Antenatal Care Recommendations

General Principles

The World Health Organization recommends a minimum of 8 antenatal care contacts throughout pregnancy, with midwife-led continuity of care throughout the antenatal, intrapartum, and postnatal periods to improve maternal and neonatal outcomes 1

Conduct comprehensive preconception counseling for women planning pregnancy, including optimization of glycemic control for women with diabetes (target A1C <6.5%), folic acid supplementation (400-800 mg daily), potassium iodide supplementation (150 mg daily), screening for diabetes, thyroid disease, and sexually transmitted infections, and review of all medications for potential teratogenicity (particularly ACE inhibitors, ARBs, and statins) 2, 3
Start low-dose aspirin (81-150 mg daily) before 16 weeks of gestation for women with risk factors for preeclampsia, including major risk factors such as prior preeclampsia, chronic hypertension, pregestational diabetes, BMI >30, chronic kidney disease, antiphospholipid syndrome, and minor risk factors (≥2) such as advanced maternal age, family history of preeclampsia, short duration of sexual relationship, primiparity, primipaternity, connective tissue disorders 1
Provide calcium supplements (1200 mg daily) if dietary calcium intake is low 1

Begin antepartum fetal surveillance at 32-34 weeks for high-risk pregnancies, including those with pregestational diabetes 4
Monitor for signs of preeclampsia, particularly in women with risk factors 1
For women with placenta accreta spectrum, plan delivery at 34 0/7-35 6/7 weeks in a center with appropriate expertise 5

Women with preexisting diabetes should ideally receive preconception care in a multidisciplinary clinic including an endocrinologist, maternal-fetal medicine specialist, registered dietitian, and diabetes educator 2, 3
Optimize glycemic control before and during pregnancy to reduce risk of congenital anomalies, preeclampsia, macrosomia, and preterm birth 2, 3
Monitor for development or progression of diabetic retinopathy with dilated eye examinations before pregnancy or in first trimester, then every trimester and for 1 year postpartum 2
Screen for comorbidities including foot examination, thyroid function, urinary protein evaluation, and electrocardiogram 4

Failing to identify and counsel women at high risk for preeclampsia who would benefit from early aspirin prophylaxis 1
Inadequate preparation for delivery in women with placenta accreta spectrum, which requires multidisciplinary planning and delivery at an experienced center 5
Overlooking the importance of preconception care, particularly for women with preexisting conditions like diabetes 2, 3