CE/CME
Prenatal Health: Screening and Intervention
Welcome to the training on Prenatal Health: Screening and Intervention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Credit Hours: 1.00 CE
EnrollTo enroll in this course, please log in or create a new account if you are not already registered.
Goal
The goal of this module is to equip Texas Health Steps providers and other health care professionals to identify and address prenatal factors that affect maternal health and safety.
Target Audience
Primary care providers and other health professionals who treat patients who are pregnant.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the leading causes of maternal morbidity and mortality in Texas.
- Specify the health risks and conditions that are associated with maternal morbidity and mortality.
- Integrate prenatal screening, treatment and counseling protocols that promote maternal health and safety.
Note: The information in this module focuses on adolescents and adults ages 18 through 44 years who can become pregnant and who deliver the majority of live babies in Texas. The terms “girl” and “woman,” along with their plurals and pronouns, are used throughout the module to refer to those individuals, although the creators intend inclusivity and wish to avoid bias based on gender identity. A companion module, Preconception Health: Screening and Intervention, addresses issues related to preconception health screening, intervention and counseling.
Texas Health Steps provides regular preventive medical checkups and other services to young people through age 20 years. Where appropriate, this module highlights Texas Health Steps-required screenings and other preventive services that can contribute to maternal health and safety.
Please note this module expires on 7/20/2025.
This module was released on 7/20/2022.
Featured
Alexopoulos, A. S., Blair, R., & Peters, A. L. (2019). Management of Preexisting Diabetes in Pregnancy: A Review. JAMA, 321(18):1811-1819.
American Academy of Pediatrics. (2021). Clinical Report: Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics, 148(5): e2021054272.
American Academy of Pediatrics. (2016). Policy Statement: Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians.
American Academy of Pediatrics & American College of Obstetricians and Gynecologists. (2017). Guidelines for Perinatal Care (Eighth Edition). Elk Grove Village, IL: American Acedemy of Pediatrics.
American College of Obstetricians and Gynecologists. (2022). Car Safety for Pregnant Women, Babies, and Children.
American College of Obstetricians and Gynecologists. (2022). Pregnancy and Heart Disease.
American College of Obstetricians and Gynecologists. (2021). Committee Opinion 711: Opioid Use and Opioid Use Disorder in Pregnancy.
American College of Obstetricians and Gynecologists. (2020). Committee Opinion 807: Tobacco and Nicotine Cessation During Pregnancy.
American College of Obstetricians and Gynecologists. (2019). Committee Opinion 569: Oral Health Care During Pregnancy and Through the Lifespan.
American College of Obstetricians and Gynecologists. (2018). Low-Dose Aspirin Use During Pregnancy.
American College of Obstetricians and Gynecologists. (2018). Screening for Perinatal Depression.
American Diabetes Association. (2021). Diabetes Risk Calculator.
American Diabetes Association. (2020). 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Suppl. 1):S14–S31.
American Thyroid Association. (2021). General Information/Press Room.
Association of Women’s Health, Obstetric and Neonatal Nurses. (2021). Position Statement: Breastfeeding and the Use of Human Milk. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(5): e1-e5.
Centers for Disease Control and Prevention. (2021). Distracted Driving.
Centers for Disease Control and Prevention. (2021). Hear Her.
Centers for Disease Control and Prevention. (2021). HIV and Pregnant Women, Infants, and Children.
Centers for Disease Control and Prevention. (2021). Reproductive Health: Unintended Pregnancy.
Centers for Disease Control and Prevention. (2021). STDs during Pregnancy—CDC Fact Sheet (Detailed).
Centers for Disease Control and Prevention. (2021). STDs in Adolescents and Young Adults.
Centers for Disease Control and Prevention. (2020). Breastfeeding Report Card, National Center for Chronic Disease Prevention and Health Promotion.
Centers for Disease Control and Prevention. (2020). Cytomegalovirus (CMV) and Congenital CMV Infection: Clinical Overview.
Centers for Disease Control and Prevention. (2020). Data on Selected Pregnancy Complications in the United States.
Centers for Disease Control and Prevention. (2020). Fact Sheet: Excessive Alcohol Use Is a Risk to Women’s Health.
Centers for Disease Control and Prevention. (2020). Pre-existing Diabetes Can Increase Risk for Birth Defects.
Centers for Disease Control and Prevention. (2020). Smoking During Pregnancy.
Centers for Disease Control and Prevention. (2019). Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. Morbidity and Mortality Weekly Report (MMWR), 68(35);762–765.
Centers for Disease Control and Prevention. (2021). Weight Gain During Pregnancy.
Centers for Disease Control and Prevention. (2018). Diabetes During Pregnancy.
Centers for Disease Control and Prevention. (2017). Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. Division of Violence Prevention, National Center for Injury Prevention and Control.
Duhig, K., Vandermolen, B., & Shennan, A. (2018). Recent advances in the diagnosis and management of pre-eclampsia. F1000Research, 7, 242.
Guttmacher Institute. (2021). State Laws and Policies: Substance Use During Pregnancy.
Le, Q. A., Eslick, G. D., Coulton, K. M., Akhter, R., Condous, G., Eberhard, J., & Nanan, R. (2021). Does Treatment of Gingivitis During Pregnancy Improve Pregnancy Outcomes? A Systematic Review and Meta-Analysis. Oral Health & Preventive Dentistry, 19(1):565-572.
MacDorman, M. F., Thoma, M., Declcerq, E., & Howell, E. A. (2021). Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017. American Journal of Public Health, 111: 1673-81.
March of Dimes. (2021). Beyond Labels.
March of Dimes Peristats. (2020). Obesity among women of childbearing age: Texas, 2008-2018.
Medical News Today. (2021). “Weathering”: What Are the Health Effects of Stress and Discrimination?
MGH Center for Women’s Mental Health. (2018). Psychiatric Disorders During Pregnancy.
National Preconception Health and Health Care Initiative. Before, Between, and Beyond Pregnancy. (2022). Resource Guide for Clinicians.
Teichman, J., Nisenbaum, R., Lausman, A., & Sholzberg, M. (2021). Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Advances, 5(22): 4666–4673.
Texas Collaborative for Healthy Mothers and Babies. (2021). TCHMB Statement of Commitment to Addressing and Combating the Effects of Racism on the Healthcare of the Women and Infants of Texas.
Texas Collaborative for Healthy Mothers and Babies. (2021). Resources from the “Statement of Commitment to Addressing and Combating the Effects of Racism on the Healthcare of Women and Children in Texas.”
- Standards for Respectful Care at Birth from the NYC Health Department
- AIM Bundle on Reduction of Peripartum Racial/Ethnic Disparities
- Implicit Bias Training from the March of Dimes
- Strategies to Overcome Racism’s Impact on Pregnancy Outcomes from the National Birth Equity Collaborative and the Society for Maternal-Fetal Medicine
- Strategies to Provide Equitable Care During COVID-19 from the Society for Maternal-Fetal Medicine
Texas Department of State Health Services. (2021). Congenital Syphilis in Texas.
Texas Department of State Health Services, Division for Community Health Improvement. (2020). Healthy Texas Mothers and Babies Data Book.
Texas Department of State Health Services. (2020). Pregnancy Risk Assessment Monitoring System (PRAMS) Survey website.
Texas Health and Safety Code. Diagnostic Testing During Pregnancy and After Birth.
U.S. Department of Health and Human Services, Office of the Surgeon General. (2020). The Surgeon General’s Call to Action to Improve Maternal Health.
U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. (2020). Substance Use in Women: Research Report.
U.S. Preventive Services Task Force. (2020). Final Recommendation Statement, Sexually Transmitted Infections: Behavioral Counseling.
U.S. Preventive Services Task Force. (2016). Depression in Adults: Screening, US Preventive Services Task Force Recommendation Statement.
Definitions
The medical definitions in this module were obtained or adapted from American Academy of Pediatrics, American Diabetes Association, Centers for Disease Control and Prevention, Cleveland Clinic, Healthline, Hematology/Oncology Clinics of North America, Journal of Women’s Health, March of Dimes, Mayo Clinic, Merck Manual, Merriam-Webster, Perception Institute, Substance Abuse and Mental Health Services Administration, and Texas Family Code.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing Continuing Professional Development
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.
Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hours of Nursing Continuing Professional Development.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1.00 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 1.00.
Licensed Marriage and Family Therapists
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is related to the practice of marriage and family therapy; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.
Licensed Professional Counselors
Up to 1.00 LPC hours may be earned at this event.
Social Workers
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.00 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
General Disclosure
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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Health-Care Providers
General Resources:
Alliance for Innovation on Maternal Health (AIM). (2022). Patient Safety Bundles.
Alliance for Innovation on Maternal Health (AIM). (2020). Urgent Maternal Warning Signs.
American Academy of Pediatrics & American College of Obstetricians & Gynecologists. Guidelines for Perinatal Care, Eighth Edition.
American Academy of Pediatrics. (2021). Supporting Children Who Have Experienced Trauma.
Centers for Disease Control and Prevention. (2022). Hear Her: Download Posters and Handouts for Healthcare Professionals.
Texas Department of State Health Services. (2022). Hear Her Texas.
Texas Health Steps, Periodicity Schedule.
Texas Medicaid Provider Procedures Manual.
U.S. Department of Health and Human Services, Office of the Surgeon General. (2020). The Surgeon General’s Call to Action to Improve Maternal Health.
Culturally Effective Health Care and Health Equity
American Academy of Family Physicians. (2021). The EveryONE Project: Implicit Bias Resources.
American College of Obstetricians and Gynecologists. (2020). Addressing Health Equity During the COVID-19 Pandemic.
American College of Obstetricians and Gynecologists. (2022). Our Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Women's Health Outcomes.
American Academy of Family Physicians. (2020). Eight tactics to identify and reduce your implicit biases.
American College of Obstetricians and Gynecologists, Council on Resident Education in Obstetrics and Gynecology (CREOG). (2022). CREOG Health Equity Curriculum.
American Medical Association. (2022). The AMA’s Strategic Plan to Embed Racial Justice and Advance Health Equity.
March of Dimes. (2021). Beyond Labels.
Texas Collaborative for Healthy Mothers and Babies. (2021). Resources from the “Statement of Commitment to Addressing and Combating the Effects of Racism on the Healthcare of Women and Children in Texas.”
- Standards for Respectful Care at Birth from the NYC Health Department
- AIM Bundle on Reduction of Peripartum Racial/Ethnic Disparities
- Implicit Bias Training from the March of Dimes
- Strategies to Overcome Racism’s Impact on Pregnancy Outcomes from the National Birth Equity Collaborative and the Society for Maternal-Fetal Medicine
- Strategies to Provide Equitable Care During COVID-19 from the Society for Maternal-Fetal Medicine
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. SDOH & Practice Improvement: Tools to Help Healthcare Organizations Address SDOH.
U.S. Department of Health and Human Services, Office of Minority Health. (2022). Culturally and Linguistically Appropriate Services (CLAS) in Maternal Health Care.
U.S. Department of Health and Human Services, Office of Minority Health. (n.d.). National Culturally and Linguistically Appropriate Services Standards.
Healthy Weight
National Child and Maternal Health Education Program. (2019). Pregnancy for Every Body.
National Institutes of Health, National Heart, Lung, and Blood Institute. (2022). Calculate Your Body Mass Index.
Hypertension and Pregnancy
American College of Obstetricians and Gynecologists. (2021). Practice Advisory: Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality.
Preeclampsia Foundation. Click “Store” on the upper right to order free educational illustrated signs and symptoms pads in English and Spanish to help patients understand the signs of preeclampsia.
Texas Department of State Health Services. (2020). Severe Hypertension in Pregnancy Bundle.
Mental Health
National Child and Maternal Health Education Program. (2019). Moms’ Mental Health Matters.
Texas Department of State Health Services, Healthy Texas Mothers and Babies (HTMB) Programs. Perinatal Depression Series, DSHS Grand Rounds.
Texas Health and Human Services Commission. (2022). Texas Clinician’s Postpartum Depression Toolkit. The Toolkit covers screening, treatment, coverage and reimbursement.
Texas Health and Human Services Commission. Local Mental Health Authorities (LMHAs) and Local Behavioral Health Authorities (LBHAs) contact information.
Texas Health Steps Periodicity Schedule.
Texas Health Steps, Eight validated, standardized mental health screening tools.
Oral Health and Pregnancy
American College of Obstetricians and Gynecologists. (2019). Committee Opinion 569: Oral Health Care During Pregnancy and Through the Lifespan.
American Dental Association. (2022). Oral health information for primary care providers treating pregnant women.
Texas Health and Human Services Commission. (2021). Information for Prenatal and Dental Providers.
Texas Medicaid & Healthcare Partnership (TMHP), Online Provider Search web page to locate Texas Health Steps dental providers in a specific geographic area.
Sexually Transmitted Disease
Texas Department of State Health Services. (2022). Congenital Syphilis—A Call to Action: Rising Rates of Congenital Syphilis in Texas.
Texas Department of State Health Services. (2022). Congenital Syphilis—Provider Resources.
Texas Department of State Health Services. (2021). Congenital Syphilis in Texas.
Texas Department of State Health Services. (2021). Disease Reporting.
Texas Department of State Health Services. (2021). Notifiable Conditions.
Smoking Cessation
American College of Obstetricians and Gynecologists. (2022). Tobacco and Nicotine Cessation During Pregnancy.
Centers for Disease Control and Prevention. Smoking Cessation: Fast Facts.
Texas Department of State Health Services. Yes Quit, including the toll-free 877-937-7848 (877-Yes-Quit) Quit line, available 24/7.
U.S. Department of Health and Human Services, National Cancer Institute. SmokefreeTXT is a 24/7 program that offers tips, advice and encouragement to help individuals quit smoking. Patients can sign up for the service on the National Cancer Institute’s Smoke Free Women website, which also offers a Pregnancy & Motherhood web page with resources.
U.S. Department of Health and Human Services. Smokefree.gov.
Substance Use and Pregnancy
American College of Obstetricians and Gynecologists. (2021). Committee Opinion 711: Opioid Use and Opioid Use Disorder in Pregnancy.
American Academy of Pediatrics. (2016). Substance Use Screening, Brief Intervention, and Referral to Treatment.
American College of Obstetricians and Gynecologists. Fetal Alcohol Spectrum Disorders (FASD) Prevention Program.
Centers for Disease Control and Prevention. (2022). Substance Use During Pregnancy.
Council on Patient Safety in Women's Health Care. Patient Safety Bundles, including Obstetric Care for Women with Opioid Use Disorder.
National Organization on Fetal Alcohol Syndrome (NOFAS). The Circle of Hope: A Mentoring Network for Birth Mothers.
National Organization on Fetal Alcohol Syndrome (NOFAS). Light Drinking During Pregnancy web page includes information and a video about the fact there is no known safe amount of alcohol to drink while pregnant.
NOFAS also offers a web page with Tools for Parents and Caregivers.
Provider’s Clinical Support System for Medication Assisted Treatment, a national training and mentoring project developed in response to the prescription opioid misuse epidemic and the availability of newer pharmacotherapies to address opioid use disorder.
Texas Health and Human Services Commission. Find Your Local Mental Health or Behavioral Health Authority.
Texas Health and Human Services Commission. Outreach, Screening, Assessment, and Referral Centers (OSARs).
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). Offers clinical guidance for treating pregnant women with opioid use disorder and their infants as well as Treatment Improvement Protocol (TIP) guides for addressing fetal alcohol spectrum disorders (FASD) and women and substance abuse.
Thyroid
American Thyroid Association. Offers (for a small fee) its Thyroid Disease During Pregnancy GUIDELINES Pocket Guide.
American Thyroid Association. Thyroid Disease in Pregnancy.
U.S. Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Thyroid Disease & Pregnancy.
Vaccinations
Centers for Disease Control and Prevention. (2019). Pregnancy and Vaccination: Toolkit for Prenatal Care Providers.
Centers for Disease Control and Prevention. (2021). COVID-19 Vaccines While Pregnant or Breastfeeding.
Centers for Disease Control and Prevention. (2021). Vaccines During and After Pregnancy.
Wellness and Pregnancy
5-2-1-0 Healthy Habits Toolkit for Maternal and Child Health Care Providers, offers a Healthy Habits During Pregnancy Questionnaire and breastfeeding toolkits for families and health-care providers.
American College of Obstetricians and Gynecologists. (2022). Nutrition During Pregnancy.
Before, Between, and Beyond Pregnancy. (2018). Resource Guide for Clinicians. National Preconception Health and Health Care Initiative.
Centers for Disease Control and Prevention. Preconception Health and Health Care web page with a wealth of information about reproductive health.
Texas Department of State Health Services. TexasAIM safety bundles.
Text4Baby.org. Pregnant women can sign up to receive free text messages to help keep themselves healthy during pregnancy and to help keep their infants healthy after birth. Tips are timed with the baby’s gestation, and texts continue through the baby’s first year.
Zika
Centers for Disease Control and Prevention. Areas with Risk for Zika.
Centers for Disease Control and Prevention. Pregnancy & Zika Testing guidance web tool for health-care providers.
Centers for Disease Control and Prevention. Zika and Pregnancy: Caring for Pregnant Women.
Other Resources
American Academy of Pediatrics. Trauma Toolbox for Primary Care.
Texas Department of State Health Services. (2021). Obstetric-Hemorrhage Bundle.
Texas Department of State Health Services, Texas Health Steps. Adolescent Health: A Guide for Providers.
Texas Health and Human Services Commission. Medical Transportation Program services may be available for emergency transportation of patients enrolled in Medicaid and the Children with Special Health Care Needs Services Program.
Texas Health and Human Services Commission. Case Management for Children & Pregnant Women.
Texas Health and Human Services Commission. Family Violence Program provides emergency shelter and support services to victims and their children, educates the public, and provides training and prevention support to various agencies.