Prior to modern medicine, many mothers and their babies did not survive pregnancy and the birth process. Today, good prenatal care can significantly improve the quality of the pregnancy and the outcome for the infant and mother.

Good prenatal care includes:

• Good nutrition and health habits before and during pregnancy
• Frequent prenatal examinations
• Routine ultrasounds to detect problems with the baby
• Routine screening for:
  • Blood pressure problems
  • Blood type problems (Rh and ABO)
  • Diabetes
  • Genetic disorders, if a family history or the age of the mother presents a high risk
  • Rubella immunity
  • Sexually transmitted diseases
  • Urine protein

Women who choose to have an abortion usually do so in the very early stages of the pregnancy (usually before 12 weeks gestation). Abortion is legal through the 24th week of pregnancy. The abortion procedure, however, becomes more difficult with advancing gestational age, and many providers do not perform pregnancy terminations in the second trimester.

Women who plan to continue a pregnancy to term need to choose a health care provider who will provide prenatal care, delivery, and postpartum services. Provider choices in most communities include:

• Doctors specializing in obstetrics and gynecology (OB/GYN)
• Certified nurse midwives (CNMs)
• Family practice physicians
• Family nurse practitioners (FNPs) or physician assistants (PAs) who work with a doctor
• Perinatologists—doctors who specialize in the very high risk pregnancy

Family health care providers, or generalists, can help manage women throughout normal pregnancies and deliveries. If there is a problem with the pregnancy, your doctor will refer you to specialist.

The goals of prenatal care are to:

• Monitor both the mother and baby throughout the pregnancy
• Look for changes that may lead to a high-risk pregnancy
• Explain nutritional requirements throughout the pregnancy and postpartum period
• Explain activity recommendations or restrictions
• Address common complaints that may arise during pregnancy (such as morning sickness, backaches, leg pain, frequent urination, constipation, and heartburn) and how to manage them, preferably without medications

Women who are considering becoming pregnant, or who are pregnant, should eat a balanced diet and take a vitamin and mineral supplement that includes at least 0.4 milligrams (400 micrograms) of folic acid. Folic acid is needed to decrease the risk of certain birth defects (such as spina bifida). Sometimes higher doses are prescribed if a woman has a higher than normal risk of these conditions.

Pregnant women are advised to avoid all medications, unless the medications are necessary and recommended by a prenatal health care provider. Women should discuss all medication use with their providers.

Pregnant women should avoid all alcohol and drug use and limit caffeine intake. They should not smoke. They should avoid herbal preparations and common over-the-counter medications that may interfere with normal development of the growing baby.

Prenatal visits are typically scheduled:

• Every 4 weeks during the first 32 weeks of gestation
• Every 2 weeks from 32 to 36 weeks gestation
• Weekly from 36 weeks to delivery

Weight gain, blood pressure, fundal height, and the baby's heart beat (as appropriate) are usually measured and recorded at each visit, and routine urine screening tests may be performed.

WHEN TO CALL YOUR DOCTOR

• Call for an appointment if you suspect you are pregnant, are currently pregnant and are not receiving prenatal care, or if you are unable to manage common complaints without medication.
• Call your health care provider if you suspect you are pregnant and are on medications for diabetes, thyroid disease, seizures, or high blood pressure.
• Notify your health care provider if you are currently pregnant and have been exposed to a sexually transmitted disease, chemicals, radiation, or unusual pollutants.
• Call your health care provider if you are currently pregnant and you develop fever, chills, or painful urination.

CALL YOUR DOCTOR IMMEDIATELY

It is urgent that you call your health care provider if you are currently pregnant and you have any amount of vaginal bleeding, severe abdominal pain, physical or severe emotional trauma, or your water breaks (membranes rupture).

Johnson RBT, Gregory KD, Niebyl JR. Preconception and prenatal care: part of the continuum. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 5.

Simpson JL, Holzgreve W. Genetic counseling and genetic screening. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 6.

Niebyl JR, Simpson JL. Drugs and environmental agents in pregnancy and lactation: embryology, teratology, epidemiology. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 8.

Richards DS. Ultrasound for pregnancy dating, growth, and the diagnosis of fetal malformations. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 9.

Alto WA. No need for glycosuria/proteinuria screen in pregnant women. J Fam Pract. 2005 Nov;54(11):978-83.

Rhode MA, Shapiro H, Jones OW. Indicated vs. routine prenatal urine chemical reagent strip testing. J Reprod Med. 2007 Mar;52(3):214-9.

Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.