Counsel on specific risks during pregnancy. Assess those with long-standing HTN for ventricular hypertrophy, retinopathy, and rena! disease. Optimize blood pressure co trol. If medications indicated, select or switch to an agent appropriate for pregnancy.
Counsel on asthma risks during pregnancy. Optimize pulmonary function preconceptionally. Treat women with pharmacologica l step therapy for chronic asthma.
Question for personal or family history of thrombotic events or recurrent poor pregnancy outcomes. If a thrombopbilia is found or known, counsel and offer appropriate anticoagulation regimen.
Counsel on specific risks during pregnancy. Optimize blood pressure control before conception. Counsel women taking ACE inhibitors and ARBs abolJt teratogenicity and the need to switch agents before pregnancy.
Inlammatory bowel disease: Counsel afected women on subfertility risks and risks of adverse pregnancy outcomes. Discuss teratogenicity of methotrexate and the other imnunomodulators. Offer effective contraception during their use and switch agents, if possible, before conception.
Hepatitis B: Vaccinate all high-risk women before conception (Table 9-7, p. 1l72).
Counsel chronic carriers on transmission prevention to partners and fetus. Treat if indicated.
Hepatitis C: Screen high-risk women. Counsel affected ,fomen on risks of disease and transmission. If treatment indicated, discuss ramifications and appropriateness of pregnancy.
Iron-deficiency anemia: Iron supplementation.
Sickle-cell disease: Screen all black women. Counsel those with trait or disease. Test partner if desired. Thalassemias: Screen women of Southeast Asian or Mediterranean ancestry.
Renal d:sease
Chap. 9, p. 170
Chap. 12, p. 244
Chap.l48,lp.l936
Chap. 61A, p. 1180
Chap. 49, p. 951
Chap. 12, pp. 241,
Chap. 50, p. 976
Chap. 51, p. 988
Chap.l52,lp.ll006
Chap. 53, p. 1025
Chap. 12, p. 241
Chap. 54, p. 1050
Chap. 12, pp. 242,
Chap. 55, p. 1064
Chap.l56,lp.ll075
TABLE 8-4. Continued
Diabetes Chap. 57, p. 1104 Optimize glycemic control to minimize teratogenicity of hyperglycemia. Evaluate for end-organ damage such as retinopathy, nephropathy, hypertension, and others. Discontinue ACE inhibitors.
Thyroid disease Chap. 58, p. 1118 Screen those with thyroid disease symptoms. Ensure diet.
Treat overt hyper-or hypothyroidism. Counsel on risks to pregnancy outcome.
Connective Chap. 59, p. 11l38 RA: Counsel on flare risk after pregnancy. Discuss methotrexate and leflunomide tissue disease Chap. 12, p. 241 teratogenicity, as well as possible effects of other immunomodulators.
Switch these agents before conception. Stop NSAIDs by 27 weeks' gestation.
SLE: Counsel on risks during pregnancy. Optimize disease before conception.
Discuss mycophenolate mofetil and cyclophosphamide teratogenicity as well as possible effects of newer immunomodulators. Switch these agents before conception.