June 26, 2018
3 min read

AAP updates recommendations for prenatal visits

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Photo of Michael Yogman
Michael W. Yogman

AAP has updated its recommendations for pediatric prenatal visits during the third trimester, according to a recently published clinical report in Pediatrics.

“We encourage a pediatric prenatal visit in order to initiate a trusted pediatric relationship and the concept of the medical home during pregnancy,” Michael W. Yogman, MD, chief of the division of ambulatory pediatrics at Mt. Auburn Hospital, assistant clinical professor, Harvard Medical School, and chair of the AAP Committee on Psychosocial Aspects of Child and Family Health, told Infectious Diseases in Children. “We encourage obstetricians to refer all patients for these visits, especially those at high psychosocial risk and/or with perinatal depression.”

Yogman and colleagues on AAP’s Committee on Psychosocial Aspects of Child and Family Health updated a 2009 clinical report from AAP on the prenatal visit.

They reported that 78% of pediatricians offer a prenatal visit but only 5% to 39% of first-time parents attend such an appointment, according to survey results.

Only 5% of urban poor pregnant women were likely to visit a pediatrician during their prenatal period, even though they are at higher risk for adverse pregnancy outcomes, according to the report. The authors also noted that rural-dwelling pregnant women have difficulty accessing a prenatal visit.

Objectives of the report included providing a foundation to build a positive partnership between families and the pediatrician, measuring aspects of past obstetric and current prenatal history, reviewing genetic family history, introducing guidance about early infant care and safety and identifying psychosocial factors that could determine future family function and adjustment to the newborn.

The authors noted that the prenatal visit can include other adults, such as grandparents, to establish a relationship with the pediatrician.

Prenatal and family history should include information about pregnancy complications, parental depression and family medical and social history. Other topics that may be addressed during the visit include plans for feeding, circumcision, child care and work schedules, and the parents’ attitudes about complementary and alternative medications.

Areas of discussion during the initial meeting can include parents’ concerns, cultural and family beliefs, connection to community resources including child care, routines around delivery and nursery care at the hospital, the benefits of breastfeeding, screening the infant for infections and the benefits and risks of circumcision.

The prenatal visit is the ideal time for parents to learn what to expect from a pediatric visit and how the office operates, as well as the pediatrician’s expectation of the family, the authors wrote.

Other issues that could be addressed at the office visit include the safety and emotions of the newborn, as well as emotions of the parents.

The report also addressed types of prenatal visits. A full prenatal visit with both expectant parents would be the most comprehensive, with a nurse practitioner possibly having a significant role in the visit.

First-time parents, adolescent and young parents and parents who are anxious for any reason would benefit most from this type of visit, according to the authors. If a woman requires bed rest with a high-risk pregnancy, there could be a prenatal visit with one parent and telephone calls that would include the same information as the full prenatal visit.

A less formal meet-and-greet session is also an option and can include key staff members and a tour of the office, the authors said. This might be a possibility for parents before deciding a full prenatal visit.

If no prenatal visit is scheduled, the information can be re-sent at the newborn or first postnatal visit.

Regarding payment, there should be a discussion with the parents whether the visit will be covered by insurance or if a referral is required.

“Alternative means of minimizing the financial burden for families are suggested, although advocacy for payment by insurers is suggested,” Yogman said regarding low-income families.

Specific recommendations from the report include:

  • incorporating prenatal visits into the pediatric practice’s routine, with flexible services designed for the needs of expectant parents;
  • advocating for payments for prenatal visits based on short-term and long-term benefits of health outcomes for infants and parents;
  • sharing established practices on prenatal visits with local obstetrician, internists and family physicians;
  • teaching pediatric residents the importance of prenatal visits; and
  • increasing partnerships with obstetrics and gynecology physicians.

The authors also provided a list of sample questions to use in the prenatal visits, including:

  • asking about previous experience with infants;
  • if working, when parents intend to return to work;
  • whether siblings are adjusting to a new brother or sister;
  • if prenatal classes were included during pregnancy;
  • expectations of the infant;
  • plans for feeding the infant;
  • to specifically ask one question of the father or partner when appropriate; and
  • how the parents cope when they are stressed.

“This is the only routine child wellness visit recommended by AAP that doesn’t actually require a child in the room,” Arthur Levin, MD, FAAP, incoming chair of the AAP Committee on Psychosocial Aspects of Child and Family Health, said in a press release. “They can talk to the pediatrician before the fatigue of new parenthood sets in and there’s an adorably distracting little human in their arms who may be crying, spitting up or in immediate need of feeding or a diaper change.”

“This visit is about laying a foundation for a trusting, supportive relationship between the family and their pediatrician, who will work together to keep the child healthy for the next 18 or 20 years.” by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.