Prenatal Care

The major goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother. A suspected pregnancy should always be confirmed with either a urine or blood test.

The earliest signs and symptoms of pregnancy include absence of expected menstruation, breast fullness and tenderness, frequent urination, nausea and fatigue. However, there are often no symptoms.

The First Prenatal Appointment

At or prior to the first prenatal visit, the patient should complete a questionnaire detailing her:

Personal and demographic information
Past obstetrical history
Personal and family medical history
Genetic history
Menstrual history
Current pregnancy history

An estimated date of delivery can be calculated from the menstrual history or, if those dates are uncertain, a physical exam or ultrasound. The first prenatal visit is also a good time to discuss the expected course of pregnancy and delivery, including:

Number and frequency of prenatal visits
Recommendations for nutrition, weight gain, exercise, rest and sexual activity
Routine pregnancy monitoring (e.g., weight, blood pressure, uterine growth, fetal activity and heart rate)
Listeria and toxoplasmosis precautions
Abstinence from alcohol, cigarettes and illicit drugs
Safety of commonly used nonprescription drugs
Recommendation to continue wearing three-point seat belts during pregnancy
Precautions for travel, work outside of the home or hobbies
Signs and symptoms to be reported (e.g., vaginal bleeding, ruptured membranes, contractions, decreased fetal activity)

Patients with substance abuse problems will be strongly advised of the risks of this behavior and referred to cessation programs.

Important Information

Dietary and Nutrition Guidelines

Vitamins: All pregnant women should eat a well-balanced diet and take a standard prenatal multivitamin that includes at least 400 micrograms of folic acid to help prevent neural tube defects. However, excessive intake of iodine, vitamin A, D, E and K may be toxic and should be avoided.
Fish: The quantity and type of fish consumed should be regulated, and certain types of fish should be avoided during pregnancy due to concerns about possible environmental toxins such as mercury. Only cooked fish should be eaten.
Caffeine: Daily caffeine intake greater than 500 mg appears to double the risk of spontaneous abortion, and excess coffee consumption may increase the risk of stillbirth or low birth weight. Therefore, restriction of caffeine consumption should be considered.

Influenza Immunization
Influenza vaccination is recommended for women in the second and third trimesters, and for high-risk women prior to influenza season regardless of stage of pregnancy.

Work
A woman with an uncomplicated pregnancy who is employed where there are no greater potential hazards than those encountered in routine daily life may continue to work without interruption until the onset of labor. However, the physical demands of the woman's job should be considered, especially for women at higher risk of preterm delivery.

The Pregnancy Discrimination Act requires employers offering medical disability benefits to treat pregnancy-related disabilities just like all other disabilities. Pregnant workers must be provided the same insurance benefits, sick leave, seniority credits and reinstatement privileges awarded workers disabled by other causes.

The Occupational Safety and Health Administration sets and enforces standards requiring employers to provide a workplace free from recognized hazards likely to cause serious physical harm. Lead, ethylene oxide, ionizing radiation and dibromochloropropane are substances with significant potential for reproductive toxicity. In addition, pregnant health care workers should minimize exposure to anesthetic gases, infectious agents, antineoplastic drugs and organic solvents. Pregnant women may work safely in operating rooms equipped with gas scavenging systems and adequate ventilation.

Exercise
In the absence of obstetric or medical complications, a pregnant woman may engage in a moderate level of physical activity. Exercise will help a pregnant woman maintain cardiorespiratory and muscular fitness.

Sex
Theoretically, sexual intercourse may stimulate labor. However, in the absence of pregnancy complications (e.g., vaginal bleeding, ruptured membranes), there is insufficient evidence to recommend against sexual intercourse during pregnancy. Pregnant women, like all women, are encouraged to practice safe sex to protect against sexually transmitted infections.

Airline Travel
Most airlines allow women to fly until 35 to 36 weeks of gestation, although individual policies may vary. Commercial airline travel is generally safe for women with uncomplicated pregnancies. However, because of the changes in heart rate and blood pressure that take place in pregnancy and the lack of availability of emergency care, certain precautions should be taken. Women with complicated pregnancies (e.g., sickle cell anemia, high risk of preterm delivery, pre-eclampsia) should avoid air travel.

Follow-Up Visits

Subsequent visits will include measurement of blood pressure, weight and fundal height to assess fetal growth, fetal heart rate check via Doppler, and determination of fetal presentation and activity. Urine is also typically screened for protein and glucose at each visit.

The frequency of prenatal visits should be based upon patient needs; in general, the minimum standard intervals for women with uncomplicated pregnancies are every four to five weeks until 28 weeks of gestation, every two to three weeks from 28 to 36 weeks, and then weekly until delivery. More frequent visits may benefit women with diabetes, hypertension, threatened preterm birth, post-term pregnancies and other pregnancy complications.

Prenatal Testing

It is best to discuss all prenatal testing with your provider and perhaps also a genetic counselor. There are a number of prenatal test options throughout pregnancy, including lab tests, genetic screens and ultrasounds to test for infections, birth defects and diseases. Some tests are routine, others are reserved for mothers at high risk for certain prenatal complications and conditions. Your provider is the best resource for your specific circumstances.