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Prenatal Care

Prenatal care is the care a woman gets during pregnancy. Prenatal care should begin as soon as a woman knows for certain or suspects she is pregnant. Early and regular prenatal visits with a health care provider are important for the health of both the mother and the fetus.

During your first prenatal visit, your health care provider will probably talk to you about the following steps you can take to help ensure a healthy pregnancy:

Take folic acid.

Begin or continue to get at least 400 micrograms of folic acid by taking vitamin supplements and eating enriched foods every day to reduce your child’s risk of neural tube defects. Folic acid is found in enriched foods, such as bread, cereal, pasta, and other grain-based foods. A related form, called folate, occurs naturally in leafy, green vegetables and orange juice, but folate is not absorbed as well as folic acid. Also, it can be difficult to get all the folic acid you need from food alone. Most prenatal vitamins contain 400 micrograms of folic acid.

Avoid alcohol and tobacco.

Drinking alcohol and smoking during pregnancy can increase your child’s risk for problems such as fetal alcohol spectrum disorders (FASDs) and sudden infant death syndrome (SIDS, also called "crib death.").

FASDs are a variety of effects on the fetus that result from the mother drinking alcohol during pregnancy. The effects range from mild to severe, and they include intellectual disabilities; behavior problems; abnormal facial features; and disorders of the heart, kidneys, bones, and hearing. FASDs last a lifetime although early intervention services can help improve a child’s development. FASDs are completely preventable. If a woman does not drink alcohol while she is pregnant, her child will not have an FASD.

SIDS is the sudden, unexplained death of an infant younger than 1 year old. It is the leading cause of death in children between 1 month and 1 year of age. Most SIDS deaths happen when babies are between 2 months and 4 months of age. Drinking or smoking during pregnancy increases the risk of SIDS; also, infants exposed to secondhand smoke are at greater risk for SIDS.

Your health care provider can be a source of help if you find it hard to quit smoking or drinking on your own.

Talk to your health care provider about medications.

As many as half of women take four or more medications during pregnancy. Although many are safe, talk to your health care provider before taking any over-the-counter or prescription medication or herbal supplement. Certain medications to treat acne and epilepsy and some dietary or herbal supplements are not safe during pregnancy.

Avoid exposure to toxic substances.

During pregnancy, exposure to radiation, pesticides, some metals, and certain chemicals can cause birth defects, premature birth, and miscarriage. If you’re not sure if something might be harmful to you or your fetus, avoid contact with it until you check with your health care provider.

If you work in a job on a farm, a dry cleaner, a factory, a nail or hair salon, you might be around or come into contact with potentially harmful substances. Talk to your health care provider and your employer about how you can protect yourself before and during pregnancy. You may need extra protection at work or a change in your job duties to stay safe.

A few examples of exposures that are known to be toxic to the developing fetus are:

Many chemicals are commonly found in the blood and body fluids of pregnant women and their infants. However, much remains unknown about the effects of fetal exposure to chemicals. It’s best to be cautious about chemical exposure when you are planning to get pregnant or if you are pregnant. Talk to your health care provider if you live or work in or near a toxic environment.

Follow a healthy diet.

Choose a variety of fruits, vegetables, whole grains, and low-fat dairy products to help ensure the developing fetus gets all the nutrients it needs. Make sure you also drink plenty of water. 

Maintain a safe diet.

Avoid certain foods such as raw fish, undercooked meat, deli meat, and unpasteurized cheeses (for example, certain types of feta, bleu cheese, and Mexican-style soft cheeses). Always check the label to make sure the cheese is pasteurized.

Some pregnant women are concerned about the amount of fish they can safely consume. Certain fish contain methylmercury, when certain bacteria cause a chemical change in metallic mercury. Methylmercury is found in foods that fish eat, and it remains in the fish’s body after it is eaten. Methylmercury in fish eaten by pregnant women can harm a fetus’s developing nervous system. According to the U.S. Food and Drug Administration (FDA), pregnant women can eat up to 12 ounces a week of fish and shellfish that have low levels of methylmercury (salmon, canned light tuna, and shrimp). Albacore (“white”) tuna has more methylmercury than canned light tuna; pregnant women should consume 6 ounces or fewer in a week. Avoid fish with high levels of methylmercury (swordfish, king mackerel, and shark). 

Limit caffeine intake.

Some studies suggest that too much caffeine can increase the risk of miscarriage. Talk to your health care provider about the amount of caffeine you get from coffee, tea, or soda. Your health care provider might limit you to 200 milligrams (the amount in about two 8-ounce cups of coffee) per day. Keep in mind, though, that some of the foods you eat, including chocolate, contain caffeine and contribute to the total amount you consume each day.

Talk to your health care provider about getting physical activity.

Most women can continue regular levels of physical activity throughout pregnancy. Regular physical activity can help you feel better, sleep better, and prepare your body for birth. After your child is born, it can help get you back to your pre-pregnancy shape more quickly. Talk to your health care provider about the amount and type of physical activity that is safe for you.

Talk to your health care provider about taking vitamin B12 and iron supplements.

Iron supplements can help reduce your risk for anemia, an iron deficiency common during pregnancy. Your health care provider may also recommend a vitamin B12 supplement if you are a vegetarian or vegan.18

Get regular dental checkups.

Your gums are more likely to become inflamed or infected because of hormonal changes and increased blood flow during pregnancy.19 Make sure you tell your dentist if you think you could be pregnant.

Prenatal Visits

What happens during prenatal visits varies depending on how far along you are in your pregnancy.

Schedule your first prenatal visit as soon as you think you are pregnant, even if you have confirmed your pregnancy with a home pregnancy test. Early and regular prenatal visits help your health care provider monitor your health and the growth of the fetus.

The First Visit

Your first prenatal visit will probably be scheduled sometime after your eighth week of pregnancy. Most health care providers won’t schedule a visit any earlier unless you have a medical condition, have had problems with a pregnancy in the past, or have symptoms such as spotting or bleeding, stomach pain, or severe nausea and vomiting.

Because your first visit will be one of your longest, allow plenty of time.

During the visit, you can expect your health care provider to do the following:

(1) to determine your blood type and Rh (Rhesus) factor. Rh factor refers to a protein found on red blood cells. If the mother is Rh negative (lacks the protein) and the father is Rh positive (has the protein), the pregnancy requires a special level of care.

(2) to do a blood count—hemoglobin, hematocrit

(3) to test for hepatitis B, HIV, rubella, and syphilis.

Prenatal Visit Schedule

If your pregnancy is healthy, your health care provider will set up a regular schedule for visits that will probably look about like this:

Later Prenatal Visits

As your pregnancy progresses, your prenatal visits will vary greatly. During most visits, you can expect your health care provider to do the following:

Several of these visits will include special tests to check for gestational diabetes (between 24 and 28 weeks) and other conditions, depending on your age and family history.

Stress and Pregnancy

It is normal to feel some stress during pregnancy. Your body is going through many changes, and as your hormones change, so do your moods. Too much stress can cause you to have trouble sleeping, headaches, loss of appetite, or a tendency to overeat—all of which can be harmful to you and your developing baby.

High levels of stress can also cause high blood pressure, which increases your chance of having preterm labor or a low-birth-weight infant.

You should talk about stress with your health care provider and loved ones. If you are feeling stress because of uncertainty or fear about becoming a mother, experiencing work-related stress, or worrying about miscarriage, talk to your health care provider during your prenatal visits.

Posttraumatic Stress Disorder (PTSD) and Pregnancy

PTSD is a more serious type of stress that can negatively affect your baby. PTSD occurs when you have problems after seeing or going through a painful event, such as rape, abuse, a natural disaster, or the death of a loved one. You may experience:

PTSD occurs in as many as 8% of women during pregnancy, increasing their infant’s risk of preterm birth or low birth weight. PTSD also increases the risk for behaviors such as smoking and drinking, which contribute to other problems.

Reducing stress is important for preventing problems during your pregnancy and for reducing your risk for health problems that may affect your developing child. Identify the source of your stress and take steps to remove it or lessen it. Make sure you get enough exercise (under a doctor’s supervision), eat healthy foods, and get lots of sleep.

If you think you may be depressed, talk to your health care provider. Getting treatment and counseling can help.

Reference: National Institutes of Child Health and Human Development