Approximately 6 million women in the US become pregnant every year, and 4 million have a live birth.

Approximately 500,000 to 1 million women die each year worldwide from complications of pregnancy.

Half of all pregnancies are unintended.

An estimated 6.2% of births in United States occur among women receiving little or no prenatal care, although rates as high as 20% have been documented in certain populations based on location and race/ethnicity (Martin JA).

Parturients heavier than previous with a doubling of the obesity rate in women.

Obesity complicates 25% of pregnancies 
Obesity prevalence in pregnancy shows a high prevalence among underrepresented racial and ethnic groups.

Women with obesity related adverse pregnancy outcomes include: gestational diabetes, hypertensive disorders of pregnancy and such patients benefit from aggressive weight management during the postpartum and intrapregnancy period.

Obese pregnant women have increased risk for preeclampsia, gestational diabetes, venous thromboembolism and stillbirth, and their offspring have increased risk for obesity and metabolic syndrome.

The percentage of women who are categorized as either overweight or obese pre-pregnancy continues to increase and is now over 50%.

The mean age at first delivery is up 3.8 years since 1970.

The mean maternal age 25.2 years for delivery of the first infant.

Number of live births to women in their early 40s has increased from 7.4 per 10000 women in 1999 to 10.3 per 1000 in 2011(Hamilton BE ET AL).

Since 1990 births to women 35-39 years of age and 40-44 years of age have increased by 43% and 62%, respectively.

Full term lasts 37-42 weeks.

Is associated with major cardiovascular, respiratory, gastrointestinal, hematologic, endocrine, nervous, and renal system changes affecting pre-existing medical conditions.

One in 10 pregnant women will suffer some illness during pregnancy, and amounted to approximately 800,000 cases in the United States in 2015.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

Pregnancy accounts for approximately 3 million patient-days in the hospital annually.

Women with a history of adverse pregnancy outcomes that include gestational hypertension, diabetes, preeclampsia, eclampsia, and preterm delivery are at increased risk of future cardiovascular disease.

More than 60% of pregnancy related deaths in the US are preventable.

31% of maternal deaths occur during pregnancy, about 36% are experienced during delivery or in the week after delivery, and 33% occur between a week and a year after delivery.

Hemorrhage, , cardiovascular and coronary conditions, cardiomyopathy, or infection cause nearly half of the deaths, but the leading cause of deathsvary by race.

Maternal cardiovascular health during pregnancy is significantly associated with offspring cardiovascular health during early adolescence (Petak A).

Preeclampsia and eclampsia, and embolism are the leading causes of death for black women, while mental health problems lead to more deaths in white women.

Deaths are most common within 42 days postpartum.

Gestational hypertension and pre-eclampsia/eclampsia confirm the risk of developing hypertension of 2.3-3.0 times, respectively.

Term pregnancy is defined as one in which 260-294 days have passed since the last menstrual period.

Due date set at 40 weeks beyond the last menstrual period, indicating a term pregnancy is one that occurs is 37 weeks or later.

Only 4% of women deliver on their estimated due date.

Only half of women deliver before 40.5 weeks of gestation.

A given woman is likely to have consistent gestation length from one pregnancy to the next.

Each trimester is 13-14 weeks.

Pregnancy is associated with time sensitive developmental changes in the embryo and the fetus.

The first trimester and early in the second trimester are periods of embryogenesis and fetal organogenesis, and maternal infection during the stages can be associated with fetal infections leading to abortion, embryopathy, or congenital malformations.

Maternal infection late in the second trimester or in the third trimester usually does not produce major structural abnormalities in the fetus, and vaccination during this time is not associated with adverse birth outcomes.

Early symptoms include missed menstrual period, frequent urination, nausea, and fatigue.

Nausea and vomiting occur in up to 80% of pregnancies.

About 1/3 of women with nausea and vomiting during pregnancy have symptoms that are clinically significant.

20-40% of early pregnancies have bleeding associated with them, and most go on to have normal pregnancies.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

More than 50% of women in US are overweight or obese doing early pregnancy.

Maternal obesity is associated with increased risk of pregnancy complications, preterm birth and still birth.

Associated with approximately three deaths per day and averages approximately 1 in 4000 live births.

Aproximately 800 women in the US die each year during pregnancy and within 42 days after delivery.

A process of complex processes with insulin resistance, thrombophilia, increased blood volume and relative immunosuppression which can unmask potential for disease.

Pregnancy causes stress is on the myocardium and the cardiovascular system, and increases the circulating volume by 30-50%, and heart rate to ensure adequate fetal blood flow.

First trimester preganacy evaluation include: CBC, Blood type + Rh for both partners, Blood glucose level, Chemistry profile to assess renal and liver function, serology for syphilis test to be repeated preferably between 28-32 weeks of pregnancy, tests to detect HIV, Hep B and C, Urinalysis, examination of vaginal discharge, Pap smear and an Ultrasound confirming the existence of intrauterine pregnancy, another is performed at 12 weeks of pregnancy, an ultrasound test that correlates with the double HCG and Estriol test and, which together calculate the risk for Down syndrome.

Ultrasound assessments are suggested at 14 to 16 weeks for early anatomy, 20 to 22 weeks for routine morphologic assessment, and 28 to 32 weeks to aid in the detection of late onset fetal growth restriction, and any time in the third trimester for excessive fetal growth.

All pregnant women should be tested/screened for syphilis early in pregnancy and at i28 weeks of gestation and at delivery.

Some studies indicate pregnancy has protected effects as a decrease incidence of acute appendicitis and improved prognosis with critical illness, while associated with worse prognosis with breast cancer or traumatic brain injury.

Surgery in patients with pregnancy is associated with more adverse events, higher risk of in hospital mortality, aproximally four fold higher after nonobstetric surgery compared to non-pregnant patients.

Plasma volume increases by 50% by 32-34 weeks gestation.

Plasma volume is proportional to the size of the fetus and exceeds red blood cell mass leading to physiological anemia.

Subsequent pregnancies have greater increases in plasma volume.

Hypervolemia of pregnancy improves delivery of nutrients to the fetus, protects from maternal hypotension and decreases the risk of hemorrhage at the time of delivery.

Blood viscosity decreases as the hematocrit drops lowering resistance to blood flow and when coupled with vasodilation of pregnancy blood pressure falls.

Associated with increased procoagulant factors including factor VIII, von Willebrand factor, and fibrinogen.

Normal pregnancy is associated with a progressive increase in VWF, such that plasma levels gradually increase from the first trimester through to term, by which time there is usually a twofold to threefold increase.

Approximately 2% of pregnant women need nonobstetric surgical procedures during the antepartum period, with a mortality rate estimated to be 0.006% to 0.25%.

The prevalence of marijuana use in pregnancy is approximately 7%.

The use of marijuana during pregnancy is associated with an increased rate of premature birth.

MRI contrast medium gadolinium crosses the placenta should not be used during pregnancy.

Lipid profile changes in normal pregnancy are characteristic by a marked elevation of total plasma cholesterol and triglyceride levels which usually return to normal levels after term.

Exacerbates preexisting lipid abnormalities in chylomicronemia syndrome.

During pregnancy mucosal and laryngeal edema is common and is partially attributed to the effect of estrogens and placental growth hormone on the mucosa.

The above leads to rhinosinusitis in approximately 20% of pregnant women.

During pregnancy the chest wall Anatomy is altered due to 40% – 50% increase in the average costal angle.

During pregnancy the diaphragm becomes elevated by 4 – 5 cm due to uterine enlargement, but its function remains uneffected .

Maternal stroke, a complication of pregnancy, is the leading cause of maternal mortality in the USA.

Alcohol use during pregnancy is one of the major preventable causes of birth defects and developmental disabilities.

Pulmonary function can change due to diaphragmatic elevation.

Functional residual capacity is decreased by 18% or 300 – 500 ml.

Functional residual capacity reduction is worse in the Supine position, that is when the diaphragmatic elevation is the highest and as a result of increased intra-abdominal pressure.

Calorie intake should be increased by 10-15%, approximately 300 calories per day.

Increasing use of opioids in pregnancy effects an estimated 5.6 per 1000 births.

Women who use opioids doing pregnancy have higher rates of depression, anxiety, chronic medical conditions.

Opioid overdose during pregnancy and postpartum occurs in approximately 30% of mothers who use opioids during pregnancy.

Opioid overdose in pregnancy associated with 4-5 fold elevated risk of maternal mortality.

Opioid use is associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth.

Opioid use in pregnancy has risen significantly and parallels an upsurge in the incidence of myocardial infarction and cardiac arrest among these mothers.

Increases is a neonatal abstinence syndrome related to opioid withdrawal attributed to prenatal opioid exposure has occurred.

For mother and infants, opioid miss use and exposure is associated with adverse outcomes: severe maternal complications including mortality, and infants with neonatal abstinence syndrome have longer and more complicated hospital stays.

One quarter to one half of aortic dissections in women under age 40 occurs during pregnancy, typically in the third trimester or early postpartum period (O’Gara PT).

Hormones of pregnancy may alter the integrity of elastin fibers with predisposition to dissection.

Coronary artery dissection may occur in the third trimester or postpartum period and involves the left anterior descending artery, most often (Sherif HM).

By term weight distribution is as follows: baby 7.8 pounds, uterus 2 pounds, placenta 1-2 pounds, amniotic fluid 2 pounds, maternal breast tissue 2 pounds, maternal blood 4 pounds, fluids in maternal tissue 4 pounds and maternal fat and nutrient stores 7 pounds.

Changes between first prepregnancy BMI and second prepregnancy BMI are associated with adverse outcomes.

Incremental increase in the risk of stillbirth occurs with BMI gain between first and second pregnancies

Excessive weight gain in pregnancy and postpartum weight retention are risk factors for obesity and lead to increased BMI with successive pregnancies

Risk for perinatal complications is higher in women who retained weight between pregnancies, regardless under-, normal, or overweight status.

The adjusted odds ratio for gestational diabetes mellitus is 2.25 for interpregnancy weight retention of 2 or more BMI units, and the adjusted odds ratio for pregnancy-induced hypertension is 3.76 with an increase of 3 or more BMI units between pregnancies, but these associations were only present in underweight and normal-weight women.

In overweight and obese women, risk increases for cesarean delivery for an interpregnancy weight retention of 2 or more BMI units.

In underweight and normal-weight women, the risk for macrosomia was halved if women who lose more than 1 BMI unit between pregnancies, but at the same time, the risk for low birth weight doubles.i

Weight retention between the first and second pregnancy is associated with an increased risk for perinatal complications, even in underweight and normal-weight women.

Stabilizing interpregnancy weight reduces adverse perinatal outcomes in a second pregnancy.

Peripartum cardiomyopathy is defined by left ventricular dysfunction and development of cardiac failure without a known cause and occurring in the final month of pregnancy and up to 5 months postpartum.

The incidence of peripartum cardiomyopathy in the United States has been estimated recently as 1 in 2,230 births and approximately 1 in 1,000 births worldwide.

There are no disease-specific therapies, management of peripartum cardiomyopathy is based on treatment of heart failure and its symptoms, repressing neurohormonal responses, and preventing long-term sequelae.

Almost 80% of pregnant women work into the third trimester and almost half work during the ninth month.

5-25% of nulliparous pregnant females have operative vaginal delivery.

Occupational fatigue and an increasing number of hours worked each week are associated with preterm premature rupture of membranes among nulliparous women only.

Lowest risk of perinatal death is associated with delivery at 38 weeks’ gestation.

Gestation of girls is longer than boys and their birthweight is less than that of boys.

Experienced ultrasonographer can identify intrauterine pregnancy on transvaginal ultrasound when HCG levels are as low as 2000 mIU per milliliter.

Use of NSAID’s does not increase risk of adverse birth outcome but is associated with increased risk of miscarriage.

Oral fluconazole is not associated with significant increase risk of birth defects overall or of the 14 of the 15 specific birth defects of previous concern, but does confirm an increase risk tetralogy of Fallot (Malgaard D et al).

Gestational age for potential survival around 24 weeks.

A hypercoaguable state with increased concentrations of von Willebrand factor, factor VIII, factor V, and fibrinogen, with acquired resistance to activated protein C and a lowered level of protein S, the cofactor for protein C.

Warfarin is contraindicated during pregnancy because it crosses the placenta and is teratogenic.

Women with history of pregnancy-associated thrombosis have a risk of 20% for recurrent thromboses in subsequent pregnancies without prophylactic treatment.

Pregnancy is a hypercoagulable state, caused by physiologic changes in the coagulation and fibrinolytic systems: the combination of pregnancy and acquired or inherited thrombophilia for the increases the risk of thrombosis.
History of prior VTE  and inherited thrombopo thrombophilia are the two most common risk factors for VTE during pregnancy. Inherited thrombophilia is present in approximately 30-50% of women with pregnancy associated with VTE.

The number of pregnant women newly diagnosed with a malignant disease annually in the U.S. is approximately 1 per 1000 population.

Melanoma, breast cancer, cervical cancer, leukemia and lymphoma are the most common malignancies that occur during pregnancy.

Approximately 1 in 3000 pregnancies is associated with concurrent breast cancer.

The incidence of cancer during pregnancy or lactation is increasing, as the age of childbearing is increasing.

Venous thromboembolism complicates 0.5 to 3.0 of every 1000 pregnancies.

11% of maternal deaths attributed to pulmonary embolism.

Pulmonary embolism a leading cause of maternal death with an overall incidence of 1.72 cases per 1000 deliveries, and accounts for approximately one death and every 100,000 deliveries.

Peripartum cardiomyopathy, a dilated cardiomyopathy of immunologic origin may occur in the last month of pregnancy and 5 months after delivery (Sliwa K).

Urge to urinate occurs in 22-62% of pregnant women according to 2 studies.

8-18% of pregnant women have urge incontinence or urodynamic evidence of detrusor instability.

High prepregnancy weight risk body mass index confers an increased risk of maternal and perinatal complications such as preeclampsia, gestational diabetes, cesarean section, macrosomia and still birth.

Weight gain between first and second pregnancies strongly associated with risk of maternal and perinatal complications even if woman are not overweight.

Excessive gestation weight gain increases adverse outcome risks such as gestational hypertension, diabetes, preeclampsia, preterm birth, high postpartum weight retention, long-term obesity, and need for cesarean delivery.

Excessive gestational weight gain has adverse consequences for infants health.

Exceeding recommended pregnancy weight gain increases, increases the risk of childhood overweight by approximately 30%.

Growth restricted babies have a lifelong propensity to obesity.

Excessive gestational weight gain is associated with increased risk of offspring of abdominal adiposity. and may be associated with offspring cognition impairments.

A gain of 1-2 BMI units during 2 years increases the risk of hypertension, gestational diabetes by an average of 20-40%.

Approximately 1-2% of patients will require a non-obstetric surgery during their pregnancy.

Use of PPIs during the first trimester of pregnancy is not associated with significant increase of major birth defects (Pasternak B, Hviid A).

Between 10% and 20% of pregnant women experience depression during pregnancy.

Increased use of antidepressants during pregnancy up to 13.4% of patients in 2003 (Cooper WO).

Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy may contribute to an increased risk of septal heart defects, preterm delivery, low 5 minute Apgar score and admission to a neonatal intensive care unit.

Anti-epileptic drug exposure during pregnancy associated with increased risk of congenital malformations and delayed cognition.

Valproic acid prenatal use is associated with a significant increase risk of autism spectrum disorder and childhood autism (Christensen J et al).

Anesthesia is safe in all stages of pregnancy for both mother and fetus (Kuczkowski KM).

A gain of 3 or more BMI units associated with stillbirth.

Overweight pregnant women have dyslipidemia, higher concentrations of leptin, interleukin-6, C reactive protein and impaired endothelial dysfunction.

Meta-analyses show even moderate increases in maternal BMI are associated with increased risk of fetal death, stillbirth, and neonatal,perinatal, and infant death (Aune D et al).

Weight loss in overweight and obese women planning to get pregnant is advocated and preventing weight gain before pregnancy helpful in preventing complications.

Cardiovascular disease and its complications or a leading risk factor for pregnancy Associated maternal mortality.

Cardiovascular conditions that may complicate pregnancy include:hypertension, preeclampsia, eclampsia, HELLP syndrome, venous thromboembolic disease, aortic dissection, coronary artery disease, coronary artery dissection, peripartum cardiomyopathy, pulmonary hypertension, Eisenmenger’s syndrome, aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, pulmonary stenosis, dilatee cardiomyopathy, Marfan’s syndrome and presence of mechanical heart valve.

Pulmonary arterial hypertension in pregnancy has signs and symptoms that overlap with those of normal pregnancy: progressive fatigue, exertional dyspnea, weight gain, anorexia, abdominal pain and swelling, exertional chest pain, pre-syncope, and syncope may ultimately develop indicating right ventricular ischemia or failure.

Pulmonary arterial hypertension decompensation occurs most frequently between 20 and 24 weeks of gestation when blood volume and cardiac output are reaching their peak, and  in the third trimester and postpartum.

The high pulmonary hypertension mortality rate in pregnancy is 17 to 33% with clinical deterioration estimated in 80% of patients.

Recommendations are to avoid pregnancy in patients with pulmonary arterial hypertension and consider pregnancy termination in such patients.

Therapy for pulmonary arterial hypertension in patients who are pregnant includes supplemental oxygen to maintain oxygen saturation above 95%, diuretics to maintain euvolemia, and anticoagulation in certain patients.

The preferred timing and mode of delivery in women with pulmonary arterial hypertension is individualized and maternal risks or weighed against appropriate therapy for pulmonary arterial hypertension, as well as neonatal risk of preterm delivery.

In women whose condition is stable, planned delivery at approximately 34 to 36 weeks of gestation is recommended.

Planned cesarean section is associated with greater risk of blood loss and infection, but it minimizes pain, Valsalva maneuver, vasovagal responses and decreased cardiac preload, risk of emergency c-section.

General anesthesia has risks among patients with pulmonary arterial hypertension owing to hemodynamic changes associated with induction, anesthetic decreased cardiac contractility, and positive pressure ventilation.

The delivery and immediate postpartum, for  up to two months, has the highest risk of cardiovascular collapse and death among pregnant women with pulmonary hypertension.

ost deaths following pulmonary arterial hypertension in pregnant women occurs within the first month after delivery, with heart failure, sudden death due to arrhythmia or pulseless electrical activity rest, and thromboembolism.

Targeted therapies with prostacyclin analogs, phoshpdiesterase -5 inhibitors can improve hemodynamic variables, and exercise capacity.

Iron deficiency anemia is common and underdiagnosed in pregnancy.

In pregnancy there is a marked increased need for iron, with physiological changes in the mother and increasing demands of the growing fetus leading to maternal hematologic changes.

There is inadequate iron delivered to the fetus if the mother is severely iron deficient, and infants who were born iron deficient have a significant increase in cognitive and behavioral abnormalities.

Low levels of iron during pregnancy and early childhood is associated with mental and behavioral delays in children. 

Maternal iron deficiency when treated with oral iron is often poorly tolerated associated with worsening constipation associated with high progesterone levels and an enlarging gravid uterus.

Maternal iron deficiency negatively affects the fetus and neonatal brain growth and development, cognition and behavior.

Antibiotics tetracyclines and fluoroquinolones should be avoided during pregnancy, and sulfonamides should be avoided during the last weeks of pregnancy to minimize the risk of hyperbilirubinemia and kernicturus in the newborn.

Smoking in pregnancy is the leading preventable cause of morbidity and death among women and infants.

Smoking in pregnancy associated with adverse outcomes, including placental abruption, prematurity, miscarriage, low birth weight, congenital abnormalities, neonatal a sudden infant deaths.

Smoking prevalence during pregnancy ranges between 13 and 25% in high income countries, and is increasing rapidly in low income and middle income countries.

Smoking cessation during pregnancy is important for maternal and fetal health.

70-80% of pregnant women take it this one prescription medication during the first trimester of pregnancy, and about 90% take at least one drug at any point during pregnancy.

Illicit drug use 16.2% among pregnant teens, and 7.4% among pregnant women aged 18-25 years.

More than 1% of susceptible women acquire herpes simplex learning the first trimester of pregnancy.

The use of a acyclovir or valacyclovir in the first trimester of pregnancy is not associated with an increased risk of major birth defects(Pasternak B et all).

In a large scale double-blind study assessing the impact of prenatal iron-folic acid and other micro nutrient supplements provided to Chinese women with no or mild anemia prevented later pregnancy anemia beyond folic acid alone but did not affect perinatal mortality or other infant outcomes (Liu J-M et al).

In twin pregnancy with the first twin in cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery (Barrett JFR et al).

Pain or bleeding in early pregnancy has diagnostic possibilities to include: viable intrauterine pregnancy, a failed intrauterine pregnancy, and ectopic pregnancy.

Serum hCG levels and pelvic ultrasound are commonly performed for the differential diagnosis of early pregnancy pain or bleeding.

Obstetric complications and severe maternal morbidity occurs in about 60,000 women or 1.6 per 100 deliveries annually in the US.

One in 10 term infants experience neonatal complications.

More than one third of maternal deaths and severe morbidity and a significant proportion of neonatal mortality and morbidity may be prevented.

Kidney disease in pregnant women is independently associated with adverse maternal and fetal outcomes, including delivery of preterm and low-birth-weight infants (Kendrick J et al).

Compared with women who did not have kidney disease, those with kidney disease have 52% increased odds of preterm delivery and 33% increased odds of delivery by cesarean section.

Infants born to women with kidney disease have a 71% increased odds of admission to the neonatal intensive care unit or infant death compared with infants born to mothers without kidney disease.

Kidney disease in pregnancy associated with 2.3 times increased odds of low birth weight of less than 2,500 grams.

There is no increased risk of maternal death associated with kidney disease.

8.8% of pregnant women have a complication of asthma.

Between 1 and 4% of pregnancies are complicated by poorly controlled asthma.

1 in 500 expectant mothers have serious health consequences from uncontrolled asthma during pregnancy, including maternal and or perinatal death from asphyxia, pre-eclampsia, intrauterine growth restriction, premature birth, and low birth weight.

0.3%-0.5% of pregnant women have overt hypothyroidism and 0.4% have overt hyperthyroidism.

Body changes during pregnancy results in increased susceptibility to discomfort and pain.

Back arching and gradual anterior shift may occur naturally with the added load of a fetus’s weight.

During pregnancy changes in the center of gravity and increased body mass may lead to lengthening and weakening of the abdominal musculature.

The above changes may lead to back pain and to compensate the patient may shift the body frequently, leading to changes in posture, which may further strain the spine and perpetuate pain.

During pregnancy mechanical interruption of intervertebral discs occurs with axial loading, decreasing height and compresses the spine.

Back pain during pregnancy is related to lumbar pain and posterior pelvic pain.

Risk factors for low back pain related to pregnancy include: parity, BMI, history of hypermobility, amenorrhea, and prior history of low back pain, older age estimated fetal birth bodyweight, physical workload, depression, and amniotic fluid index.

About 1/3 of pregnant women suffer from lumbar pain, and most women experience

lumbar pain during their first pregnancy.

Approximately 80% of pregnant women have their daily routine disturbed by lumbar pain, and 10% are unable to work.

The increased mass distribution of the trunk and center of gravity shift during pregnancy may result in lumbar lordosis.

The pelvis tilt which occurs as a result of Lumbar hyperlordosis, the inner curvature of the lumbar spine formed by the wedging of Lumbar vertebral bodies and the intervertebral discs contribute to low back pain.

Lumbar pain may increase relaxin levels and increase pelvic ligament relaxation.

With increased lumbar lordosis there is a lack of the ability of the pelvis to compensate leading to strain.

Approximately 50% of pregnant patients suffer from some kind of low back pain, such as pelvic girdle pain and lumbar pain, during their pregnancies or postpartum period.

Is many years 70% of women have dyspnea during normal pregnancy.

Dyspnea during pregnancy can be related to: increased blood volume and cardiac output, elevation of the diaphragm, decreased functional residual capacity, progesterone mediated increased respiratory drive and minute ventilation.

Pregnancy associated with an increased risk of vaginal candidiasis due to increased secretion of sex hormones.

Prevalence of vaginal candidiasis is estimated to be 10% in the US.

Topical intravaginal azoles first line treatment for vaginal candidiasis in pregnancy.

Use of fluconazole in pregnancy for vaginal candidiasis associated with an increased risk of spontaneous abortion and should be avoided.

Pregnancy is dependent on progesterone production by the corpus luteum through the first nine weeks of gestatio, until placental progesterone production has increased enough to take the place of corpus luteum progesterone production.

Pertussis and influenza vaccinations are recommended for pregnant women.

The tetanus, diphtheria, and a cellular pertussis (Tdap) vaccine is routinely administered during each pregnancy at 27-36 weeks gestation and provides pertussis-specific antibody to the infant during a time window in infancy when heightened susceptibility to severe pertussis disease.

First trimester pertussis vaccination is not significantly associated with birth defects.

Inactivated influenza vaccine is recommended for pregnant women or those who might be pregnant during the influenza season anytime in pregnancy.

The risks associated with isoniazid preventive therapy during pregnancy is greater than those associated with the initiation of therapy during the postpartum period.

Pregnant women infected with human papillomavirus (HPV) may be at increased risk for miscarriages and preterm deliveries.


Mothers who have HPV are almost twice as likely as those who are not infected to have premature rupture of membranes and 50% more likely to have preterm deliveries.


Women with HPV are also more than twice as likely to experience a miscarriage or stillbirth.


Maternal antenatal corticosteroid treatment to accelerate fetal maturation is standard care before 34 weeks gestation when there is a risk of delivery within seven days.


In infants born before 34 weeks corticosteroids reduces the risk of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, need for mechanical ventilation, systemic infections, and death.


In a study of 670,097  children exposed to maternal antenatal corticosteroid treatment was associated with significant mental and behavioral disorders in children (Raikkonen K).


Seizures during pregnancy are a danger to both mother and fetus as a result of blunt trauma and hypoxemia. 


There is a higher incidence of maternal death among pregnant women with epilepsy than among other pregnant women, with-up to 79% of epilepsy related deaths attributed to sudden, unexpected death. 


The range of increased frequency of seizures during pregnancy varies from 14-62%.

The benefits of exercise for pregnant women include: reduced rates of maternal and fetal complications, such as preeclampsia, gestational hypertension, gestational diabetes, cesarean section, excessive gestational weight gain, and  macrosomia.

Pregnant women without contraindication should exercise for at least 150 minutes per week.

The prevalence of marijuana use among pregnant women is approximately 7%.

The use of marijuana in pregnancy is associated with a significant increase in the rate of preterm birth.

Cannabis use is associated with a 12% preterm birth rate, while it is is 6.1% among non-users.

In a  multi center observational study adverse pregnancy outcome-small for gestational age birth, medically indicated preterm birth, stillbirth, or hypertensive disorder in pregnancy are more frequent in patients with cannabis exposure.

The risk for adverse outcomes is higher among those who continue to use cannabis beyond the first trimester.

Cannabis you should be avoided during pregnancy to optimize, maternal and neonatal outcomes.



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