Prenatal Care and Testing

Prenatal Care and Testing is a topic covered in the 5-Minute Clinical Consult.

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Basics

The goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother by the following:

  • Identifying the patient who is at risk for complications
  • Estimating the gestational age (GA) as accurately as possible
  • Evaluating the health status of mother and fetus
  • Encouraging and empowering the patient to do her part to care for herself and her baby-to-be
  • Intervening when fetal abnormalities are present to prevent morbidity

General Prevention

  • A recommended but not evidence-based prenatal care schedule consists of the following:
    • Monthly visits to a health care professional for weeks 4 to 28 of pregnancy
    • Visits twice monthly from 28 to 36 weeks
    • Weekly after week 36 (delivery at weeks 38 to 40)
  • Recommendations for use of dietary supplements in pregnancy
    • Folic acid 0.4 mg daily beginning at least 1 month prior to attempting conception and continuing throughout pregnancy; 1 to 4 mg for women at higher risk of having child with neural tube defect beginning 1 to 3 months before conception, continued through first 12 weeks of gestation, and then reduced to 0.4 mg daily
    • Calcium: 1,000 to 1,300 mg/day; supplement may be beneficial for women with high risk for gestational hypertension or communities with low dietary calcium intake.
    • Iron: Screen for anemia (hemoglobin/hematocrit) and treat if necessary.
    • Vitamin A: Pregnant women in industrialized countries should limit to <5,000 IU/day.
    • Vitamin D: 200 to 1,200 IU (dose in standard prenatal vitamin) is recommended until more evidence is available to support different dose.
  • Routine screening for thyroid and vitamin D deficiency during pregnancy is not recommended.

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