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Guidelines and Recommendations > Pregnancy and Reproductive Health Pregnancy and Reproductive Health
Guidelines and Recommendations
Below are selected prevention and treatment guidelines, recommendations,
frameworks, approaches, and other documents related to pregnancy, birth defects prevention, and reproductive health. Also see
related links on this page.
Revised
Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women
in Health-Care Settings
(11/29/06)http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
These recommendations for HIV testing are intended for all health-care
providers in the public and private sectors. The recommendations address HIV
testing in health-care settings only.
The
CDC Guide to Breastfeeding Interventions (6/19/06) http://www.cdc.gov/breastfeeding/resources/guide.htm
This guide provides state and local community members information to choose
the breastfeeding intervention strategy that best meets their needs. The
Guide builds upon the research evidence demonstrating effective
interventions as well as the
expertise
of the nation’s leading
scientists and experts in breastfeeding management and interventions.
Guidelines
for Vaccinating Pregnant Women (6/19/06) http://www.cdc.gov/vaccines/pubs/preg-guide.htm
Benefits of vaccinating pregnant women usually outweigh potential risks when
the likelihood of disease exposure is high, when infection would pose a risk
to the mother or fetus, and when the vaccine is unlikely to cause harm.
Recommendations to
Improve Preconception Health and Health Care- United States
(4/24/06)
http://www.cdc.gov/mmwr/PDF/rr/rr5506.pdf
This report provides recommendations to improve both preconception health
and care. The goal of these recommendations is to improve the health of
women and couples before conception of a first or subsequent pregnancy. The
recommendations should be used by consumers, clinical care providers, public
health professionals, researchers, policy makers, and others concerned with
the health of women, children, and families.
Influenza
Vaccination in Pregnancy: Practices among Obstetrician-Gynecologists- United
States, 2003-2004 Influenza Season (10/30/05)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5441a4.htm
PDF (p. 1050)
http://www.cdc.gov/mmwr/PDF/wk/mm5441.pdf
To assess understanding of the Advisory Committee on Immunization Practices
(ACIP) recommendations among obstetrician-gynecologists (OB/GYNs), the
American College of Obstetricians and Gynecologists, with support from CDC,
surveyed a national sample of OB/GYNs in May 2004. This report describes the
results of that survey, which indicated that 52% of OB/GYNs surveyed would
recommend influenza vaccination for a healthy woman in the first trimester
of pregnancy, 95% would recommend the vaccine for a healthy pregnant woman
beyond the first trimester, and 63% would recommend vaccination for a woman
with a medical condition in the first trimester. However, of the physicians
who would recommend vaccination, 36%-38% reported that influenza vaccination
was not offered in their practices. Increased efforts are needed to improve
vaccine availability and to educate OB/GYNs regarding the updated ACIP
recommendations on the use of influenza vaccine in the first trimester for
both healthy pregnant women and pregnant women at high risk.
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis
(8/30/04)
http://www.cdc.gov/ncbddd/fas/documents/FAS_guidelines_accessible.pdf
These guidelines update and refine diagnostic and referral criteria in light of the scientific and clinical advances in the understanding of this
disorder during the past 30 years. The guidelines are organized into several sections: background information; revised and refined diagnostic and
referral criteria for FAS; comparison of the guidelines with other diagnostic methods currently in use; a discussion of the essential services for
affected individuals; identifying and intervening with women at risk for an alcohol-exposed pregnancy; and future needs and efforts related to FAS
and other prenatal alcohol-related disorders.
From Data to Action, Using Surveillance To Promote Public Health: Examples from the
Pregnancy Risk Assessment Monitoring System (PRAMS) (2002)
http://www.cdc.gov/nccdphp/drh/dataAct2002/
PRAMS surveillance data can be incorporated into public health decision-making, or translated, in a variety of ways. In this booklet, examples
show how PRAMS data have been used by states to set priorities, change policies, change programs, and identify new resources.
Strategies to Reduce
Pregnancy-Related Deaths
(2001)
http://www.cdc.gov/nccdphp/drh/pdf/Strategies.pdf
This manual describes strategies for conducting pregnancy-related or maternal mortality surveillance in the United States. All these steps-
identification, data collection, analysis, and action- are needed on an ongoing basis in order to justify the effort and reduce pregnancy-related
deaths.
HIV Testing Among
Pregnant Women - United States and Canada, 1998-2001 (2002)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5145a1.htm
PDF
http://www.cdc.gov/mmwr/PDF/wk/mm5145.pdf
To assess the effectiveness of three different prenatal HIV-testing approaches, CDC reviewed prenatal HIV-antibody testing rates associated with
these approaches. Medical record data suggest that the "opt-in" voluntary testing approach is associated with lower testing rates than either the
"opt-out" voluntary testing approach or the mandatory newborn HIV testing approach. Prenatal HIV testing affords the best opportunity for the
prevention of perinatal HIV transmission. On the basis of clinical trial data, perinatal HIV-transmission rates among HIV-infected women who begin
antiretroviral treatment during pregnancy are as low as <2%, compared with 12%-13% early transmission rates among women who do not begin
preventive treatment until labor and delivery or after birth and 25% among women who receive no preventive treatment.
Prevention of
Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC (2002)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm
PDF
http://www.cdc.gov/mmwr/PDF/rr/rr5111.pdf
Data collected after the issuance of the 1996 guidelines prompted reevaluation of prevention strategies. The new recommendations are based on
available evidence and expert opinion where sufficient evidence was lacking. Although many of the recommendations in the 2002 guidelines are the
same as those in 1996, they include some key changes: 1) Recommendation of universal prenatal screening for vaginal and rectal GBS colonization of
all pregnant women at 35-37 weeks' gestation; 2) Updated prophylaxis regimens for women with penicillin allergy; 3) Detailed instruction on
prenatal specimen collection and expanded methods of GBS culture processing; 4) Recommendation against routine intrapartum antibiotic prophylaxis
for GBS-colonized women undergoing planned cesarean deliveries who have not begun labor or had rupture of membranes; 5) A suggested algorithm for
management of patients with threatened preterm delivery; and 6) An updated algorithm for management of newborns exposed to intrapartum antibiotic
prophylaxis. Group B streptococcus (GBS) remains a leading cause of serious neonatal infection despite great progress in perinatal GBS disease
prevention in the 1990s.
Prenatal Screening
is Most Effective Strategy to Prevent Newborn Strep B Infections (2002)
http://www.cdc.gov/media/pressrel/r020724b.htm
NEJM Web Site
http://content.nejm.org/cgi/content/short/347/4/233 (Non-CDC site)
Routine screening for group B streptococcus late in pregnancy is the most effective way to prevent transmission of the bacteria from mother to
child during delivery. The data were published in the July 25, 2002 issue of the New England Journal of Medicine (NEJM). Guidelines issued in 1996
to prevent transmission of the bacteria from mother to newborn recommend that health care providers use one of two methods. The new data show that
the prenatal screening method was more than 50 percent more effective in preventing transmission than the clinical risk factor method. The new
guidelines will be published in the CDC Morbidity and Mortality Weekly Report. Group B streptococcal disease remains a leading infectious cause of
illness and death among newborns in the United States, resulting in approximately 1,600 illnesses and 80 deaths each year.
National Task Force
on Fetal Alcohol Syndrome and Fetal Alcohol Effect: Defining the National Agenda for Fetal Alcohol Syndrome and Other Prenatal Alcohol-Related
Effects (2002)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5114a2.htm
PDF
http://www.cdc.gov/mmwr/PDF/rr/rr5114.pdf
This report describes the structure, function, mission, and goals of the Task Force and provides their first recommendations. An explanation of
how the Task Force recommendations were generated and the Task Force's next steps are also reported. Prenatal alcohol exposure can lead to serious
birth defects and developmental disabilities. A need exists to develop effective strategies for both children with fetal alcohol syndrome (FAS) or
other prenatal alcohol-related effects and for women at high risk for having an alcohol-exposed pregnancy.
Folic Acid and Prevention of Spina Bifida and Anencephaly: 10 Years After the U.S. Public
Health Service Recommendation
(2002)
http://www.cdc.gov/mmwr/PDF/rr/rr5113.pdf
This issue of the MMWR Recommendations and Reports presents data to assess the impact of efforts to prevent neural tube defects through increased
folic acid consumption. Five articles are included.
FAQs: Guidelines for Pregnant
Women Who Have Been Exposed to Anthrax But Do Not Have Symptoms (2001)
http://www.cdc.gov/ncbddd/bd/anthrax.htm
These questions and answers discuss medicine to prevent anthrax in pregnant women who have been exposed to anthrax, but who do not have symptoms
of anthrax disease. For CDC guidelines for treating anthrax disease, see MMWR, October 26, 2001/Vol. 50/No. 42.
Revised
Recommendation for Avoiding Pregnancy After Receiving a Rubella-Containing Vaccine (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5049a5.htm
PDF (p.1117)
http://www.cdc.gov/mmwr/PDF/wk/mm5049.pdf
On October 18, 2001, the Advisory Committee on Immunization Practices (ACIP) reviewed data from several sources indicating that no cases of
congenital rubella syndrome (CRS) had been identified among infants born to women who were vaccinated inadvertently against rubella within 3
months or early in pregnancy. On the basis of these data, ACIP shortened its recommended period to avoid pregnancy after receipt of
rubella-containing vaccine from 3 months to 28 days. Data were available from 680 live births to susceptible women who were inadvertently
vaccinated 3 months before or during pregnancy with one of three rubella vaccines. None of the infants was born with CRS.
Revised Guidelines
for HIV Counseling, Testing, and Referral (CTR) (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a1.htm
PDF (p. 1)
http://www.cdc.gov/mmwr/PDF/rr/rr5019.pdf
These Guidelines and Recommendations replace guidelines previously issued by CDC and the Public Health Service. The new Counseling, Testing and
Referral guidelines include the following significant revisions: providing guidance to all providers of voluntary HIV counseling, testing and
referral (CTR), both in the public and private sectors; underscoring the importance of early knowledge of HIV status by making testing more
accessible and available; acknowledging providers' need for flexibility in implementing the guidelines, given their particular client base,
setting, HIV prevalence level, and available resources; recommending that CTR be targeted efficiently through risk screening and other strategies;
and addressing ways to improve the quality and provision of HIV CTR.
Revised
Recommendations for HIV Screening of Pregnant Women (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a2.htm
PDF
http://www.cdc.gov/mmwr/PDF/rr/rr5019.pdf
These Guidelines and Recommendations replace guidelines previously issued by CDC and the Public Health Service. Major revisions to the 1995
Screening of Pregnant Women recommendations include: emphasizing HIV testing as a routine part of prenatal care; strengthening the recommendation
that all pregnant women be tested for HIV; recommending simplification of the testing process and making the consent process more flexible;
recommending that providers explore and address reasons for refusal of testing; and emphasizing HIV testing and treatment at the time of delivery
for women who have neither received prenatal testing nor antiretroviral drugs, if HIV-positive.
Notice to Readers:
Updated Recommendations for Antimicrobial Prophylaxis Among Asymptomatic Pregnant Women After Exposure to Bacillus anthracis (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5043a5.htm
PDF (p. 960)
http://www.cdc.gov/mmwr/PDF/wk/mm5043.pdf
Pregnant women are likely to be among the persons receiving antimicrobial prophylaxis for exposure to B. anthracis. Clinicians, public health
officials, and women who are candidates for treatment should weigh the possible risks and benefits to the mother and fetus when choosing an
antimicrobial for postexposure anthrax prophylaxis. Women who become pregnant while taking antimicrobial prophylaxis should continue the
medication and consult a health-care provider or public health official to discuss these issues. The antimicrobial of choice for initial
prophylactic therapy among asymptomatic pregnant women exposed to Bacillus anthracis is ciprofloxacin, 500 mg twice a day for 60 days.
Preventing Exposure
During Pregnancy to Medications Known to Cause Birth Defects (Press Release) (2001)
http://www.cdc.gov/media/pressrel/r010817a.htm
CDC reported that despite prevention efforts some women who take Accutane®, a prescription medication given for severe acne and known
to cause birth defects, still become pregnant while on this medication. The CDC also reported that a symbol intended to remind women that they
must not get pregnant while taking these medications is commonly misinterpreted. The two studies, "Continued Occurrence of Accutane®-exposed
Pregnancies" and "Interpretations of a Teratogen Warning Symbol", are published in the September issue of the journal Teratology.
Control and
Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Pregnant Women, and Surveillance for Congenital Rubella
Syndrome (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5012a1.htm
PDF
http://www.cdc.gov/mmwr/PDF/rr/rr5012.pdf
Health-care providers should be aware of the need for rubella prevention and control among women of childbearing age and of the appropriate
follow-up for pregnant women exposed to rubella. This report describes seven steps for evaluating and managing suspected rubella outbreaks. This
report also provides guidelines for evaluating and managing rubella in pregnant and nonpregnant women and evaluating infants for congenital
rubella infection.
Update: Interim
Recommendations for Antimicrobial Prophylaxis for Children and Breastfeeding Mothers and Treatment of Children with Anthrax (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5045a5.htm
PDF (p. 1014)
http://www.cdc.gov/mmwr/PDF/wk/mm5045.pdf
Because of its known safety for infants, amoxicillin is an option for antimicrobial prophylaxis in breastfeeding mothers when B. anthracis is
known to be penicillin-susceptible and no contraindication to maternal amoxicillin use is indicated. Decisions about antimicrobial choice and
continuation of breastfeeding should be made by the mother and her and the infant's health-care providers.
Notice to Readers:
Updated Recommendations for Antimicrobial Prophylaxis Among Asymptomatic Pregnant Women After Exposure to Bacillus anthracis (2001)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5043a5.htm
PDF (p. 960)
http://www.cdc.gov/mmwr/PDF/wk/mm5043.pdf
Pregnant women are likely to be among the persons receiving antimicrobial prophylaxis for exposure to B. anthracis. Clinicians, public health
officials, and women who are candidates for treatment should weigh the possible risks and benefits to the mother and fetus when choosing an
antimicrobial for postexposure anthrax prophylaxis.
Preventing
Congenital Toxoplasmosis (2000)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4902a5.htm
PDF (p. 57)
http://www.cdc.gov/mmwr/PDF/rr/rr4902.pdf
Toxoplasma infection can be prevented in large part by a) cooking meat to a safe temperature (i.e., one sufficient to kill Toxoplasma); b) peeling
or thoroughly washing fruits and vegetables before eating; c) cleaning cooking surfaces and utensils after they have contacted raw meat, poultry,
seafood, or unwashed fruits or vegetables; d) pregnant women avoiding changing cat litter or, if no one else is available to change the cat
litter, using gloves, then washing hands thoroughly; and e) not feeding raw or undercooked meat to cats and keeping cats inside to prevent
acquisition of Toxoplasma by eating infected prey.
Related Links
Pregnancy and Reproductive Health: Women’s Health
Topics A-Z
http://www.cdc.gov/women/az/reprhlth.htm
Guide to Community Preventive
Services
http://www.cdc.gov/epo/communityguide.htm
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This page last reviewed
December 31, 2006
This page last updated
January 4, 2008
URL: http://www.cdc.gov/women/gderecom/reprhlth.htm
US
Department of Health and Human Services
Centers for Disease Control and Prevention
Office of Women's Health
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