What is the standard prescription format for Antenatal Care (ANC)?

Prescription Format for Antenatal Care (ANC)

The standard prescription format for antenatal care follows the WHO-recommended minimum of 8 contacts throughout pregnancy, with specific interventions prescribed at designated gestational ages based on risk stratification and evidence-based protocols. 1, 2

First Trimester Prescriptions (Before 16 weeks)

Universal Supplementation

• Folic acid 400-800 mcg (0.4-0.8 mg) daily starting preconception or as soon as pregnancy confirmed, continuing through first trimester 2, 3
• Potassium iodide 150 mcg daily for thyroid support 2
• Prenatal multivitamin containing 2.6 mcg vitamin B12 daily to prevent theoretical B12 deficiency concerns 3

Risk-Based Aspirin Prophylaxis

• Aspirin 81-150 mg daily starting before 16 weeks (optimally between 12-16 weeks) for women with major risk factors (prior preeclampsia, chronic hypertension, pregestational diabetes, BMI >30, chronic kidney disease, antiphospholipid syndrome) OR ≥2 minor risk factors (advanced maternal age, family history of preeclampsia, primiparity, connective tissue disorders) 1, 2
• Continue until 37 weeks gestation 1

Calcium Supplementation

• Calcium 1200 mg daily if dietary calcium intake is low in the local population 1, 2

High-Risk Folic Acid Dosing

For women at moderate risk (diabetes requiring medication, epilepsy on anticonvulsants, BMI ≥35, family history of neural tube defects):

• Folic acid 1.0 mg daily starting 3 months before conception through 12 weeks gestation 3
• Then reduce to 0.4-1.0 mg daily for remainder of pregnancy 3

For women at high risk (personal or partner history of neural tube defect, previous affected pregnancy):

• Folic acid 4.0 mg daily (requires separate folic acid tablets plus multivitamin, not multiple multivitamin doses) starting 3 months before conception through 12 weeks gestation 3
• Then reduce to 0.4-1.0 mg daily for remainder of pregnancy 3

Second Trimester Prescriptions (14-28 weeks)

Diabetes-Specific Care

For women with pregestational diabetes:

• Continue aspirin 81 mg daily (if started in first trimester) 1, 2
• Schedule fetal echocardiogram (diagnostic test, not prescription) 1, 2
• Maintain strict glycemic control with insulin as needed 1

Anemia Prevention

• Iron supplementation if indicated by hemoglobin testing around 30 weeks (not routine in well-nourished populations) 4
• Iron and folate combination in areas of high anemia prevalence 4

Third Trimester Prescriptions (28+ weeks)

Corticosteroids for Preterm Risk

For singleton pregnancies at 34 0/7 to 36 6/7 weeks with high risk of delivery within 7 days:

• Betamethasone 12 mg intramuscular, 2 doses 24 hours apart (single course only) 1
• Contraindicated in women with pregestational diabetes due to risk of worsening neonatal hypoglycemia 1
• Not recommended for multiple gestations, low likelihood of preterm delivery, or routine use 1

Hypertension Management in Diabetic Pregnancy

First-line antihypertensives (in order of preference):

• Labetalol (preferred beta-blocker, safe and effective) 5
• Methyldopa (alternative first-line) 5
• Long-acting nifedipine (alternative first-line) 5
• Avoid atenolol (associated with fetal growth restriction and lower birth weight) 5
• Avoid ACE inhibitors, ARBs, and chronic diuretics (teratogenic/harmful to fetus) 2, 5
• Target blood pressure: 110-135/85 mmHg 5

Preeclampsia Management

• Magnesium sulfate (MgSO4) must be available at community-level centers for prevention/treatment of eclampsia 1
• Specific dosing per institutional protocols for severe preeclampsia or eclampsia 1

Common Pitfalls to Avoid

• Do not prescribe multiple multivitamin tablets to achieve higher folic acid doses; use separate folic acid tablets to reach target dose 3
• Do not delay aspirin initiation beyond 16 weeks for preeclampsia prophylaxis, as efficacy decreases significantly 1, 2
• Do not prescribe late preterm corticosteroids to women with pregestational diabetes due to severe neonatal hypoglycemia risk 1
• Do not use atenolol for hypertension management in pregnancy despite being a beta-blocker 5
• Do not prescribe routine iron supplementation in well-nourished populations without documented anemia 4

Prescription Documentation Format

Each prescription should include:

• Medication name and dose
• Route of administration
• Frequency and timing
• Duration of therapy
• Gestational age at initiation
• Indication (risk factor or condition)
• Special instructions (e.g., "take with food," "continue until 37 weeks")

This structured approach ensures comprehensive, evidence-based antenatal care prescribing that addresses both universal needs and risk-stratified interventions throughout pregnancy. 1, 2, 5, 3