What are the recommended prenatal care and interventions for each trimester of pregnancy?

Recommended Prenatal Care and Interventions for Each Trimester of Pregnancy

Comprehensive prenatal care should follow a trimester-specific approach focusing on maternal and fetal health monitoring, appropriate screenings, and interventions to optimize pregnancy outcomes and reduce morbidity and mortality.

Preconception Care

• Develop a reproductive life plan with patients, discussing timing of pregnancy and health optimization before conception 1
• Conduct comprehensive risk assessment including reproductive history, medical conditions, medication review, and genetic screening 1
• Prescribe daily folic acid supplementation (400-800 mcg) at least one month before conception to prevent neural tube defects 1, 2
• Update immunizations including hepatitis B, rubella, varicella, Tdap, and influenza vaccines as needed 1, 3
• Promote healthy prepregnancy weight (BMI 19.8-26.0 kg/m²) through exercise and nutrition 1, 3
• Screen for and treat chronic conditions like diabetes, hypertension, thyroid disorders, and asthma before pregnancy 1, 3
• Counsel on avoiding teratogenic medications, alcohol, tobacco, and recreational drugs 1, 3

First Trimester Care (Weeks 1-13)

• Confirm pregnancy and establish accurate dating through last menstrual period and early ultrasound 3, 4
• Complete comprehensive laboratory testing including:
  • Complete blood count, blood type and Rh status, urinalysis 1, 3
  • Screening for infections: rubella, syphilis, hepatitis B, HIV, gonorrhea, chlamydia 1, 3
  • Screening for asymptomatic bacteriuria 3, 5
• Offer genetic screening based on family history, ethnic background, and age 1, 3
• Continue daily prenatal vitamins with folic acid supplementation 3, 2
• Screen for depression, anxiety, intimate partner violence, and substance use 3, 4
• Provide counseling on expected physiological changes, nutrition, and exercise during pregnancy 3, 5
• Begin low-dose aspirin (81 mg daily) at 12 weeks for women at high risk of preeclampsia 3, 4

Second Trimester Care (Weeks 14-27)

• Monitor fetal growth through fundal height measurements and fetal heart rate assessment 3, 6
• Perform anatomical ultrasound between 18-22 weeks to assess fetal development 3, 6
• Screen for gestational diabetes between 24-28 weeks 3, 4
• Continue monitoring blood pressure and assess for signs of preeclampsia 3, 4
• Administer Rho(D) immune globulin at 28 weeks for Rh-negative women 3, 5
• Assess for cervical insufficiency with serial cervical length measurements if indicated 1, 3
• Consider vaginal progesterone for women with shortened cervical length (<25 mm) 1, 3
• Provide education on fetal movement monitoring and signs of preterm labor 3, 6

Third Trimester Care (Weeks 28-40)

• Continue regular assessment of maternal weight, blood pressure, and urine protein 3, 6
• Monitor fetal growth, position, and well-being through clinical examination and ultrasound if indicated 3, 6
• Screen for group B streptococcus between 35-37 weeks 3, 5
• Provide intrapartum antibiotic prophylaxis for GBS-positive women during labor 3, 5
• Discuss labor signs, delivery options, pain management, and postpartum care 3, 6
• Prepare for breastfeeding and newborn care 1, 3
• Consider timing of delivery based on maternal and fetal conditions, with recommendations for delivery at 39-40 weeks for uncomplicated pregnancies 3, 6

Special Considerations for High-Risk Pregnancies

• For women with preexisting diabetes: aim for A1C <6.5%, monitor fasting glucose (<95 mg/dL) and postprandial glucose levels (<140 mg/dL at 1 hour) 3, 4
• For women with chronic hypertension: maintain blood pressure <140/90 mmHg with pregnancy-safe medications like methyldopa if needed 3, 7
• For women with history of preterm birth: consider progesterone supplementation starting at 16-24 weeks 3, 5
• For women with multiple gestations: increase frequency of prenatal visits and ultrasound monitoring 3, 6
• For women with autoimmune conditions: coordinate care with specialists and adjust medications to pregnancy-safe alternatives 1, 3

Common Pitfalls to Avoid

• Delaying prenatal care initiation beyond 10 weeks, which is associated with poorer outcomes 3, 4
• Failing to screen for and treat iron deficiency anemia, which increases risks of preterm delivery and growth restriction 3, 5
• Missing opportunities for genetic counseling and screening in the appropriate timeframe 1, 3
• Inadequate monitoring of weight gain during pregnancy (recommended 25-35 lbs for normal BMI) 1, 3
• Overlooking mental health screening and support throughout pregnancy 3, 4
• Insufficient education about warning signs requiring immediate medical attention 3, 6