Prenatal & pregnancy health care 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 care guidelines |
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| 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 1 month 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 |
Rubella and Tdap
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Determine immunity and immunize if indicated |
Hepatitis B (HepB)
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For those at high risk |
| Care during pregnancy |
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| Prenatal exam frequency |
- First exam: As early as possible
- First 28 weeks: Every four weeks
- Between 28 and 36 weeks: Every 2 to 3 weeks
- After 36 weeks: Weekly
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| 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).
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| HIV, chlamydia, gonorrhea, syphilis screening |
Screen all pregnant women |
| Influenza (flu) vaccine |
Administer vaccine after first trimester (14 weeks or more of gestation) if pregnant during influenza season |
| 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 if patient less than 25 years old and at low risk for diabetes
- Urine culture at 12 to 16 weeks
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| Follow-up care after pregnancy |
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Physical exam frequency
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- Newborns should be evaluated within 2 to 3 days after discharge. Go to the well-child visit schedule to see how often babies need exams.
- Mother should have one visit 4 to 6 weeks after delivery for maternal post-partum care.
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Clinical screenings
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Weight and blood pressure, blood count (if indicated), breast exam, abdominal and pelvic exam, Pap test (if indicated) |
Breastfeeding
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Counseling on the importance of breastfeeding for at least 3 months |
Tetanus, diphtheria and pertussis (Tdap)
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One dose before leaving the hospital (if the mother's last Td was at least 2 years ago) |
