Interpregnancy care aims to maximize a woman’s level of wellness not just between pregnancies and during subsequent pregnancies, but also along her life course, says the American College of Obstetricians and Gynecologists in its “Obstetric Care Consensus” document, published online Dec. 20, 2018. (See https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Interpregnancy-Care).
All women of reproductive age who have been pregnant – regardless of the outcome of their pregnancies – should receive interpregnancy care as a continuum from postpartum care, says ACOG. For women with chronic medical conditions, interpregnancy care provides an opportunity to optimize health before a subsequent pregnancy. For women who will not have any future pregnancies, the period after pregnancy also affords an opportunity for secondary prevention and improvement of future health.
The consensus statement was endorsed by the American College of Nurse-Midwives and the National Association of Nurse Practitioners in Women’s Health, and was developed by the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine.
The statement contains a table on specific health conditions, including – but not limited to – the following:
Condition Counseling Test/screening Management
| Gestational diabetes | Women with gestational diabetes have a sevenfold increased risk of developing type 2 diabetes. | 2-hour oral glucose tolerance test (OGTT) at 4-12 weeks postpartum. Screening every 1-3 years. | Women with impaired fasting glucose, impaired glucose tolerance or diabetes should be referred for preventive or medical therapy. |
| Diabetes | Poorly controlled diabetes damages eyes, heart, blood vessels and kidney. Poor control further increases risk of birth defects in the next pregnancy. Diabetes is a risk factor for future heart disease. | Patients should demonstrate good control of blood sugars with hemoglobin A1c <7.0%. | Weight management.
Testing for underlying vasculopathy; retinal examination; 24-hour urine protein testing; and electrocardiography. Thyroid screening. |
| Preeclampsia | Women with a history of preeclampsia have an increased risk of recurrence in subsequent pregnancies, as well as a twofold increased risk of subsequent cardiovascular disease. | Evaluate blood pressure for resolution of hypertension. | |
| Gestational hypertension | Women with a history of gestational hypertension have an increased risk of developing chronic hypertension, as well as a twofold increased risk of subsequent cardiovascular disease. | Evaluate blood pressure for resolution of hypertension. | |
| Chronic hypertension | Hypertensive disease is a major cause of maternal morbidity and mortality. Uncontrolled hypertension leads to end organ damage, renal disease and cardiovascular disease, such as heart attacks and strokes. | Evaluate blood pressure for resolution of hypertension. | |
| Cardiovascular disease | Cardiovascular disease is the leading cause of maternal mortality. | Optimal contraception counseling.
Evaluation and management by a cardiac disease specialist. |
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| Overweight and obesity | Obesity is associated with increased risk of perinatal and maternal morbidity as well as infertility. Weight loss in between pregnancy reduces that risk.
Obesity increases the risk of type 2 diabetes, hypertension, certain types of cancer, arthritis and heart disease. |
Measure BMI.
Preventive screening for diabetes and lipids. |
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| Renal disease | Pregnancy may be associated with irreversible worsening of renal function in women with moderate to severe renal disease. | Serum creatinine.
Urine protein. |
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| Thyroid disease | Poorly controlled thyroid disease is associated with adverse pregnancy outcomes, such as spontaneous abortion, preterm delivery, low birth weight, preterm birth, impaired neuropsychological development of the offspring, and possibly miscarriage. | Thyrotropin (also known as thyroid-stimulating hormone).
Free T4 |
Management by primary provider to remain ehthyroid.
Women with symptoms of hypothyroidism should undergo thyroid screening before attempting pregnancy. |
| Immunizations | Immunization against vaccine-preventable diseases is crucial for long-term maternal and infant health. | All women should be screened for relevant vaccination opportunities per CDC guidelines. |
Other conditions covered in the document: Depression or mental health disorders, HIV, epilepsy, systemic lupus erythematosus (SLE) and autoimmune disease, sexually transmitted infections, tobacco cessation, thrombophilia, psychosocial risks, and antiphospholipid antibody syndrome. (See https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Interpregnancy-Care).
Source: Interpregnancy care. Obstetric Care Consensus No. 8. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e51-72.