Recommended Prenatal Care for Pregnant Individuals
Comprehensive prenatal care should include early initiation of care, regular scheduled visits, appropriate screening tests, lifestyle modifications, and specialized care for high-risk conditions to optimize maternal and fetal outcomes.
Timing and Frequency of Prenatal Visits
- First prenatal visit should occur as early as possible in the first trimester, ideally before 12 weeks gestation 1
- Standard visit schedule includes monthly visits until 28 weeks, biweekly visits until 36 weeks, and weekly visits until delivery, totaling 12-14 visits during pregnancy 2
- Early initiation of prenatal care is associated with improved health outcomes for both women and newborns 3
- Modern approaches may include flexible models with some virtual visits, particularly for low-risk pregnancies 4
Essential Components of Prenatal Care
Initial Visit Assessment
- Complete medical history including reproductive history, previous pregnancy complications, chronic medical conditions, and medication use 2
- Physical examination focusing on periodontal, thyroid, heart, breast, and pelvic examinations 2
- Determination of estimated due date, ideally using first-trimester ultrasound 3
- Assessment of psychosocial concerns including screening for depression, anxiety, domestic violence, and major stressors 2
Laboratory Testing and Screening
- Initial laboratory testing should include complete blood count, urinalysis, blood type and screen 2
- Screening for infections including rubella, syphilis, hepatitis B, HIV, gonorrhea, and chlamydia 2
- Universal screening for gestational diabetes in mid-pregnancy (24-28 weeks), with additional early screening for those with risk factors 3
- Screening for chromosomal or genetic disorders based on family history, ethnic background, and age 2
Nutrition and Supplementation
- Prenatal vitamins with 400-800 mg of folic acid and 150 mg of potassium iodide should be prescribed prior to conception and continued throughout pregnancy 2
- Comprehensive nutrition assessment including recommendations for healthy weight management, meal planning, and correction of dietary deficiencies 2
- Promotion of adequate hydration and balanced nutrition with emphasis on "five-a-day" (two servings of fruit and three servings of vegetables) 2
Lifestyle Recommendations
- Regular moderate exercise appropriate for pregnancy 2
- Avoidance of alcohol, tobacco, recreational drugs, and other teratogenic substances 2
- Counseling on safe food preparation techniques 2
- Promotion of adequate sleep and avoidance of hyperthermia (hot tubs) 2
Specialized Care for High-Risk Conditions
Preexisting Diabetes
- Preconception care should aim for A1C <6.5% to reduce risks of congenital anomalies, preeclampsia, and preterm birth 2
- Multidisciplinary care team including endocrinologist, maternal-fetal medicine specialist, registered dietitian, and diabetes educator 2
- Fasting and postprandial glucose monitoring with targets of fasting glucose <95 mg/dL and either 1-hour postprandial glucose <140 mg/dL or 2-hour postprandial glucose <120 mg/dL 2
- Dilated eye examinations before pregnancy or in first trimester, then every trimester and for 1 year postpartum 2
Preeclampsia Prevention
- Low-dose aspirin (81-150 mg/day) starting at 12-16 weeks gestation for women at high risk of preeclampsia 2, 3
- Regular monitoring of blood pressure and proteinuria throughout pregnancy 2
Third Trimester Care and Delivery Planning
- Ultrasound for fetal growth assessment 2
- Antepartum fetal surveillance starting at 32-34 weeks for high-risk pregnancies 2
- Delivery timing based on maternal and fetal conditions:
- For uncomplicated pregnancies: offer induction at 41 weeks with recommendation for delivery before 42 weeks 3
- For women with diabetes and good glycemic control: deliver at 39 0/7 to 39 6/7 weeks 2
- For women with diabetes and poor glycemic control or vascular complications: deliver at 36 0/7 to 38 6/7 weeks 2
Common Pitfalls in Prenatal Care
- Delayed initiation of prenatal care - only 58.6% of pregnant individuals worldwide receive early antenatal care 5
- Inadequate screening for gestational diabetes, which can lead to undetected complications 3
- Failure to provide appropriate preconception counseling, especially for women with chronic conditions 2
- Lack of attention to mental health issues during pregnancy 1
- Insufficient focus on postpartum care planning and transition 2