Prenatal care, also known as antenatal care, is a type of preventive healthcare for pregnant women. It is provided in the form of medical checkups and healthy lifestyle recommendations for the pregnant person. Antenatal care also consists of educating the pregnant woman or girl about maternal physiological and biological changes in pregnancy, along with prenatal nutrition, all of which prevent potential health problems throughout the pregnancy and promote good health for the parent and the fetus. The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections, and other preventable health problems.
Visits Traditional prenatal care in high-income countries generally consists of: monthly visits during the first two trimesters (from the 1st week to the 28th week) fortnightly visits from the 28th week to the 36th week of pregnancy weekly visits after 36th week to the delivery, from the 38th week to the 42nd week Assessment of parental needs and family dynamics
The WHO recommends that pregnant women receive at least eight antenatal visits to spot and treat problems and give immunizations. Although antenatal care is important to improve the health of both mother and baby, many women do not receive the recommended eight visits. There is little evidence behind the number of antenatal visits pregnant women receive and what care and information is given at each visit. It has been suggested that women who have low-risk pregnancies should have fewer antenatal visits. However, when this was tested, women with fewer visits had babies who were much more likely to be admitted to neonatal intensive care and stay there for longer (though this could be down to chance results).
A 2015 Cochrane Review findings buttresses this notion, with evidence that in settings with limited resources, where the number of visits is already low, programmes of ANC with reduced visits are associated with an increase in perinatal mortality. Therefore, it is doubtful that the reduced visits model is ideal, even in low-income countries (LICs), where pregnant women are already attending fewer appointments. Not only is visiting prenatal care early is highly recommended, but also a more flexible pathway allowing more visits, from the time a pregnant woman books for prenatal care, as it potentially enables more attention to those women who come late. Also, women who had fewer antenatal visits were not as satisfied with the care they received compared with women who had the standard number of visits.
Examinations
At the initial antenatal care visit, pregnant women are classified into either low risk or high risk. Antenatal risk assessment began in the United Kingdom before becoming a widespread practice.
Prenatal screening is testing for diseases or conditions in a fetus or embryo before it is born, and prenatal diagnosis refers to the official confirmation of these potential diseases or conditions. Obstetricians and midwives have the ability to monitor mother's health and prenatal development during pregnancy through series of regular check-ups.
Physical examinations generally consist of: Collection of the mother's (and general family) medical history Checking blood pressure of the mother Documentation of the mother's height and weight Pelvic exam Doppler fetal heart rate monitoring Blood and urine tests on the mother Discussion with caregiver
In some countries, such as the UK, the symphysial fundal height (SFH) is measured as part of antenatal appointments from 25 weeks of gestation. (The SFH is measured from the woman's pubic bone to the top of the uterus. A review into this practice found only one piece of research, so there is not enough evidence to say whether measuring the SFH helps to detect small or large babies. As measuring the SFH is not costly and is used in many places, the review recommends carrying on this practice.
Growth charts are a way of detecting small babies by the measuring the SFH. There are two types of growth chart: Population-based chart, which shows a standard growth and size for each baby Customized growth chart, which is calculated by looking at the mother's height and weight, along with the weights of their previous babies. Examples of these growth charts are created by the World Health Organization and Centers for Disease Control and Prevention, which differ based on the sex of the infant, and can be found at: https://www.cdc.gov/growthcharts/who-charts.html A review looking into which of these charts detected small babies found that there is no good quality research to show which is best. More research is needed before the customized growth charts are recommended because they cost more money and take more time for healthcare workers to make.
Ultrasounds Obstetric ultrasounds are most commonly performed during the second trimester at approximately week 20. Ultrasounds are considered relatively safe and have been used for over 35 years for monitoring pregnancy. Among other things, ultrasounds are used to: Diagnose pregnancy (uncommon) Check for the number of fetuses (e.g., twins, triplets, etc.) Assess possible risks to the mother (e.g., miscarriage, blighted ovum, ectopic pregnancy, or a molar pregnancy condition) Check for fetal malformation (e.g., club foot, spina bifida, cleft palate, clenched fists) Determine if an intrauterine growth retardation condition exists Note the development of fetal body parts (e.g., heart, brain, liver, stomach, skull, other bones) Check the amniotic fluid and umbilical cord for possible problems Determine the due date and how far along the mother is based on measurements and relative developmental progress Generally, an ultrasound is ordered whenever an abnormality is suspected, or along a schedule similar to the following: 7 weeks — confirm pregnancy, ensure that it's neither molar nor ectopic, determine due date 13–14 weeks (some areas) — evaluate the possibility of Down syndrome 18–20 weeks — see the expanded list above 34 weeks (some areas) — evaluate the size, verify the placental position
A review looking at routine ultrasounds past 24 weeks found that there is no evidence to show any benefits to the mother or the baby.
Early scans mean that multiple pregnancies can be detected at an early stage of pregnancy and also gives more accurate due dates so that fewer women are induced who do not need to be.
Levels of feedback from the ultrasound can differ. High feedback is when the parents can see the screen and are given a detailed description of what they can see. Low feedback is when the findings are discussed at the end, and the parents are given a picture of the ultrasound. The different ways of giving feedback affect how much the parents worry and the mother's health behaviour, although there is not enough evidence to make clear conclusions. In a small study, mothers receiving high feedback were more likely to stop smoking and drinking alcohol; however, the quality of the study is low, and more research is needed to say for certain which type of feedback is better.
Women experiencing a complicated pregnancy may have a test called a Doppler ultrasound to look at the blood flow to their unborn baby. This is performed to detect signs that the baby is not getting a normal blood flow and therefore is 'at risk'. A review looked at performing Doppler ultrasounds on all women, even if they were at 'low risk' of having complications. The review found that routine Doppler ultrasounds may have reduced the number of preventable baby deaths, but the evidence was not strong enough to recommend that they should be made routine for all pregnant women.
Prevention of Maternal Deaths
The leading causes of maternal death in the United States are overdose, homicide, and suicide. Of these causes, unintentional drug overdose was the leading cause at 5.2 deaths per 100,000 live births, and homicide and suicide accounted for 3.9 deaths per 100,000 live births. Preventing these unnecessary deaths starts in the prenatal period. Some screenings ask pregnant women about suicidal ideation and other common mental health conditions through the Patient Health Questionnaire (PHQ 2 or 9), the Generalized Anxiety Screener (GAD 3 or 7), and the Pregnancy/Postnatal Depression Scale (EPDS). However, these screenings lack thoroughness in their ability to create a full picture of a person's mental well-being due to the standardized nature of the screener. Earlier intervention in the pregnancy through asking about coping mechanisms, home life, financial stability, employment, and past trauma can create a clearer perspective of a pregnant person's emotional and mental well-being.
Prevention of homicide and interpersonal violence for pregnant women and birthing persons can lead to better mental health and maternal mortality outcomes for pregnant individuals. Homicides were committed 77% of the time with a firearm. Screening for firearms in the household or firearm use could prevent some of these deaths. Additionally, another mode of prevention can occur through state Red Flag laws. These laws help keep firearms out of the way of people who could harm someone.
Currently, most maternal deaths, 62%, occur after the 42 days up until 1 year post-partum. The standard of care is one follow-up visit 6-weeks post-partum. The American College of Obstetricians and Gynecologists (ACOG) has recommended that this standard include more visits within 12 weeks, but this recommendation has not yet become the standard practice of care. Due to the limited amount of check-ups post-partum, many women and birthing people may feel isolated at the beginning of motherhood. 21.8% of American Indian/Alaska Native people report symptoms of post-partum depression compared to 16.3% of Black, non-Hispanic, 15.4% Multiple Race, Non-Hispanic, 13.8% Hispanic, 11.7% White, and 8% Asian. Systemic racism can exacerbate symptoms of post-partum depression through making it harder to access medical care, implicit bias in providers, and race-based traumatic stress (RBTS). Creating more avenues for women and birthing people to have interactions with a doctor or trusted medical professional could create better mental health outcomes. Asking about existing support networks in place for these women and birthing people can also aid medical professionals in learning about gaps in their patients' network of care.
Diet Main article: Prenatal nutrition
Prenatal care not only applies to the parent carrying the baby, but it also applies to the sperm donor. Sperm affects the fetus's ability to grow properly, and proper nutrition is one of the main factors. For example, a zinc deficiency can lead to sperm deformations and reduced sperm motility which can cause infertility or improper fertilization of the egg, which has the potential to cause miscarriages or fetal deformities. Spina bifida, which is caused by a folic acid deficiency, is another example of the effects of prenatal malnutrition. Foods are typically fortified with folic acid to reduce this, but some flours like masa flour are not within those federal outlines, which is theorized to be why Hispanic women are most likely to have children with spina bifida. Because of all this, it is normally encouraged that women take a prenatal vitamin to prevent these fetal deformations and deficiency symptoms.
Exercise Research suggests that physical activity levels during pregnancy can impact delivery outcomes. A study examining the effects of exercise intensity on delivery type and risk of preterm birth found that varying levels of physical activity were linked to different pregnancy outcomes and associated risks.