Ideally, women planning to become pregnant and their partners should see a doctor or other health care professional prior to pregnancy. At the visit, the medical, obstetric, and family histories of both the woman and partner are reviewed. The clinician provides advice about managing chronic diseases or medications or receiving vaccinations prior to pregnancy. Referral for genetic counseling is made, if appropriate.
For prevention, all pregnant women and women who are planning to or may become pregnant should take a supplement that contains 400 to 800 micrograms of folateneural tube defect), such as spina bifida, is increased. Women who take medications that decrease folate (such as certain epilepsy medications) or have had a baby with a neural tube defect should take 4,000 micrograms of folate, starting 3 months before conception and continuing through 12 weeks of pregnancy—a much larger amount than usually recommended.
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If the couple decides to try to have a baby, they and the doctor discuss ways to make the pregnancy as healthy as possible. A woman should ask the doctor about factors that could impair her health or the health of the developing fetus.
Factors or situations to avoid include the following:
Using tobacco, alcohol, cannabis, or illicit drugs
Being exposed to secondhand cigarette smoke
Having contact with cat litter or cat feces (unless the cats are strictly confined to the home and are not exposed to other cats), because such contact can transmit toxoplasmosis, an infection that can damage the fetus’s brain
Being exposed to hot temperatures for a long time (for example, in a hot tub or sauna)
Being exposed to chemicals or paint fumes
Having contact with people with viral infections that can harm the fetus (such as rubella, chickenpox, or shingles), unless the woman has been vaccinated against these infections and has had a blood test to confirm she is immune
Knowing about and dealing with such factors before pregnancy may help reduce the risk of problems during pregnancy (see Risk Factors for Pregnancy Complications). In addition, a woman can discuss her diet and her social, emotional, and medical concerns with the doctor.
When a woman sees a doctor or another health care professional before she becomes pregnant, she can be given any needed vaccines, such as the rubella vaccine. If she is not already taking folate, doctors can prescribe prenatal multivitamins that contain the recommended amount of folate or a larger amount of folate, if needed.
First prenatal visit
Prenatal care is important for the health of the pregnant woman and baby.
At the first prenatal visit, usually at 8 to 12 weeks of pregnancy, the clinician may do a pregnancy test or an ultrasound to confirm the pregnancy.
Doctors ask about a woman's medical history, medications she takes, and details about previous pregnancies, including problems that occurred such as gestational diabetes, miscarriage, and birth defects. Doctors ask about current or past mental illness or current symptoms of depression or anxiety. They routinely ask women about intimate partner violence—whether she is being mentally, physically, or sexually abused by her partner or by someone else she lives with.
The first physical examination during pregnancy is very thorough. It includes the following:
Measurement of weight and blood pressure
General physical examination of the heart, lungs, abdomen, and legs
Pelvic examination to note the size and position of the uterus
Screening for cervical cancer using a Papanicolaou (Pap) test and/or human papillomavirus testing on samples taken from the cervix
Tests for sexually transmitted infections: Swabs of the cervix or vagina or a urine sample tested for gonorrhea and chlamydia; blood tests for syphilis, hepatitis, and human immunodeficiency virus (HIV)
Additional blood tests: A complete blood cell count, evidence of immunity to rubella and chickenpox (varicella), and blood type, including Rh factor status (positive or negative)
Additional urine tests: Urine analyzed for infection and protein
Skin tests for tuberculosis are advisable for all women.
Other tests may be done, depending on a woman’s situation. For example, blood tests to screen for or monitor thyroid disorders are done in women with one or more of the following:
Symptoms or other reasons for the clinician to suspect thyroid disease
Thyroid disease or family history of thyroid disease
Type 1 diabetes
If a woman has Rh-negative blood, her blood is tested for antibodies to the Rh factor (see Rh Incompatibility). A woman's immune system produces these antibodies if her Rh-negative blood comes in contact with Rh-positive blood—for example, in a previous pregnancy with a fetus who has Rh-positive blood. The antibodies (called Rh antibodies) may destroy blood cells in a fetus with Rh-positive blood, causing severe problems (even death) for the fetus. If antibodies in a pregnant woman’s blood are detected early, the doctor can take measures to protect the fetus.
All women with Rh-negative blood are given Rh(D) immune globulin, injected into a muscle, at 28 weeks (or at both 28 and 34 weeks) of pregnancy. They are also given an injection after any possible contact between their blood and the fetus's blood—for example, after an episode of vaginal bleeding, after amniocentesis, and after delivery. Rh(D) immune globulin reduces the risk that the fetus's blood cells will be destroyed.
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Women with African ancestry are tested for sickle cell trait or disease if they have not been tested previously.
If either potential parent has a known or suspected genetic abnormality, the couple should be referred for genetic counseling and testing.
Ongoing prenatal visits
After the first prenatal visit, a pregnant woman should see her doctor as follows:
Every 4 weeks until 28 weeks of pregnancy
Then every 2 weeks until 36 weeks
Weekly from 36 weeks to delivery
At each prenatal visit, a woman’s weight and blood pressure are recorded, and a urine sample is tested for protein. Protein in urine may indicate preeclampsia (a type of high blood pressure that develops during pregnancy).
The size of the uterus is noted to determine whether the fetus is growing normally. Doctors check the fetal heartbeat. It can usually be detected at about 10 to 11 weeks with a handheld Doppler ultrasound device. Once a heartbeat has been detected, doctors check it at each visit to determine whether it is normal.
Doctors test all women for the type of diabetes that develops during pregnancy (gestational diabetes). This blood test is done at 24 to 28 weeks. It measures the level of sugar (glucose) in the blood 1 hour after women drink a liquid that contains a certain amount of glucose—called a glucose tolerance test. If women have risk factors for gestational diabetes, this test is done early in the pregnancy, preferably before 12 weeks.
Risk factors for gestational diabetes include a combination of obesity and one or more of the following:
Physical inactivity
First-degree relatives (such as mother or sisters) with diabetes
High-risk race or ethnicity (eg, African American, Latino, Native American, Asian American, Pacific Islander)
Gestational diabetes or a large baby (weighing 10 pounds [4,000 grams] or more) in a previous pregnancy
High blood pressure
High cholesterol level
Other conditions associated with insulin resistance
History of cardiovascular disease
A history of having sugar in the urine over a long period of time
Polycystic ovary syndrome with insulin resistance
If results of the initial test are normal, these at-risk women are retested at 24 to 28 weeks.
Ultrasound
Most doctors recommend at least one ultrasound examination during each pregnancy, ideally between 16 and 20 weeks. Earlier ultrasound may be done if there is uncertainty about the estimated delivery date or if a woman has symptoms (for example, vaginal bleeding or pelvic pain).
For the procedure, a device that produces sound waves (transducer) is placed on a woman’s abdomen. The sound waves are processed to form an image that is displayed on a monitor. Sometimes, particularly during early pregnancy, the doctor uses an ultrasound device that can be inserted in the vagina. Ultrasound produces high-quality images, including live-action images that show the fetus in motion. These images provide the doctor with useful information and can reassure a pregnant woman.
Ultrasound can also be used to do the following:
Confirm pregnancy and check for a fetal heartbeat, as early as 5 weeks of pregnancy
Identify the sex of the fetus, as early as 14 weeks of pregnancy
See whether a woman is carrying more than 1 fetus (such as twins or triplets)
Identify abnormalities, such as a mislocated placenta (placenta previa), too much fluid in the sac that contains the fetus (polyhydramnios ), or an abnormal position of the fetus
Identify birth defects (sometimes)
Check for evidence of Down syndrome (and some other disorders) by measuring the fluid-filled space near the back of the fetus’s neck (called nuchal translucency)
Guide the placement of instruments during certain procedures, such as prenatal diagnostic testing
Toward the end of pregnancy, ultrasound may be used to confirm the position of the fetus (head down or breech) or to assess the fetus if there is a concern about fetal growth or other pregnancy complications.
Immunizations
Vaccines during pregnancy are as effective in women who are pregnant as in those who are not.
Live-virus vaccines, such as those for rubella or chickenpox, should not be used during pregnancy.
Pregnant women should receive the following vaccinations if they not already up-to-date with these vaccines (see Centers for Disease Control and Prevention [CDC]: Pregnancy and Vaccination):
Influenza vaccine: All pregnant women during the influenza (flu) season
COVID-19 vaccine: People who are pregnant, breastfeeding, trying to get pregnant, or might become pregnant in the future (see also Centers for Disease Control and Prevention (CDC): COVID-19 Vaccines While Pregnant or Breastfeeding)
Tetanus-diphtheria-pertussis (Tdap) vaccine: Booster shot after 20 weeks of pregnancy (preferably at 27 to 36 weeks) or after delivery, even if the shots are up-to-date.
Respiratory syncytial virus (RSV) vaccine: For pregnant women at 32 to 36 weeks gestation from September through January in most of the continental United States (in locations with RSV seasonality that differs from most of the continental United States [for example, Alaska and locations with a tropical climate], timing is based on local RSV seasonality)
Giving the RSV vaccine during pregnancy helps protect the newborn from RSV for about 6 months after birth because protective antibodies transfer from mother to fetus through the placenta. The vaccine should be administered regardless of previous RSV infection.
Other vaccines should be reserved for situations in which a woman or fetus is at significant risk of exposure to a hazardous infection and the risk of adverse effects from the vaccine is low. For example, pneumococcal vaccination is recommended for pregnant individuals at increased risk of severe pneumococcal disease. Vaccinations for cholera, hepatitis A, hepatitis B, measles, mumps,poliomyelitis, rabies, typhoid, and yellow fever may be given during pregnancy if risk of infection is substantial.
