Pregnancy guidelines

Even before you get pregnant, there are things you can do to help make sure you will have healthy babies. Here's how to take good care of yourself before and during pregnancy.

Preconception Guidelines
Nutrition	Details
Folic acid supplements	If no previous pregnancy affected by neural tube defect: 0.4 to 0.8 mg per day of folic acid supplementation from at least 12 months prior to conception through the first trimester. If previous pregnancy affected by neural tube defect: 4 mg per day of folic acid supplementation from one to three months prior to conception through the first trimester.
Immunizations	When
Rubella immunity	Determine immunity and immunize (if indicated)
Hepatitis B (HepB)	For those at high risk

Guidelines FOR PREGNANCY
Prenatal exam frequency	When
	First visit: As early as possible in the first trimester Every four weeks for the first 28 weeks of pregnancy Every two to three weeks between 28 and 36 weeks of pregnancy Weekly after 36 weeks of pregnancy
Prenatal clinical screenings	Details
Initial screenings	Complete physical exam including family, medical, surgical, social and OB history; review of medications; screenings for tobacco use, alcohol/drug misuse, and family and intimate partner violence. Complete blood count (CBC), urinalysis, blood type, Rh and antibody screening, Rubella titer, Hepatitis B antibody titer, VDRL serology, Pap test, if indicated. As determined by the physician: group B strep, maternal serum alpha-fetoprotein, amniocentesis and chorionic villus sampling (if older than age 34 and depending on history).
HIV, chlamydia, gonorrhea screening	Screen all pregnant women
Influenza (flu) vaccine	Administer vaccine after first trimester (14 weeks or more of gestation) if pregnant during influenza season.
Tetanus, diphtheria and pertussis (Tdap) during pregnancy	One dose of Tdap before leaving the hospital (if last Td was at least 2 years ago).
Ongoing clinical screenings	Blood pressure, weight, tobacco use, alcohol misuse, urine (for protein and glucose), fundal height, fetal presentation, swelling, fetal heartbeat and activity Ultrasound in second trimester (physician discretion) Glucose screening up to 28th week of pregnancy, at the discretion of the physician Urine culture at 12 to 16 weeks

Follow-Up CARE AFTER DELIVERY
Physical exam frequency	All newborns to be evaluated within two to three days after discharge followed by one visit four to six weeks after delivery.
Clinical screenings	Weight and blood pressure, blood count (if indicated), breast exam, abdominal and pelvic exam, Pap test (if indicated)
Breastfeeding	Counsel women of the importance of breastfeeding for at least three months.