| Intervention | Comments |
| Optimize management of any maternal medical disorders | - Includes management of the patient's prepregnancy health conditions (eg, diabetes mellitus, hypertension, thyroid disease) and pregnancy-related conditions
|
| Low-dose aspirin for patients at high risk of developing preeclampsia | - High-risk factors include:
- Previous pregnancy with preeclampsia, especially early onset and with an adverse outcome
- Type 1 or 2 diabetes mellitus
- Chronic hypertension
- Multifetal gestation
- Kidney disease
- Autoimmune disease with potential vascular complications (antiphospholipid syndrome, systemic lupus erythematosus)
|
| Provide counselling and intervention to reduce tobacco and substance use | - Identify individuals who smoke tobacco products
- Ask about maternal substance use (eg, alcohol, misuse of prescription or nonprescription drugs)
- Provide information on the maternal and fetal risks associated with smoking and substance use
- Help with smoking cessation
- Treat opioid use disorder
|
| Identify individuals with body mass index above or below the normal range | - Encourage prepregnancy weight loss or gain, as appropriate
|
| Provide counselling about the optimal interpregnancy interval | - Optimal interval is 18 months
- Avoid interval <6 months (or >60 months)
- Avoid unplanned pregnancies
|
| Reduce the iatrogenic occurrence of multifetal gestations | - IVF: Single embryo transfer, when appropriate.
- Ovulation induction without IVF: Use either clomiphene citrate or aromatase inhibitors, as appropriate, rather than gonadotropins. In patients with an excessive number of mature follicles, convert to IVF or cancel cycle.
- Offer multifetal pregnancy reduction, especially for high order multiple gestations (triplets or more).
|
| Reduce the impact of cervical/uterine surgery on future pregnancies | - Avoid surgical evacuation of uterine contents (if safely possible) and use cervical ripening agents when mechanical dilation needed
- Consider myomectomy in selected patients
- Patients undergoing treatment of cervical intraepithelial neoplasia should undergo the procedure that best diagnoses or prevents cervical cancer and also incurs the lowest risk of reproductive effects
|
| Identify and treat short cervix or cervical insufficiency | - Monitor cervical length between 16 and 24 weeks of gestation with ultrasound. A short cervix is defined as ≤25 mm.
- Treatments for short cervix and cervical insufficiency include vaginal progesterone and cerclage.
|
| Address maternal infection risk | - Screen for and treat asymptomatic bacteriuria
- In areas where malaria is endemic, address mosquito avoidance and provide prophylactic drug therapy
|
| Treat acute preterm labor with tocolytics | - Nifedipine or indomethacin is preferred, depending on the gestational age
|
| Surgically correct congenital uterine abnormalities, when appropriate | - Examples: Uterine septum, bicornuate uterus, or communicating hemiuterus
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