Dr. Barton is Director of Maternal-Fetal Medicine at Baptist Health Lexington in Lexington, Kentucky.
Dr. Sibai is Professor of Maternal-Fetal Medicine (MFM) and Director of the MFM Fellowship Program, Department of Obstetrics, Gynecology, and Reproductive Sciences, at the University of Texas Medical School at Houston, Texas.
Dr. Barton reports that he receives grant or research support from Alere, and that he is on the clinical advisory board of NX PharmaGen Inc.
Dr. Sibai reports no financial relationships relevant to this article.
For an overview of evaluation and management of pregnant women aged 40 or older, seeTABLE 4.
TAble 4: Evaluation and management of the pregnant woman older than age 40
Preconception
Identify risk factors (ie, diabetes, obesity, hypertension, cardiac dysfunction, family history
Review outcome of previous pregnancy, if applicable
Review risks (multiple gestation, birth defects) associated with assisted reproductive technologies if they were needed to achieve pregnancy
Optimize maternal health
Begin folic acid supplementation
Encourage smoking cessation
If the patient is ≥45 years old: – Electrocardiogram – Glucose screening (fasting plasma glucose or hemoglobin A1c) – Echocardiogram for patients with chronic hypertension
First trimester
Ultrasonography for dating and to assess fetal number and chorionicity
Baseline metabolic profile and complete blood count
Baseline urinalysis
Continue folic acid supplementation
Offer first-trimester genetic testing or other genetic screening
Second trimester
If first-trimester genetic testing is declined, offer second-trimester testing or screening
Detailed fetal anomaly evaluation by ultrasound
Fetal echocardiogram if pregnancy was achieved by in vitro fertilization or if it is a monochorionic twin gestation
Screen for gestational diabetes
Third trimester
Increased antenatal testing for routine indications, including hypertension, diabetes, and lupus
Ultrasonography for growth and later ultrasonographic findings of fetal aneuploidy
Consider delivery
Share your thoughts on this article! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.
