Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Initial prenatal assessment and first-trimester prenatal care

Charles J Lockwood, MD, MHCM
Urania Magriples, MD
Section Editor
Susan M Ramin, MD
Deputy Editor
Kristen Eckler, MD, FACOG


The major goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother. There are several components involved in achieving this objective:

Early, accurate estimation of gestational age

Identification of the patient at risk for complications

Ongoing evaluation of the health status of both mother and fetus

Anticipation of problems and intervention, if possible, to prevent or minimize morbidity


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 13, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National vital statistics reports; vol 59 no 1. Hyattsville, MD: National Center for Health Statistics. 2010.
  2. Fiscella K. Does prenatal care improve birth outcomes? A critical review. Obstet Gynecol 1995; 85:468.
  3. Klerman LV, Ramey SL, Goldenberg RL, et al. A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. Am J Public Health 2001; 91:105.
  4. Villar J, Farnot U, Barros F, et al. A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Perinatal and Reproductive Research. N Engl J Med 1992; 327:1266.
  5. Villar J, Ba'aqeel H, Piaggio G, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001; 357:1551.
  6. American College of Obstetricians and Gynecologists. www.acog.org (Accessed on May 01, 2012).
  7. The Management of Uncomplicated Pregnancy Working Group. DoD/VA Clincial Practice Guideline for the Management of Uncomplicated Pregnancy. Washington, DC: Department of Defense and Veterans Administration, 2002.
  8. Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care www.aafp.org.
  9. National Institute for Health and Clinical Excellence (see Antenatal Care: Routine Care for the Healthy Pregnant Woman). www.nice.org.uk. (Accessed on April 19, 2012).
  10. Society of Obstetricians and Gynaecologists of Canada. Clinical Practice Guidelines. Obstetrics. www.sogc.org (Accessed on May 01, 2012).
  11. WHO Reproductive Health Library. Pregnancy and Childbirth. http://apps.who.int/rhl/pregnancy_childbirth/en/ (Accessed on May 01, 2012).
  12. Sakala C, Corry MP. Evidence-based maternity care: what is it and what can it achieve. October 2008. www.milbank.org (Accessed on February 11, 2009).
  13. Khan-Neelofur D, Gülmezoglu M, Villar J. Who should provide routine antenatal care for low-risk women, and how often? A systematic review of randomised controlled trials. WHO Antenatal Care Trial Research Group. Paediatr Perinat Epidemiol 1998; 12 Suppl 2:7.
  14. Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2013; :CD004667.
  15. Whitworth M, Quenby S, Cockerill RO, Dowswell T. Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes. Cochrane Database Syst Rev 2011; :CD006760.
  16. Wilson A, Gallos ID, Plana N, et al. Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis. BMJ 2011; 343:d7102.
  17. American College of Obstetricians and Gynecologists. ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women's health care. Obstet Gynecol 2005; 106:665.
  18. ACOG Committee Opinion No. 518: Intimate partner violence. Obstet Gynecol 2012; 119:412.
  19. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 554: reproductive and sexual coercion. Obstet Gynecol 2013; 121:411.
  20. American College of Obstetricians and Gynecologists. Committee on Health Care for Underserved Women. Committee opinion no. 498: Adult manifestations of childhood sexual abuse. Obstet Gynecol 2011; 118:392.
  21. Shah PS, Shah J, Knowledge Synthesis Group on Determinants of Preterm/LBW Births. Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta-analyses. J Womens Health (Larchmt) 2010; 19:2017.
  22. Kiely M, El-Mohandes AA, El-Khorazaty MN, et al. An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial. Obstet Gynecol 2010; 115:273.
  23. White A. Responding to prenatal disclosure of past sexual abuse. Obstet Gynecol 2014; 123:1344.
  24. American College of Obstetricians and Gynecologists Committee on Health Care for Undeserved Women. ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol 2006; 108:469.
  25. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 7th ed, AAP, ACOG, Elk Grove Village, IL, Washington DC 2012.
  26. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol 2008; 112:201.
  27. Perinatal infections. In: Guidelines for perinatal care, 7, American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. (Ed), 2012.
  28. Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1.
  29. American College of Obstetrics and Gynecology Committee on Obstetric Practice. ACOG Committee Opinion No. 418: Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2008; 112:739.
  30. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  31. SOGC Clinical Practice Guideline. HIV screening in pregnancy. http://www.jogc.com/abstracts/full/200612_SOGCClinicalPracticeGuidelines_1.pdf (Accessed on April 23, 2012).
  32. Royal College of Obstetricains and Gynaecologists. HIV in pregnancy, Management (Green-top 39) http://www.rcog.org.uk/womens-health/clinical-guidance/management-hiv-pregnancy-green-top-39 (Accessed on April 23, 2012).
  33. Walmsley S. Opt in or opt out: what is optimal for prenatal screening for HIV infection? CMAJ 2003; 168:707.
  34. Breese P, Burman W, Shlay J, Guinn D. The effectiveness of a verbal opt-out system for human immunodeficiency virus screening during pregnancy. Obstet Gynecol 2004; 104:134.
  35. U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009; 150:869.
  36. Lin K, Vickery J. Screening for hepatitis B virus infection in pregnant women: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009; 150:874.
  37. LeFevre ML, U.S. Preventive Services Task Force. Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161:902.
  38. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med 2005; 142:914.
  39. Canadian Agency for Drugs and Technologies in Health. Urine Based Testing for Gonorrhea and Chlamydia: A Review of Diagnostic Accuracy, Cost-Effectiveness, and Compliance. November 2009. http://www.cadth.ca/media/pdf/L0124_Urine_Based_Testing_for_Gonorrhea_and_Chlamydia_final.pdf (Accessed on April 01, 2011).
  40. Expert Consultation Meeting Summary Report January 13‐15, 2009. Atlanta, GA. Laboratory Diagnostic Testing for Chlamydia trachomatis and Neisseria gonorrhoeae. http://www.aphl.org/aphlprograms/infectious/std/Documents/CTGCLabGuidelinesMeetingReport.pdf (Accessed on April 01, 2011).
  41. National chlamydia coalition. Developments in STD Screening: Chlamydia Testing. 2010. http://www.prevent.org/data/files/ncc/research%20brief%201%20std%20testing.pdf (Accessed on April 01, 2011).
  42. Roberts SW, Sheffield JS, McIntire DD, Alexander JM. Urine screening for Chlamydia trachomatis during pregnancy. Obstet Gynecol 2011; 117:883.
  43. Hogge JS, Hogge WA. Preconception genetic counseling. Clin Obstet Gynecol 1996; 39:751.
  44. Committee on Patient Safety and Quality Improvement, Committee on Professional Liability. ACOG Committee Opinion No. 381: Subclinical hypothyroidism in pregnancy. Obstet Gynecol 2007; 110:959.
  45. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007; 92:S1.
  46. Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21:1081.
  47. Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding? J Clin Endocrinol Metab 2007; 92:203.
  48. Horacek J, Spitalnikova S, Dlabalova B, et al. Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding. Eur J Endocrinol 2010; 163:645.
  49. Chang DL, Leung AM, Braverman LE, Pearce EN. Thyroid testing during pregnancy at an academic Boston Area Medical Center. J Clin Endocrinol Metab 2011; 96:E1452.
  50. Granfors M, Åkerud H, Skogö J, et al. Targeted thyroid testing during pregnancy in clinical practice. Obstet Gynecol 2014; 124:10.
  51. Brent GA. Diagnosing thyroid dysfunction in pregnant women: Is case finding enough? J Clin Endocrinol Metab 2007; 92:39.
  52. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med 2012; 366:493.
  53. Brent GA. The debate over thyroid-function screening in pregnancy. N Engl J Med 2012; 366:562.
  54. Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 2010; 95:1699.
  55. www.ahrq.gov/clinic/cps3dix.htm (Accessed on May 22, 2006).
  56. Coonrod DV, Jack BW, Stubblefield PG, et al. The clinical content of preconception care: infectious diseases in preconception care. Am J Obstet Gynecol 2008; 199:S296.
  57. www.cdc.gov/mmwr/preview/mmwrhtml/mms5703a2.htm (Accessed on May 04, 2010).
  58. Centers for Disease Control and Prevention Morbidity and Mortality Report: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016 http://www.cdc.gov/mmwr/volumes/65/wr/mm6515e1.htm?s_cid=mm6515e1_e (Accessed on April 15, 2016).
  59. World Health Organization. Prevention of sexual transmission of Zika virus. Interim guidance update. 30 May 2016 http://apps.who.int/iris/bitstream/10665/204421/1/WHO_ZIKV_MOC_16.1_eng.pdf?ua=1 (Accessed on June 01, 2016).
  60. United States Centers for Disease Control and Prevention. Update: interim guidance for prevention of sexual transmission of Zika Virus- United States, July 2016. Morbidity and Mortality Weekly Report. http://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6529e2.pdf (Accessed on July 25, 2016).
  61. Verani JR, Montgomery SP, Schulkin J, et al. Survey of obstetrician-gynecologists in the United States about Chagas disease. Am J Trop Med Hyg 2010; 83:891.
  62. Buekens P, Almendares O, Carlier Y, et al. Mother-to-child transmission of Chagas' disease in North America: why don't we do more? Matern Child Health J 2008; 12:283.
  63. Ramos JM, Milla A, Sánchez V, et al. [Prenatal screening for Trypanosoma cruzi and human T lymphotropic virus types 1 and 2 in pregnant Latin American women]. Enferm Infecc Microbiol Clin 2009; 27:165.
  64. ACOG Committee on Obstetrics. ACOG Practice Bulletin No. 78: hemoglobinopathies in pregnancy. Obstet Gynecol 2007; 109:229.
  65. Ryan K, Bain BJ, Worthington D, et al. Significant haemoglobinopathies: guidelines for screening and diagnosis. Br J Haematol 2010; 149:35.
  66. Langlois S, Ford JC, Chitayat D, et al. Carrier screening for thalassemia and hemoglobinopathies in Canada. J Obstet Gynaecol Can 2008; 30:950.
  67. ACOG Committee on Genetics. ACOG committee opinion No. 432: spinal muscular atrophy. Obstet Gynecol 2009; 113:1194.
  68. Prior TW, Professional Practice and Guidelines Committee. Carrier screening for spinal muscular atrophy. Genet Med 2008; 10:840.
  69. Prior TW. Spinal muscular atrophy: a time for screening. Curr Opin Pediatr 2010; 22:696.
  70. Ettinger, AS, Gurthrie Wengrovitz, A (Eds). Guidelines for the identification and management of lead exposure in pregnant and lactating women. National Center for Environmental Health/Agency for Toxic Substances and Disease Registry; Centers for Disease Control and Prevention, Atlanta, GA, 2010 available at http://www.cdc.gov/nceh/lead/publications/LeadandPregnancy2010.pdf.
  71. Committee on Obstetric Practice. Committee opinion No. 533: lead screening during pregnancy and lactation. Obstet Gynecol 2012; 120:416.
  72. Rischitelli G, Nygren P, Bougatsos C. Screening for elevated lead levels in childhood and pregnancy: Update of a 1996 United States Preventive Services Task Force review. US Preventive Services Task Force Evidence Syntheses, Agency for Healthcare Research and Quality, Rockville MD 2006.
  73. Klinich KD, Flannagan CA, Rupp JD, et al. Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint. Am J Obstet Gynecol 2008; 198:450.e1.
  74. Motozawa Y, Hitosugi M, Abe T, Tokudome S. Effects of seat belts worn by pregnant drivers during low-impact collisions. Am J Obstet Gynecol 2010; 203:62.e1.
  75. Schiff MA, Mack CD, Kaufman RP, et al. The effect of air bags on pregnancy outcomes in Washington State: 2002-2005. Obstet Gynecol 2010; 115:85.
  76. The American College of Obstetricians and Gynecologists. Car safety for you and your baby. http://www.acog.org/publications/patient_education/bp018.cfm (Accessed on December 10, 2010).
  77. Vitamin supplementation in pregnancy. Drug Ther Bull 2016; 54:81.
  78. Cheschier N, ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin. Neural tube defects. Number 44, July 2003. (Replaces committee opinion number 252, March 2001). Int J Gynaecol Obstet 2003; 83:123.
  79. Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can 2006; 28:680.
  80. Czeizel AE, Vereczkey A, Szabó I. Folic acid in pregnant women associated with reduced prevalence of severe congenital heart defects in their children: a national population-based case-control study. Eur J Obstet Gynecol Reprod Biol 2015; 193:34.
  81. De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev 2015; :CD007950.
  82. Peña-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2012; 12:CD004736.
  83. Cantor AG, Bougatsos C, Dana T, et al. Routine iron supplementation and screening for iron deficiency anemia in pregnancy: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 162:566.
  84. Sukumaran L, McCarthy NL, Kharbanda EO, et al. Association of Tdap Vaccination With Acute Events and Adverse Birth Outcomes Among Pregnant Women With Prior Tetanus-Containing Immunizations. JAMA 2015; 314:1581.
  85. Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 2013; 62:131.
  86. Centers for Disase Control and Prevention. Question and Answer: Zika virus infection and pregnancy. http://www.cdc.gov/zika/pregnancy/question-answers.html (Accessed on February 26, 2016).
  87. www.cdc.gov/mmwr/preview/mmwrhtml/mm54d812a1.htm (Accessed on August 29, 2006).
  88. Grobman WA, Gilbert SA, Iams JD, et al. Activity restriction among women with a short cervix. Obstet Gynecol 2013; 121:1181.
  89. McCall CA, Grimes DA, Lyerly AD. "Therapeutic" bed rest in pregnancy: unethical and unsupported by data. Obstet Gynecol 2013; 121:1305.
  90. Maloni JA. Lack of evidence for prescription of antepartum bed rest. Expert Rev Obstet Gynecol 2011; 6:385.
  91. Biggio JR Jr. Bed rest in pregnancy: time to put the issue to rest. Obstet Gynecol 2013; 121:1158.
  92. Agopian AJ, Lupo PJ, Canfield MA, et al. Swimming pool use and birth defect risk. Am J Obstet Gynecol 2013; 209:219.e1.
  93. Read JS, Klebanoff MA. Sexual intercourse during pregnancy and preterm delivery: effects of vaginal microorganisms. The Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol 1993; 168:514.
  94. Sayle AE, Savitz DA, Thorp JM Jr, et al. Sexual activity during late pregnancy and risk of preterm delivery. Obstet Gynecol 2001; 97:283.
  95. Daniell WE, Vaughan TL, Millies BA. Pregnancy outcomes among female flight attendants. Aviat Space Environ Med 1990; 61:840.
  96. Huch R, Baumann H, Fallenstein F, et al. Physiologic changes in pregnant women and their fetuses during jet air travel. Am J Obstet Gynecol 1986; 154:996.
  97. ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 443: Air travel during pregnancy. Obstet Gynecol 2009; 114:954.
  98. Freeman M, Ghidini A, Spong CY, et al. Does air travel affect pregnancy outcome? Arch Gynecol Obstet 2004; 269:274.
  99. Magann EF, Chauhan SP, Dahlke JD, et al. Air travel and pregnancy outcomes: a review of pregnancy regulations and outcomes for passengers, flight attendants, and aviators. Obstet Gynecol Surv 2010; 65:396.
  100. Chibber R, Al-Sibai MH, Qahtani N. Adverse outcome of pregnancy following air travel: a myth or a concern? Aust N Z J Obstet Gynaecol 2006; 46:24.
  101. Artal R, Fortunato V, Welton A, et al. A comparison of cardiopulmonary adaptations to exercise in pregnancy at sea level and altitude. Am J Obstet Gynecol 1995; 172:1170.
  102. Barish RJ. In-flight radiation exposure during pregnancy. Obstet Gynecol 2004; 103:1326.
  103. National Council on Radiation Protection and Measurements. Limitation of exposure to ionizing radiation. NCRP Report 116. Bethesda (MD): NCRP; 1993.
  104. International Commission on Radiological Protection. 1990 Recommendations of the ICRP. ICRP Publication 60. In: Annals of the ICRP 21 (1–3). New York (NY): Pergammon Press; 1991. p. 42, 46.
  105. Huch R. Physical activity at altitude in pregnancy. Semin Perinatol 1996; 20:303.
  106. Baumann H, Huch R. [Altitude exposure and staying at high altitude in pregnancy: effects on the mother and fetus]. Zentralbl Gynakol 1986; 108:889.
  107. Parer JT. Effects of hypoxia on the mother and fetus with emphasis on maternal air transport. Am J Obstet Gynecol 1982; 142:957.
  108. Kametas NA, McAuliffe F, Krampl E, et al. Maternal cardiac function during pregnancy at high altitude. BJOG 2004; 111:1051.
  109. Niermeyer S. The pregnant altitude visitor. Adv Exp Med Biol 1999; 474:65.
  110. Chua-Gocheco A, Bozzo P, Einarson A. Safety of hair products during pregnancy. October 2008. www.motherisk.org/prof/updatesDetail.jsp?content_id=890 (Accessed on January 05, 2010).
  111. Organization of Teratology Information Specialists. Hair Treatments and Pregnancy. www.OTISpregnancy.org (Accessed on January 05, 2010).
  112. Dindelli M, Parazzini F, Basellini A, et al. Risk factors for varicose disease before and during pregnancy. Angiology 1993; 44:361.
  113. Thaler E, Huch R, Huch A, Zimmermann R. Compression stockings prophylaxis of emergent varicose veins in pregnancy: a prospective randomised controlled study. Swiss Med Wkly 2001; 131:659.
  114. Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol 2005; 193:771.
  115. Palmsten K, Hernández-Díaz S, Chambers CD, et al. The Most Commonly Dispensed Prescription Medications Among Pregnant Women Enrolled in the U.S. Medicaid Program. Obstet Gynecol 2015; 126:465.
  116. www.Reprotox.org (Accessed on July 01, 2009).
  117. Feldkamp ML, Meyer RE, Krikov S, Botto LD. Acetaminophen use in pregnancy and risk of birth defects: findings from the National Birth Defects Prevention Study. Obstet Gynecol 2010; 115:109.
  118. Liew Z, Ritz B, Rebordosa C, et al. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr 2014; 168:313.
  119. Thompson JM, Waldie KE, Wall CR, et al. Associations between acetaminophen use during pregnancy and ADHD symptoms measured at ages 7 and 11 years. PLoS One 2014; 9:e108210.
  120. Stergiakouli E, Thapar A, Davey Smith G. Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding. JAMA Pediatr 2016; 170:964.
  121. FDA Drug Safety Communication: FDA has reviewed possible risks of pain medicine use during pregnancy. U.S. Food and Drug Administration, 2015.
  122. Kristensen DM, Hass U, Lesné L, et al. Intrauterine exposure to mild analgesics is a risk factor for development of male reproductive disorders in human and rat. Hum Reprod 2011; 26:235.
  123. Snijder CA, Kortenkamp A, Steegers EA, et al. Intrauterine exposure to mild analgesics during pregnancy and the occurrence of cryptorchidism and hypospadia in the offspring: the Generation R Study. Hum Reprod 2012; 27:1191.
  124. Jensen MS, Rebordosa C, Thulstrup AM, et al. Maternal use of acetaminophen, ibuprofen, and acetylsalicylic acid during pregnancy and risk of cryptorchidism. Epidemiology 2010; 21:779.
  125. Black RA, Hill DA. Over-the-counter medications in pregnancy. Am Fam Physician 2003; 67:2517.
  126. Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204:259.e1.
  127. Hadi I, da Silva O, Natale R, et al. Opioids in the parturient with chronic nonmalignant pain: a retrospective review. J Opioid Manag 2006; 2:31.
  128. Broussard CS, Rasmussen SA, Reefhuis J, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol 2011; 204:314.e1.
  129. Bracken MB, Holford TR. Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol 1981; 58:336.
  130. Yazdy MM, Mitchell AA, Tinker SC, et al. Periconceptional use of opioids and the risk of neural tube defects. Obstet Gynecol 2013; 122:838.
  131. Geber WF, Schramm LC. Congenital malformations of the central nervous system produced by narcotic analgesics in the hamster. Am J Obstet Gynecol 1975; 123:705.
  132. www.reprotox.org (Accessed on September 20, 2012).
  133. Einarson A, Phillips E, Mawji F, et al. A prospective controlled multicentre study of clarithromycin in pregnancy. Am J Perinatol 1998; 15:523.
  134. Lin KJ, Mitchell AA, Yau WP, et al. Safety of macrolides during pregnancy. Am J Obstet Gynecol 2013; 208:221.e1.
  135. Andersen JT, Petersen M, Jimenez-Solem E, et al. Clarithromycin in early pregnancy and the risk of miscarriage and malformation: a register based nationwide cohort study. PLoS One 2013; 8:e53327.
  136. www.reprotox.com (Accessed on November 19, 2009).
  137. Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Antibiotics potentially used in response to bioterrorism and the risk of major congenital malformations. Paediatr Perinat Epidemiol 2009; 23:18.
  138. Bar-Oz B, Moretti ME, Boskovic R, et al. The safety of quinolones--a meta-analysis of pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2009; 143:75.
  139. Hernández-Díaz S, Werler MM, Walker AM, Mitchell AA. Folic acid antagonists during pregnancy and the risk of birth defects. N Engl J Med 2000; 343:1608.
  140. Newman RD, Parise M, Nahlen B. Folic acid antagonists during pregnancy and risk of birth defects. N Engl J Med 2001; 344:934; author reply 934.
  141. Hernández-Díaz S, Werler MM, Walker AM, Mitchell AA. Neural tube defects in relation to use of folic acid antagonists during pregnancy. Am J Epidemiol 2001; 153:961.
  142. Crider KS, Cleves MA, Reefhuis J, et al. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Arch Pediatr Adolesc Med 2009; 163:978.
  143. Källén BA, Otterblad Olausson P. Maternal drug use in early pregnancy and infant cardiovascular defect. Reprod Toxicol 2003; 17:255.
  144. Nordeng H, Lupattelli A, Romøren M, Koren G. Neonatal outcomes after gestational exposure to nitrofurantoin. Obstet Gynecol 2013; 121:306.
  145. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 494: Sulfonamides, nitrofurantoin, and risk of birth defects. Obstet Gynecol 2011; 117:1484.
  146. Forna F, McConnell M, Kitabire FN, et al. Systematic review of the safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: implications for resource-limited settings. AIDS Rev 2006; 8:24.
  147. Klarskov P, Andersen JT, Jimenez-Solem E, et al. Short-acting sulfonamides near term and neonatal jaundice. Obstet Gynecol 2013; 122:105.
  148. ANDERSEN DH, BLANC WA, CROZIER DN, SILVERMAN WA. A difference in mortality rate and incidence of kernicterus among premature infants allotted to two prophylactic antibacterial regimens. Pediatrics 1956; 18:614.
  149. Loperamide www.reprotox.org (Accessed on April 26, 2012).
  150. Wilson DL, Barnes M, Ellett L, et al. Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy. Aust N Z J Obstet Gynaecol 2011; 51:38.
  151. Hertz G, Fast A, Feinsilver SH, et al. Sleep in normal late pregnancy. Sleep 1992; 15:246.
  152. Okun ML, Kiewra K, Luther JF, et al. Sleep disturbances in depressed and nondepressed pregnant women. Depress Anxiety 2011; 28:676.
  153. Pregnancy and sleep http://www.sleepfoundation.org/article/sleep-topics/pregnancy-and-sleep (Accessed on October 06, 2011).
  154. Okun ML, Ebert R, Saini B. A review of sleep-promoting medications used in pregnancy. Am J Obstet Gynecol 2015; 212:428.
  155. Interactive site for clinicians serving women with disabilities http://www.acog.org/About_ACOG/ACOG_Departments/Women_with_Disabilities/Interactive_site_for_clinicians_serving_women_with_disabilities (Accessed on April 20, 2012).
Topic Outline