufficient evidence to recommend for or against the use of aspirin to reduce recurrent spontaneous preterm birth. (Neither for or against)
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Hypertensive Disorders

We recommend initiating aspirin therapy at or before 16 weeks’ gestation in patients at risk of developing preeclampsia. (Strong for)
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We suggest low-dose aspirin of 100–150 mg daily for patients at risk of preeclampsia. (Weak for)
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We suggest patients with cardiometabolic disorders (e.g., gestational diabetes mellitus, hypertension, and obesity) be counseled on the benefits of following the Dietary Approaches to Stop Hypertension diet. (Weak for)
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There is insufficient evidence to recommend for or against self-monitoring for blood pressure during pregnancy and the postpartum period. (Neither for or against)
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Bariatric Surgery

We suggest patients who have undergone bariatric surgery be evaluated for nutritional deficiencies and the need for nutritional supplementation where indicated (e.g., vitamin B12, folate, iron, calcium). (Weak for)
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There is insufficient evidence to recommend for or against the routine supplementation of vitamins A, D, E, or K for pregnant patients who have undergone bariatric surgery. (Neither for or against)
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Mental Health

Screening

We recommend screening for use of tobacco and nicotine products, alcohol, cannabis, illicit drugs, and inappropriate use of prescription medication. See VA/DoD Substance Use Disorders CPG. (Strong for)
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We recommend screening for depression periodically using a standardized tool, such as the Edinburgh Postnatal Depression Scale or the 9-item Patient Health Questionnaire, during pregnancy and postpartum. (Strong for)
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We suggest screening patients with posttraumatic stress disorder (PTSD) for active PTSD and offering PTSD treatment. See VA/DoD PTSD CPG. (Weak for)
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Treatment

We recommend offering individual or group Interpersonal Psychotherapy or cognitive behavioral therapy for pregnant patients at risk of perinatal depression. (Strong for)
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We recommend offering Interpersonal Psychotherapy for treating depression during pregnancy or postpartum. (Strong for)
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We suggest offering cognitive behavioral therapy for treating depression during pregnancy or postpartum. (Weak for)
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We suggest offering peer support for people with perinatal depression or risk of perinatal depression to improve depressive symptoms. (Weak for)
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We suggest exercise, mindfulness, yoga, or any combination of these interventions for depressive symptoms in perinatal patients. (Weak for)
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We suggest offering psychotherapies (e.g., cognitive behavioral therapy, Interpersonal Psychotherapy) or yoga or both for anxiety symptoms during and after pregnancy. (Weak for)
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Recommendation Grading

Overview

Title

Management of Pregnancy

Authoring Organization

Veterans Health Administration / Department of Defense

Publication Month/Year

August 1, 2023

Last Updated Month/Year

January 22, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Childcare center, Hospital, Medical transportation

Intended Users

Dietician nutritionist, nurse, nurse midwife, nurse practitioner, physician, physician assistant, social worker

Scope

Diagnosis, Assessment and screening, Treatment, Management, Prevention

Diseases/Conditions (MeSH)

D011247 - Pregnancy

Keywords

pregnancy, Obstetric, Pregnancy care

Methodology

Number of Source Documents
356
Literature Search Start Date
May 18, 2017
Literature Search End Date
May 1, 2022