Risk assessment is part of routine prenatal care. Family history and genetic evaluation Prenatal Genetic Testing of Parents Genetic testing is part of routine prenatal care and is ideally done before conception. The extent of genetic testing is related to how the woman and her partner weigh factors such as The probability... read more are especially important. Risk is also assessed during or shortly after labor and at any time that events may modify risk status. Risk factors Risk Factors for Complications During Pregnancy Risk factors for complications during pregnancy include Preexisting maternal disorders Physical and social characteristics (eg, age) Problems in previous pregnancies (eg, a previous history... read more are assessed systematically because each risk factor present increases overall risk.
Risk Assessment During Pregnancy
Several pregnancy monitoring and risk assessment systems are available. The most widely used system is the Pregnancy Assessment Monitoring System (PRAMS), which is a project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS provides information for state health departments to use to improve the health of mothers and infants. PRAMS also enables the CDC and states to monitor changes in health indicators (eg, unintended pregnancy, prenatal care, breastfeeding, smoking, drinking, infant health).
High-risk pregnancies require close monitoring and sometimes referral to a perinatal center, especially if women have complex high-risk conditions. These centers offer many specialty and subspecialty services, provided by maternal, fetal, and neonatal specialists (1 Risk assessment reference In a high-risk pregnancy, the mother, fetus, or neonate is at increased risk of morbidity or mortality before, during, or after delivery. Risk assessment is part of routine prenatal care. Family... read more ). When referral is needed, transfer before, rather than after, delivery results in lower neonatal morbidity and mortality rates.
The most common reasons for referral before delivery are
Preexisting or developing disorders (eg, diabetes Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more , hypertension Hypertension Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential... read more , severe [morbid] obesity Obesity Obesity is excess body weight, defined as a body mass index (BMI) of ≥ 30 kg/m2. Complications include cardiovascular disorders (particularly in people with excess abdominal fat)... read more )
Risk assessment reference
1. American College of Obstetricians and Gynecologists: Levels of maternal care: Obstetric care consensus No. 9. Obstet Gynecol 134(2):428-434, 2019. doi: 10.1097/AOG.0000000000003384