The areas of focus address aspects of all levels of disability prevention. Prenatal exposure to alcohol, tobacco and other substances can cause birth defects and permanent intellectual or developmental disabilities. Although all of these substances are harmful to a developing fetus, alcohol has the strongest influence. An acquired brain injury is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder.
These include strokes, brain illness and other brain injuries. All types of brain injury are serious and can be life altering.
Preventing Prenatal Harm
Recovery often looks identical between different types of brain injury. Although there is no complete cure, many people recover and regain much of their abilities through therapy and treatment, or they adapt to and cope with their new limitations. The good news is that almost all brain injuries are preventable. Early intervention can make a huge difference in the lives of children who are at-risk for or who have been diagnosed with a developmental disability. Some examples of drugs which should be managed carefully during the preconception period are:.
STIs can have harmful effects on pregnant women, their partners, and their fetuses. All women of reproductive age and their sex partners should be asked about STIs, counseled about the possibility of perinatal infections during pregnancy, and given access to treatment if needed preconceptionally and during pregnancy. Evaluation for BV might be conducted during the first prenatal visit for asymptomatic patients who are at high risk for preterm labor e.
All pregnant women should be routinely tested for Chlamydia trachomatis at the first prenatal visit. All pregnant women at risk for gonorrhea or living in an area in which the prevalence of Neisseria gonorrhoeae is high should be tested at the first prenatal visit for N. A repeat test should be performed during the third trimester for those at continued risk. All pregnant women should be routinely tested for hepatitis B surface antigen HBsAg during an early prenatal visit e. All laboratories that conduct HBsAg tests should use an HBsAg test that is FDA-cleared and should perform testing according to the manufacturer's labeling, including testing of initially reactive specimens with a licensed neutralizing confirmatory test.
All pregnant women at high risk for hepatitis C infection should be tested for hepatitis C antibodies at the first prenatal visit. Women at high risk include those with a history of injection drug use and those with a history of blood transfusion or organ transplantation before All pregnant women in the United States should be tested for HIV infection as early in pregnancy as possible. Cervical cytology testing should be obtained at the first prenatal visit if none has been documented during the preceding year.
Food and Drug Administration has approved a quadrivalent human papillomavirus HPV vaccine for females aged 9—26 years. ACOG recommends the vaccination of females in this age group. Thus, vaccination use during pregnancy is not recommended at this time. Women who will be pregnant during the influenza season October through mid May should be vaccinated with the influenza vaccine. The ideal time to administer the vaccine is October and November; however, it is appropriate to vaccinate patients throughout the influenza season as long as the vaccine supply lasts.
This intramuscular, inactivated vaccine may be used in all three trimesters. Any theoretical risk of the vaccination is outweighed by its benefits.
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Likewise, the benefits of the vaccine outweigh any unproven potential concerns about traces of thimerosal preservative, which exist only in the multidose vials. It should be noted that the intranasal vaccine spray contains a live, attenuated virus and should not be used during pregnancy. The rubella vaccine is a live attenuated virus and is highly effective with few side effects in rubella susceptible women of reproductive age.
Rubella vaccination is not recommended during pregnancy and women should be advised to avoid conception for one month following immunization. Additionally, this vaccine should be administered to all susceptible women preconceptionally. Preconceptional immunization of women to prevent disease in the offspring, when practical, is preferred to vaccination of pregnant women with certain vaccines.
The risks involved for pregnant women who contract varicella include an increased chance of developing severe pneumonia. Live virus vaccine during pregnancy is contraindicated for varicella vaccination, but no adverse outcomes have been reported when given during pregnancy. However, specific immune globulin immunization should be considered for healthy pregnant women exposed to varicella to protect against maternal, not congenital infection. One dose intramuscularly within 96 hours of varicella exposure should be given to the mother.
For women not actively seeking to become pregnant, discuss current contraceptive methods and any concerns or problems with that method. Established in , the mission of the Initiative is to help prevent pregnancy-related deaths through improved understanding of the causes and risk factors for maternal mortality.
Navigation menu. Behavioral Return to the table of contents Alcohol Misuse Women who are heavy drinkers five or more drinks on one occasion on five or more days in the past 30 days have a higher risk of cardiac and hepatic complications. Psychosocial Concerns Psychosocial issues are nonbiomedical factors that affect mental and physical well being.
Smoking Health risks associated with smoking during pregnancy include intrauterine growth restriction, placenta previa, and abruption placetae. Chronic Diseases Return to the table of contents Asthma Asthma during pregnancy requires special attention and comprehensive treatment. Genetics Return to the table of contents Cystic Fibrosis CF Preconception carrier screening for CF allows carrier couples to consider all reproductive options.
The following are recommendations for CF screening: Information about CF screening should be accessible to all couples.
CF carrier screening should be offered before conception or early in pregnancy when both partners are Caucasian, European, or of Ashkenazi Jewish ethnicity. In individuals with a family history of CF, medical records of the affected family members should be obtained. Reproductive partners with CF or congenital bilateral absence of vas deferens may benefit from an expanded panel of mutations, or a complete analysis of the CFTR gene by sequencing.
When both partners are CF carriers, genetic counseling is recommended to review reproductive options. CF carrier screening may identify individuals with two CF mutations who have not been previously diagnosed with CF. Level A : 19 Individuals of African, Southeast Asian, and Mediterranean descent are at increased risk for being carriers of hemoglobinopathies and should be offered carrier screening, and if both parents are determined to be carriers, genetic counseling is recommended.
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A complete blood count and hemoglobin electrophoresis are the appropriate laboratory tests for screening for hemoglobinopathies. Solubility tests alone are inadequate for screening because they fail to identify important transmissible hemoglobin gene abnormalities affecting fetal outcome.
Girls, Women, Alcohol, and Pregnancy
Couples at risk for having a child with sickle cell disease or thalassemia should be offered genetic counseling to review prenatal testing and reproduction options. Prenatal diagnosis of hemoglobinopathies is best accomplished by DNA analysis of cultured amniocytes or chorionic villi. Genetic Disorders-European Jewish Descent Seven Recommendations from ACOG Committee on Genetics: 20 The family history of individuals considering pregnancy, or who are already pregnant, should determine whether either member of the couple is of Eastern European Ashkenazi Jewish ancestry or has a relative with one or more of the genetic conditions.
Carrier screening for TSD, Canavan disease, cystic fibrosis, and familial dysautonomia should be offered to Ashkenazi Jewish individuals before conception or during early pregnancy so diagnostic testing options may be considered. When only one partner is of Ashkenazi Jewish descent, that individual should be screened first.
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If it is determined that this individual is a carrier, the other partner should be offered screening. Individuals with positive family history of one of the disorders should be offered carrier screening for the specific disorder and may benefit from genetic counseling. When both partners are carriers of one of the disorders, they should be referred for genetic counseling and offered prenatal diagnosis. Carrier couples should be informed of the disease manifestations, range of severity, and availabile treatment options.
When an individual is found to be a carrier, his or her relatives are at risk for carrying the same mutation. However, if you have other risk factors such as advanced maternal age, excess weight, family history of hypertension , you should be watchful and alert to early warning signs. More research is needed to know more certainly how high your risk is. If you had preeclampsia during your first pregnancy, you may get it again. While repeat occurrence is often less severe, no one can predict for sure. If you've had preeclampsia in a previous pregnancy, you and your healthcare provider should carefully monitor you and your baby during your current pregnancy for any signs or symptoms.
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