Prenatal Care Guidelines

Initial Visit and First Trimester Care

The American College of Obstetricians and Gynecologists recommends initiating folic acid supplementation (400-800 mg daily) and potassium iodide (150 mg daily) prior to conception or as soon as pregnancy is confirmed, for women with preexisting medical conditions, to reduce the risk of congenital malformations 1, 3
Women with pregestational diabetes should achieve A1C <6.5% before conception to reduce congenital malformations from the 1.4-10.9% range to 1.0-1.7%, according to the American Diabetes Association 4, 1, 3
The National Institute for Health and Care Excellence (NICE) guidelines recommend screening for diabetes, thyroid disease, and sexually transmitted infections at the initial visit, for all pregnant women 1, 3
Review all medications for teratogenicity, particularly discontinuing ACE inhibitors, ARBs, and statins (pregnancy category X) before conception, as recommended by the American College of Obstetricians and Gynecologists 4, 1

Identify women requiring low-dose aspirin (81-150 mg daily) starting before 16 weeks gestation, based on major risk factors such as previous preeclampsia, chronic hypertension, pregestational diabetes, BMI ≥35, chronic kidney disease, and antiphospholipid syndrome, according to the American College of Obstetricians and Gynecologists 5, 6, 1
The British Medical Journal recommends monitoring for signs and symptoms of preeclampsia, including new hypertension, proteinuria, headache, visual disturbances, epigastric pain, and reduced fetal movements, at every visit after 20 weeks, for all pregnant women 5, 6, 7

Perform detailed fetal anatomy ultrasound, as recommended by the American Institute of Ultrasound in Medicine, between 16 and 22 weeks gestation, to detect congenital anomalies 1, 2
For women with pregestational diabetes, schedule fetal echocardiogram, as recommended by the American Heart Association, between 16 and 22 weeks gestation, to detect cardiac anomalies 1, 2
Continue low-dose aspirin for those on preeclampsia prophylaxis, as recommended by the American College of Obstetricians and Gynecologists, until 36 weeks gestation 1, 2

Establish multidisciplinary care, including endocrinologist, maternal-fetal medicine specialist, registered dietitian, and diabetes educator, for women with pregestational diabetes, as recommended by the American Diabetes Association 1, 3
Monitor fasting glucose <95 mg/dL and either 1-hour postprandial <140 mg/dL or 2-hour postprandial <120 mg/dL, as recommended by the American Diabetes Association, for women with pregestational diabetes 3

Promote balanced nutrition with "five-a-day" (2 servings fruit, 3 servings vegetables), as recommended by the Academy of Nutrition and Dietetics, for all pregnant women 3
Recommend regular moderate exercise, such as brisk walking, swimming, or prenatal yoga, appropriate for pregnancy, as recommended by the American College of Obstetricians and Gynecologists, for all pregnant women 3
Counsel on complete avoidance of alcohol, tobacco, and recreational drugs, as recommended by the American College of Obstetricians and Gynecologists, for all pregnant women 3

Inquire about mental health at every consultation, and connect women to relevant resources, such as counseling or support groups, as recommended by the American College of Obstetricians and Gynecologists, for all pregnant women 2