How many antenatal (prenatal) visits should a pregnant woman have?

Recommended Number of Antenatal Visits

For low-risk pregnancies, ACOG traditionally recommends 12-14 prenatal visits, though evidence demonstrates that 8-10 visits produce equivalent maternal and neonatal outcomes, and ACOG has endorsed reduced visit schedules since 2020. 1, 2

Standard Visit Schedule for Low-Risk Pregnancies

The traditional ACOG schedule includes: 3

• Monthly visits from initial presentation through 28 weeks' gestation
• Every 2 weeks from 28 to 36 weeks' gestation
• Weekly visits from 36 weeks until delivery

This schedule totals approximately 12-14 visits and has been maintained since 1930, despite limited evidence supporting its superiority over reduced schedules. 1

Evidence-Based Alternative: Reduced Visit Schedules

A meta-analysis of over 5,000 patients from high-income countries demonstrated equivalent maternal and neonatal outcomes when visits were reduced from 12-14 to 9 visits for low-risk patients. 1 International evidence further supports this approach:

• WHO recommends 8 contacts for a positive pregnancy experience 1
• Meta-analyses show 8-10 visits are sufficient for low-risk pregnancies when enhanced with telemedicine and remote monitoring 2
• Countries like France and the Netherlands average 7.5 visits, the UK has 9 visits, and Sweden has 10 visits—all with excellent maternal outcomes 2

Defining Low-Risk vs. High-Risk Pregnancy

Low-risk pregnancy is defined as one without: 2

• Medical conditions (diabetes, hypertension, cardiac disease, renal disease)
• Obstetric complications (prior preterm birth, prior cesarean, multiple gestation)
• Psychosocial factors threatening maternal or fetal health
• Adequate psychosocial support present

High-risk pregnancies require individualized, more frequent visits beyond standard schedules, with frequency determined by specific medical and psychosocial risk factors. 2, 3

Modified Schedules for High-Risk Conditions

For women with preeclampsia: 3

• Serial ultrasound evaluations every 2 weeks minimum for fetal growth, amniotic fluid, and umbilical artery Doppler from 24 weeks until birth
• Weekly or twice-weekly antenatal surveillance at 32-34 weeks' gestation

For women with suspected fetal growth restriction: 3

• Biweekly ultrasound assessments as the minimum interval for evaluating fetal growth

Critical Timing for Specific Assessments

Regardless of total visit number, certain assessments must occur at specific gestational ages: 3

• First trimester visit (ideally within 12 weeks) for risk assessment and early screening
• 24-28 weeks: Universal gestational diabetes screening
• 18-20 weeks: Anatomy ultrasound scan
• 28 weeks onward: Increased surveillance frequency as pregnancy advances

Important Clinical Caveats

Common pitfalls to avoid: 2

• Rigidly adhering to the 1930 visit schedule without evidence supporting its superiority—reduced schedules with enhanced services may improve patient satisfaction and reduce stress while maintaining safety
• Failing to distinguish between low-risk and high-risk pregnancies when determining visit frequency
• Overlooking psychosocial risk factors (intimate partner violence, substance use, housing insecurity, mental health disorders) that may require additional support services beyond standard prenatal visits 2

Key evidence considerations: 1, 4

• Recent trials indicate that fewer routine visits for low-risk women do not increase pregnancy risks, though they may lessen patient satisfaction in some populations
• Timely ANC initiation in the first trimester is a major driving force toward achieving adequate total visits—women with first-trimester initiation have 4.7 times higher odds of receiving eight contacts 5

Practical Implementation

For low-risk women in 2025: 2

• 8-10 visits can be safely implemented when enhanced with telemedicine and remote monitoring
• All prenatal care models must deliver core evidence-based services including nutrition education, psychosocial screening, and preparation for labor and delivery
• Women should be educated about warning signs of complications that require contact between scheduled visits

For high-risk women: 2, 6

• More frequent visits and specialized services are required, including home visiting programs, nutritional interventions, and case management
• Women with high-risk pregnancy at first ANC visit have increased occurrence of complications during pregnancy (OR 1.23) and labor/delivery (OR 1.24), necessitating close obstetric monitoring