Ultima Revisione:
Ultima Modifica: 29.06.2018.
Screening in gravidanza

La gravidanza corrisponde al periodo compreso tra il concepimento e la nascita del bambino dopo il suo accrescimento nell'utero materno. La donna in gravidanza o che progetta una gravidanza deve di solito sottoporsi a molteplici esami, molti dei quali di laboratorio. I test di laboratorio forniscono molte informazioni utili dal momento in cui la gravidanza viene progettata fino alla nascita del bambino.

L’obiettivo dei test prenatali è quello di ricercare e diagnosticare qualsiasi problema che possa alterare la salute della madre o del bambino, identificarlo, e se possibile risolverlo, prima che si manifesti ed anche determinare il rischio di avere un figlio con anomalie cromosomiche o genetiche. Questi test generalmente richiedono solo un piccolo campione (facilmente ottenibile) di sangue, di urine o di cellule del collo dell’utero.

Alcuni di questi test sono eseguiti prima della gravidanza o durante la gravidanza secondo un calendario preciso. Altri sono prescritti in caso di necessità, per determinare e risolvere alcune patologie o problemi che sopraggiungono durante la gravidanza. Altri ancora sono prescritti alle donne a rischio per particolari patologie/condizioni cliniche, a causa della loro età o del loro stile di vita, o sulla base della della storia clinica, personale e familiare della donna o della coppia.

La tabella seguente contiene informazioni schematizzate e riassunte, circa i test di routine e speciali che il medico può richiedere. E’ possibile che il medico richieda esami aggiuntivi, che qui non sono elencati, sulla base della storia clinica della paziente. E’ opportuno parlare col proprio medico circa ogni dubbio che possa insorgere.

Test di screening in gravidanza

Il medico può aiutare la paziente a capire rischi e benefici di ogni test.

Obiettivo

Nome del test

Perché viene eseguito

Quando viene eseguito

Su chi e su quale campione viene eseguito

Test genetici per patologie ereditarie

Test genetici per malattie ereditarie

Verificare se i genitori siano portatori di alcune patologie genetiche per determinare il rischio che il bambino sia malato

Pre-concepimento o durante il primo trimestre

Entrambi i genitori (campione di sangue)

Test genetici per emoglobinopatie

Verificare se i genitori siano portatori di alcune varianti emoglobiniche per determinare il rischio che il bambino sia malato

Pre-concepimento o durante la gravidanza

Entrambi i genitori (campione di sangue)

Fibrosi cistica (portatori)

Verificare se i genitori siano portatori di CF

Pre-concepimento o durante il primo trimestre

Entrambi i genitori (campione di sangue)

Esami associati alle condizioni di salute della madre che possono influenzare la gravidanza

Immunità alla rosolia

Testare l’immunità al virus (un’infezione può causare danni al nascituro)

Pre-concepimento o durante il primo trimestre. Se non si è immuni da ripetere nel secondo trimestre.

Madre (campione di sangue)

Glicemia e Emoglobina glicata

Rilevare donne affette da diabete di tipo 2 (diverso dal diabete gestazionale)

Pre-concepimento o durante il primo trimestre

Madre (campione di sangue)

Test per gli anticorpi anti HIV (virus dell’immunodeficienza umana)

Rilevare la presenza del virus nella madre, ridurre la probabilità di infettare il nascituro

Pre-concepimento o durante il primo trimestre. Può essere ripetuto durante il terzo trimestre se il rischio è alto

Madre (campione di sangue)

Gonorrea, clamidia e test della sifilide

Rilevare la presenza di infezioni sessualmente trasmesse (IST) nella madre, che possono causare aborto o infezioni nel neonato durante il parto

Pre-concepimento o durante il primo trimestre. Può essere ripetuto durante il terzo trimestre se il rischio è alto

Madre (cellule della cervice, urine o sangue, dipende dal test)

Pap test e HPV test

Rilevare il cancro del collo dell'utero o altre IST

Pre-concepimento o durante il primo trimestre (se non effettuato nei tre anni precedenti)

Madre (cellule del collo dell’utero)

Screening per l’epatite B e C

Rilevare la presenza di infezione da HBV o HCV nella madre

Pre-concepimento o durante il terzo trimestre.

Madre (campione di sangue)

Test sulla varicella zoster

Testare l’immunità contro la varicella, che può determinare difetti al nascituro

Pre-concepimento o durante il primo trimestre.

Madre (campione di sangue)

Pannello TORCH

Rilevare toxoplasmosi e per altre infezioni che possono causare danni al nascituro

Pre-concepimento o durante il primo trimestre, se si sospetta l’infezione

Madre (campione di sangue)

Vaginite batterica

Rilevare la presenza dell’infezione, che può determinare un parto pre-termine

Pre-concepimento o alla comparsa dei sintomi

Madre (secrezioni vaginali)

Urinocoltura

Rilevare infezioni batteriche del tratto urinario, che possono portare a infezioni renali o ad un aumento del rischio di parto pre-termine e scarso peso alla nascita

Alla prima visita prenatale o fra la 12° e la 16° settimana; può essere ripetuto nel terzo trimestre

Madre (campione di urine)

Streptococchi di gruppo B

Determinare la presenza di infezioni, che possono danneggiare il bambino durante la nascita e infettare l’utero materno, il tratto urinario e ogni incisione eseguita per il cesareo 

Tra la 35° e la 37° settimana di gravidanza

Madre (tampone prelevato dalla vagina o dal retto)

Conferma e monitoraggio della gravidanza e della salute della madre

Test di gravidanza (hCG)

Confermare la gravidanza

Primo trimestre

Madre (campione di sangue o di urina)

Glucosio e/o proteine urinarie

Ricerca della presenza di segni di infezioni renali o vescicali, diabete gestazionale o pre-eclampsia

Durante tutta la gravidanza

Madre (campione di urine)

Emocromo

Rilevare un'eventuale anemia e/o bassa conta piastrinica

Durante tutta la gravidanza

Madre (campione di sangue)

Tipizzazione RH e screening anticorpale

Rilevare un'eventuale incompatibilità materno-fetale

Primo trimestre

Madre (campione di sangue)

TSH

Nelle donne con patologie tiroidee accertate, per l'eventuale modifica dei farmaci

Ad ogni visita

Madre (campione di sangue)

Curva da carico con 75g di glucosio

Rilevare il diabete gestionale

Tra la 14° e la 18° settimana e tra la 24° e la 27° settimana (se a rischio)

Madre (campione di sangue)

Determinazione della presenza di anomalie fetali o del rischio associato

Screening del primo trimestre per le anomalie cromosomiche

Determinare il rischio di avere un feto affetto da certe anomalie cromosomiche, come la sindrome di Down  

Di solito tra la 11° (+0 g.) e la 13° (+6 g.) settimana

Madre (campione di sangue ed ecografia con translucenza nucale)

Screening del secondo trimestre per le anomalie cromosomiche

Determinare il rischio di essere portatori di un feto con anomalie cromosomiche o difetti del tubo neurale

Tra la 15° (+0 g.) e la 20° (+0 g.) settimana di gravidanza

Madre (campione di sangue)

DNA fetale libero circolante (cffDNA)

Determinare il rischio di avere un feto affetto da anomalie cromosomiche; raccomandato per le donne a rischio.  

Durante o dopo la 10° settimana di gravidanza

Madre (campione di sangue)

Analisi dei villi coriali (villocentesi)

Rilevare la presenza di anomalie cromosomiche nel feto

Tra la 10° e la 12° settimana di gravidanza, se raccomandato 

Madre (cellule della placenta)

Analisi del liquido amniotico

Rilevare la presenza di anomalie cromosomiche

Tra la 15° e la 20° settimana di gravidanza, se raccomandato 

Madre (liquido amniotico)

Cordocentesi

Rilevare la presenza di anomalie cromosomiche, patologie ematiche e certi tipi di infezione

Tra la 18° e la 22° settimana di gravidanza, se raccomandato 

Madre/feto (sangue fetale ottenuto da una vena del cordone ombelicale)

Maturità fetale

Analisi del liquido amniotico

Determinare lo sviluppo dei polmoni fetali

Dopo la 32° settimana di gravidanza se c’è il rischio di parto pre-termine

Madre (liquido amniotico)

Fibronectina fetale (fFN)

Rilevare la presenza di fFN; un risultato negativo è altamente predittivo dell'assenza di parto nei 7-14 giorni successivi

Tra la 22° e la 35° settimana di gravidanza, in caso di sintnomi di parto pre-termine

Madre (campioni di secrezioni vaginali o cervicali)

Fonti
Fonti utilizzate nella revisione corrente

(©2015) Stanford Children's Health. For Your Health. Available online at http://www.stanfordchildrens.org/en/health-topics?. Accessed October 2015.

(©January 2014) American College of Obstetricians and Gynecologists. Pregnancy, Frequently Asked Questions. Available online at http://www.acog.org/-/media/For-Patients/faq133.pdf?dmc=1&ts=20150917T1442554275. Accessed October 2015.

(September 27, 2010) Womenshealth.gov. Pregnancy, Prenatal Care and Tests. Available online at http://www.womenshealth.gov/pregnancy/you-are-pregnant/prenatal-care-tests.html. Accessed October 2015.

(June 29, 2015) American Academy of Pediatrics. Tests and Screenings during Pregnancy. Available online at https://www.healthychildren.org/English/ages-stages/prenatal/Pages/Tests-During-Pregnancy.aspx. Accessed October 2015.

(March 2015) March Of Dimes. Prenatal Tests. Available online at http://www.marchofdimes.org/pregnancy/prenatal-tests.aspx. Accessed October 2015.

(July 31, 2015) Centers for Disease Control and Prevention. Preconception Health and Health Care, Information for Health Professionals. Available online at http://www.cdc.gov/preconception/hcp/index.html. Accessed October 2015.

(August 25, 2105) Centers for Disease Control and Prevention. During Pregnancy. Available online at http://www.cdc.gov/pregnancy/during.html. Accessed October 2015.

(©November 2013) American College of Obstetricians and Gynecologists. Hepatitis B and Hepatitis C during Pregnancy. Available online at http://www.acog.org/~/media/For%20Patients/faq093.pdf. Accessed October 2015.

(April 2011) American College of Obstetricians and Gynecologists. Committee Opinion, Update on Carrier Screening for Cystic Fibrosis. Available online at http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Genetics/Update-on-Carrier-Screening-for-Cystic-Fibrosis. Accessed October 2015.

(July 2013) Centers for Disease Control and Prevention. STDs during Pregnancy - CDC Fact Sheet. Available online at http://www.cdc.gov/std/pregnancy/stdfact-pregnancy.htm. Accessed October 2015.

(July 2013) Eunice Kennedy Shriver National Institute of Child Health and Human Development. Preconception Care and Prenatal Care: Condition Information. Available online at https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/Pages/default.aspx. Accessed October 2015.

(March 2015) March Of Dimes. Antepartum Assessment & Laboratory Evaluation: The First Visit. Available online at https://www.marchofdimes.org/nursing/index.bm2?cid=00000003&spid=ne_m3_3&tpid=ne_m3_3_1_10_1.4#hep_c. Accessed October 2015.

©2015) American Pregnancy Association. Prenatal Testing. Available online at http://americanpregnancy.org/prenatal-testing/. Accessed October 2015.

(July 2008) U.S. Preventive Services Task Force. Asymptomatic Bacteriuria in Adults: Screening. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/asymptomatic-bacteriuria-in-adults-screening. Accessed October 2015.

(April 2012) National Institute of Diabetes and Digestive and Kidney Diseases. Pregnancy and Thyroid Disease. Available online at http://www.niddk.nih.gov/health-information/health-topics/endocrine/pregnancy-and-thyroid-disease/Pages/fact-sheet.aspx. Accessed October 2015.

(September 2015) American College of Obstetricians and Gynecologists. Committee Opinion, Cell-free DNA Screening for Fetal Aneuploidy. Available online at http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Genetics/Cell-free-DNA-Screening-for-Fetal-Aneuploidy. Accessed October 2015.

Fonti utilizzate nelle precedenti revisioni

HI5: Pregnancy Tests, ©2000 by AACC.

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

(2002 February). Rubella. March of Dimes Quick Reference Fact Sheets [On-line information]. Available online at http://www.marchofdimes.com/professionals/14332_1225.asp.

Yen, S. (2003 October 31). Bacterial Vaginosis More Prevalent Than Previously Thought. ACOG News Release [On-line press release]. Available online through http://www.acog.org.

(2002 November 29). ACOG Advises Screening All Pregnant Women for Group B Strep. ACOG News Release [On-line press release]. Available online through http://www.acog.org.

Macones, G., Reviewed (2000 August). Prenatal Tests. KidsHealth for Parents, Nemour Foundation [On-line information]. Available online at http://kidshealth.org/parent/system/medical/prenatal_tests.html.

(2005). Your First Tests. March of Dimes [On-line information]. Available online at http://www.marchofdimes.com/pnhec/159_519.asp.

(2000). Routine Tests During Pregnancy. Medem Medical Library, American College of Obstetricians and Gynecologists [On-line information]. Available online through http://www.medem.com.

(2000 November). Pre-pregnancy Planning. March of Dimes [On-line information]. Available online at http://www.marchofdimes.com/professionals/14332_1156.asp.

(2003). Toxoplasmosis, an Important Message for Women. CDC [On-line brochure]. Available online through http://www.cdc.gov.

(2002 November). Pregnancy After 35. March of Dimes Quick Reference and Fact Sheets [On-line information]. Available online at http://www.marchofdimes.com/professionals/14332_1155.asp.

Ghidini, A. and McLaren, R. (2002 April 18). Patient information: Chorionic villus sampling. UpToDate Patient Information [On-line information]. Available online through http://patients.uptodate.com.

Ghidini, A. (2004 November 1). Patient information: Amniocentesis [On-line information]. Available online through http://patients.uptodate.com.

Stewart, D. (2003 July 25, Updated). Genetics. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/002048.htm.

Norek, S. (1999 June). Common Genetic Diseases in the Ashkenazi Jewish Population. The Jewish Magazine [On-line Magazine Article]. Available online at http://www.jewishmag.com/22MAG/disease/disease.htm.

(2005). Maternal Serum Screening. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online through http://www.aruplab.com.

Preeclampsia Foundation: About Preeclampsia. Available online at http://www.preeclampsia.org/about.asp through http://www.preeclampsia.org.

Familydoctor.org: Preeclampsia. Available online at http://familydoctor.org/064.xml.

MedlinePlus Medical Encyclopedia: Preeclampsia. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000898.htm.

Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 651-652.

(2004 June). Maternal Blood Screening for Down Syndrome and Neural Tube Defects. March of Dimes [On-line information]. Available online at http://www.marchofdimes.com/professionals/681_1166.asp. Accessed on 2/25/07.

Prenatal tests. Reviewed Jul 2005. Nemours Foundation. Available online at http://kidshealth.org/parent/pregnancy_newborn/pregnancy/prenatal_tests.html. Accessed 17 Dec 2007.

Preconception care questions and answers: Professionals. 12 Apr 2006. US Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/ncbddd/preconception/QandA_providers.htm. Accessed 18 Dec 2007.

The Art and Science of Diabetes Self-Management Education. Mensing C, ed. American Association of Diabetes Educators: Chicago. Pp 237 and 780.

American Diabetes Association. Preconception care of women with diabetes (position statement). Diabetes Care. Jan 2004;27 Suppl 1:S76-8.

Diabetes and pregnancy FAQ. 5 Oct 2005. US Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/ncbddd/bd/diabetespregnancyfaqs.htm#whatcanhappentoawoman. Accessed 18 Dec 2007.

Diabetes in pregnancy. Sep 2006. March of Dimes. Available online at http://www.marchofdimes.com/professionals/19695_1197.asp. Accessed 18 Dec 2007.

Guidelines for the use of antiretroviral agents in pediatric HIV Infection. 25 Oct 2006. Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children, National Institutes of Health. PDF available for download at http://www.aidsinfo.nih.gov/ContentFiles/PediatricGuidelines.pdf. Accessed 27 Dec 2007.

Sexually transmitted diseases treatment guidelines 2006: special populations. Last reviewed 30 Nov 2007. US Centers for Disease Control and Prevention 4 Aug 2006. MMWR 55(RR-11). Available online at http://www.cdc.gov/std/treatment/2006/specialpops.htm. Accessed 14 Dec 2007.

STDs and pregnancy (fact sheet). Content reviewed May 2004. US Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/std/STDFact-STDs&Pregnancy.htm. Accessed 14 Dec 2007.

How to prevent sexually transmitted diseases (education phamphlet AP009). American College of Obstetricians and Gynecologists. Available online at http://www.acog.org/publications/patinet_education/bp009.cfm. Accessed 14 Dec 2007.

Preconception care questions and answers: General Public. 12 Apr 2006. US Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/ncbddd/preconception/QandA.htm. Accessed 24 Jan 2008.

Bacterial vaginosis: complications. Last updated 2 Jul 2007. National Institute of Allergy and Infectious Diseases. Available online at http://www3.niaid.nih.gov/healthscience/healthtopics/bacterialVaginosis/complications.htm. Accessed 18 Dec 2007.

About amniocentesis. Emory University School of Medicine, Department of Human Genetics. PDF available for download at http://www.genetics.emory.edu/pdf/Emory_Human_Genetics_Amniocentesis.PDF. Accessed 18 Dec 2007.

Percutaneous umbilical blood sampling. Last updated Sep 2003. University of North Carolina Center for Maternal and Infant Health. Available online at http://www.mombaby.org/index.php?c=-1&s=14&p=45. Accessed 27 Dec 2007.

Cordocentesis. Last updated Feb 2006. American Pregnancy Association. Available online at http://www.americanpregnancy.org/prenataltesting/cordocentesis.html. Accessed 27 Dec 2007.

University of North Carolina Center for Maternal and Infant Health. Available online at http://www.mombaby.org/index.php?c=-1&s=14&p=45. Accessed 27 Dec 2007.

U.S. Preventive Services Task Force. Screening for Bacterial Vaginosis in Pregnancy to Prevent Preterm Delivery: U.S. Preventive Services Task Force Recommendation Statement. 5 February 2008 | Volume 148 Issue 3 | Pages 214-219. Available online at http://www.annals.org/cgi/content/full/148/3/214.

U.S. Preventive Services Task Force (USPSTF). Recommendations and Rationale: Screening for Gestational Diabetes Mellitus. Release Date: February 2003. Available online at http://www.ahrq.gov/clinic/3rduspstf/gdm/gdmrr.htm.

American Association of Clinical Endocrinologists. Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus. Endocrine Practice Vol 13 (Suppl 1) May/June 2007. PDF available for download at http://www.aace.com/pub/pdf/guidelines/InpatientDiabetesPositionStatement.pdf.

March of Dimes. Your Checkup before Pregnancy. Available online at http://www.marchofdimes.com/pnhec/173_27541.asp. Accessed April 2008.

American College of Obstetricians and Gynecologists. Good Health Before Pregnancy: Preconceptional Care. ACOG Educational Pamphlet AP056. Available online at http://www.acog.org/publications/patient_education/bp056.cfm. Accessed April 2008.

Centers for Disease Control and Prevention. Preconception Health are Care, 2006. PDF available for download at http://www.cdc.gov/ncbddd/preconception/documents/At-a-glance-4-11-06.pdf. Accessed April 2008.

National Institute of Child Health and Human Development. Preconception Care. Available online at http://www.nichd.nih.gov/health/topics/preconception_care.cfm. Accessed April 2008.

Freda MC, Moos MK, Curtis M. The History of Preconception Care: Evolving Guidelines and Standards. Maternal and Child Health Journal. Published online 19 May 2006. Available online at http://www.springerlink.com/content/t3007lt83nkl1375/fulltext.html. Accessed April 2008.

Campbell KP, Chattopadhyay S. Asymptomatic bacteriuria evidence-statement: screening. In: Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.

U.S. Preventive Services Task Force. USPSTF Reaffirms Recommendations for Asymptomatic Bacteriuria Screening. Annals of Internal Medicine. 1 July 2008. Volume 149, Issue 1. Pp 43-47.

U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008 May 20; 148:759.

Hillier TA et al. Screening for gestational diabetes mellitus: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008 May 20; 148:766.

American Diabetes Association. Standards of Medical Care in Diabetes—2011. Diabetes Care January 2011, 34: S11-S61. Available online at http://care.diabetesjournals.org/content/34/Supplement_1/S11.full./p>

Metzger BE et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-82.

Womenshealth.org. Prenatal care and tests. Available online at http://www.womenshealth.gov/pregnancy/you-are-pregnant/prenatal-care-tests.cfm. Accessed March 2012.

March of Dimes. Rubella (German Measles). Available online at http://www.marchofdimes.com/pregnancy/complications_rubella.html. Accessed March 2012.

March of Dimes. Fetal Fibronectin (fFN): A Test for Premature Delivery. Available online at http://www.marchofdimes.com/prematurity/1149.asp. Accessed March 2012.

Centers for Disease Control and Prevention. STD Facts – STDs & Pregnancy. Available online at http://www.cdc.gov/std/pregnancy/STDFact-Pregnancy.htm. Accessed March 2012.

Centers for Disease Control and Prevention. Implementation of newborn hepatitis B vaccination—worldwide, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(46):1249–1252. Available online at http://www.ncbi.nlm.nih.gov/pubmed/19023261. Accessed March 2012.

Centers for Disease Control and Prevention. GBS Prevention in Newborns. Available online at http://www.cdc.gov/groupbstrep/about/prevention.html. Accessed March 2012.

American Academy of Family Physicians. Caring for Pregnant Women and Newborns with Hepatitis B or C – November 15, 2010. Available online at http://www.aafp.org/afp/2010/1115/p1225.html#afp20101115p1225-b2. Accessed March 2012.

MayoClinic.com. Cordocentesis. Available online at http://www.mayoclinic.com/health/percutaneous-umbilical-blood-sampling/MY00147/METHOD=print. Accessed March 2012.

National Guideline Clearinghouse. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Available online at http://guidelines.gov/content.aspx?id=12507&search=acog+glucose+tolerance. Accessed March 2012.

U.S. Preventive Services Task Force. Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement [DRAFT]. Available online at http://www.uspreventiveservicestaskforce.org/draftrec2.htm. Accessed June 15, 2013.

(December 2012) American College of Obstetricians and Gynecologists. Committee Opinion: Noninvasive Prenatal Testing for Fetal Aneuploidy. Available online through http://www.acog.org. Accessed March 2014.

(April 4, 2013) Position Statement from the Aneuploidy Screening Committee on Behalf of the Board of the International Society for Prenatal Diagnosis (ISPD). PDF available for download at http://www.ispdhome.org/public/news/2013/PositionStatementAneuploidy4apr2013.pdf. Accessed March 2014.

(June 1 2012) National Society of Genetic Counselors (NSGC). Noninvasive prenatal testing/noninvasive prenatal diagnosis: the position of the National Society of Genetic Counselors. Noninvasive Prenatal Testing/Noninvasive Prenatal Diagnosis (NIPT/NIPD), NSGC Executive Office. Available online at http://nsgc.org/p/bl/et/blogid=47&blogaid=33. Accessed March 2014.

(October 13, 2012) Mayo Clinic. First trimester screening: Results. Available online at http://www.mayoclinic.com/health/first-trimester-screening/MY00126/DSECTION=results. Accessed March 2014.

(February 23, 2103) Mayo Clinic. Noninvasive prenatal tests. Available online at http://www.mayoclinic.org/tests-procedures/noninvasive-prenatal-testing/basics/definition/prc-20012964. Accessed March 2014.

(March 08, 2014) Ricki Lewis. Fetal DNA Testing for Low-Risk Women Gets Mixed Reviews. Medscape Medical News. Available online at http://www.medscape.com/viewarticle/821690. Accessed March 2014.

Patel, S. and Reddy, D. (Updated 2012 September 18). Gestational Diabetes Testing Protocol. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2049380-overview. Accessed September 2014.

(2014 January). Standards of Medical Care in Diabetes 2014. Diabetes Care Volume 37, Supplement 1 [On-line information]. Available online at http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html. Accessed September 2014.

(2013 September). Gestational Diabetes. American College of Obstetricians and Gynecologists [On-line information]. Available online at http://www.acog.org/Patients/FAQs/Gestational-Diabetes. Accessed September 2014.

DeSisto, et al. Centers for Disease Control and Prevention. Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Available online at http://www.cdc.gov/pcd/issues/2014/13_0415.htm. Accessed September 2014.

July 25, 2013. Nainggolan, Lisa. ACOG Issues New Practice Bulletin on Gestational Diabetes. Available online at http://www.medscape.com/viewarticle/808409. Accessed October 2014.

U.S. Preventive Services Task Force. Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Available online at http://www.guideline.gov/content.aspx?id=47757&search=uspstf+diabetes#Section420. Accessed October 2014.