A 27-year-old woman, gravida 2 para 1, at 10 weeks gestation comes to the office for an initial prenatal visit. The patient has had no cramping or vaginal bleeding. She was not expecting this pregnancy because she had an uncomplicated term vaginal delivery 6 months ago and breastfed for the first 4 months postpartum. She is taking a daily prenatal vitamin and has no chronic medical conditions. Blood pressure is 126/80 mm Hg and pulse is 76/min. BMI is 24 kg/m². The abdomen is soft, nontender, and nondistended. Pelvic ultrasound reveals a singleton intrauterine pregnancy at 10 weeks gestation with a fetal heart rate of 165/min. Hemoglobin is 10.4 g/dL. This patient is at increased risk for which of the following pregnancy-related complications?

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11ec25c8_da80_2246_bc81_43c6f18b96fc_MD0003_00 Pregnancy, delivery, and the postpartum period place increased physical and metabolic demands on women in order to develop and provide nutrition for the fetus and newborn. During pregnancy, maternal folate and iron are depleted for fetal development, and the resulting maternal anemia is exacerbated by normal blood loss during delivery (eg, up to 10%-20% of blood volume). In breastfeeding women, continued nutritional demands from the newborn prevent repletion of normal folate and iron stores, resulting in prolonged anemia (as seen in this patient). Due to these increased demands, women with short interpregnancy intervals (eg, <6-18 months between delivery and the next pregnancy) have an increased risk of pregnancy complications including low birthweight, preterm labor, and preterm prelabor rupture of membranes (possibly due to persistent genital tract inflammation). Therefore, appropriate pregnancy timing with interval contraception (eg, progestin-containing intrauterine device) is recommended for adequate maternal recovery and optimization for future pregnancies. (Choice A) Risk of gestational diabetes mellitus is increased with obesity, certain medical conditions (eg, polycystic ovary syndrome), and prior gestational diabetes mellitus, which are not seen in this patient. Risk is not increased by a short interpregnancy interval. (Choice B) Short interpregnancy intervals increase risk of preterm (not postterm) delivery. Risk factors for postterm pregnancies include nulliparity and prior postterm pregnancy. (Choice C) Risk of preeclampsia is increased by prior preeclampsia, comorbid medical conditions (eg, chronic hypertension, diabetes mellitus), and nulliparity-not by short interpregnancy intervals. (Choice E) A protracted labor course is more likely with advanced maternal age (age >35), fetal macrosomia, and an increased interpregnancy interval (eg, >24 months). Risk is not increased by a short interpregnancy interval. Educational objective: Short interpregnancy intervals (eg, <6-18 months between delivery and next pregnancy) are associated with an increased risk of pregnancy complications including preterm labor, preterm prelabor rupture of membranes, and low birth weight. References: Interpregnancy interval and obstetrical complications. (http://www.ncbi.nlm.nih.gov/pubmed/22990461)

A 27-Year-Old Woman, Gravida 2 Para 1, at 10 Weeks