Prenatal care in the United States is a health care preventive care protocol recommended to women to provide regular check-ups that allow obstetricians-gynecologists, family medicine physicians, or midwives to detect, treat and prevent potential health problems throughout pregnancy while promoting healthy lifestyles that benefit both mother and child.Prenatal care fact sheet. by the Office on Women's Health at the U.S. Department of Health and Human Services. Content last updated March 6, 2009. Reviewed by John W. Schmitt. Patients are encouraged to attend monthly checkups during the first two trimesters and in the third trimester, gradually increasing to weekly visits. Women who suspect they are pregnant can schedule pregnancy tests prior to 9 weeks of gestation. Once pregnancy is confirmed, an initial appointment is scheduled after 8 weeks of gestation. Subsequent appointments typically include various tests, ranging from blood pressure checks to glucose level assessments, to monitor the health of both the mother and fetus. If not, appropriate treatment will then be provided to prevent any further complications.
Prenatal care in the United States started as a preventive measure against preeclampsia, which included program visits during which medical professionals conducted physical, history, and risk evaluations. Over the last century, prenatal care has shifted focus to low birth weight and other preventive conditions to decrease the rate of infant mortality. Increased use of prenatal care was found to reduce the rates of birth-weight-related mortality and other preventable medical ailments such as post-partum depression and infant injuries.
The United States has socioeconomic disparities that prevent the equal adoption of prenatal care throughout the country. Various levels of prenatal care accessibility can be observed in both developing and developed countries, such as the U.S. Although women can benefit from taking advantage of prenatal care, there exists varying degrees of health care accessibility between different demographics, by ethnicity, race, and income-level, throughout the United States. Education level can also influence the utilization and accessibility of prenatal care. Nearly one-fifth of women in the United States do not access prenatal care during the first trimester of pregnancy. The prenatal health care system, along with personal attitudes, all contribute to the utilization and accessibility of prenatal care. Suggested steps to improve prenatal care in the United States include the implementation of community-based healthcare programs and an increase in the number of those insured.
Background
Prenatal care is health care provided to pregnant women as a type of preventive care to provide regular check-ups that allow obstetricians-gynecologists, family medicine physicians, or midwives to detect, treat and prevent potential health problems throughout the pregnancy while promoting healthy lifestyles that benefit both mother and child. Health professionals instruct mothers on prenatal nutrition, the benefits of breastfeeding, lifestyle changes, injury and illness prevention, and methods to monitor potentially dangerous health conditions.Retrieved on 11 March 2012. Medical professionals also inform the mother on the birthing process and basic skills for taking care of a newborn.
During visits, physicians determine the due date, family and medical history, conduct a physical exam and pelvic exam, and run various blood work. Physicians also conduct ultrasounds to monitor the baby's health periodically throughout the pregnancy.Your First Prenatal Doctor's Visit WebMD Retrieved April 1, 2012. Ultrasounds are used to measure fetal growth, heartbeats, movement, and the identification of physically identifiable abnormalities. Regular check-ups allow physicians to assess changes to the mothers' blood pressure, weight, uterus size, protein supplies from urine samples, and various diseases such as diabetes through screening tests. Prenatal care serves as a tool to inform mothers on common concerns, and on methods to take care of themselves (amount of rest needed, the proper nutritional diet, etc.).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.
Schedule A prenatal care schedule is recommended to consist of: Monthly visits to a health care professional for weeks 1 through 28 -(up to month 7) Visits twice a month from 28 to 36 weeks of pregnancy -(the 7th and 8th month) Weekly after week 36 (delivery at week 38–40)-(After the 8th month)
More frequent visits are warranted for women older than 35 or in case of a high risk pregnancy, with the number and types of extra controls depending on individual risk factors. On the other hand, it has been suggested that 8 to 11 visits in total can be sufficient for women considered at low risk of adverse perinatal outcomes.
+ Example of prenatal care schedule in the United States for low-risk pregnanciesUnless otherwise given in boxes, reference for prenatal care schedule is:Health Care Guideline: Routine Prenatal Care. Fourteenth Edition. By the Institute for Clinical Systems Improvement. July 2010. Fifteenth edition: Screening and monitoring Education and intervention Vaccination and other prophylaxis Pre-conception check up Height and weight to calculate BMI Blood pressure Medical history Abdominal and pelvic examination Rubella testing Varicella testing Domestic violence Depression Blood lipids (cholesterol and HDL) Pap testPreterm labor education and prevention Substance use Weight and nutrition and pregnancy Domestic violence and pregnancy List of medications, dietary supplements, herbal supplements Accurate recording of menstrual dates Counseling in case of potential vaginal birth after Caesarean Tdap or tetanus booster if needed rubella and/or varicella vaccination if needed Hepatitis B vaccine Folic acid supplementation Visit 1, 3–6 weeks Height and weight to calculate BMI Blood pressure Medical history Abdominal and pelvic examination Rubella testing Varicella testing Domestic violence Depression Complete blood count ABO/rh blood typing Syphilis test Gonorrhea and chlamydia for women at high risk for STDs Urine culture HIV testing Lead poisoning test if necessary Hepatitis B Hepatitis C if high riskPreterm labor education and prevention Exercise in pregnancy Nutrition Follow-up of modifiable risk factors in pregnancy Nausea and vomiting in pregnancy Warning signs Course of care Physiology of pregnancy Counseling in case of potential vaginal birth after Caesarean Discussion of diagnosis of fetal aneuploidyTdap or tetanus booster if needed Nutritional supplements if needed Influenza vaccination if necessary Varicella vaccination if necessary Tetanus and pertussis vaccination if necessary Visit 2, 10–13 weeks Weight Blood pressure Fetal heart monitoring Diagnosis of fetal aneuploidy if warrantedPreterm labor education and prevention Fetal growth Review of labs from visit 1 Breastfeeding Nausea and vomiting in pregnancy Physiology of pregnancy Follow-up of modifiable risk factors in pregnancy Visit 3, 16 weeksWeight Blood pressure Fetal heart monitoring Fundal height Depression Diagnosis of fetal aneuploidy if warranted Obstetric ultrasonography (optional)Preterm labor education and prevention Follow-up of modifiable risk factors Physiology of pregnancy Second-trimester growth Quickening Progesterone for prevention of preterm birth if necessary Visit 4, 18–21 weeks Weight Blood pressure Fetal heart monitoring Fundal heightPreterm labor education and prevention Follow-up of modifiable risk factors Parent education program Family issues Length of stay Gestational diabetes Rho(D) immune globulin Visit 5, 24–28 weeksWeight Blood pressure Fetal heart monitoring Fundal height Preterm labor risk Depression Gestational diabetes screening Domestic abuse Rh antibody status if needed Hepatitis B surface antigen if needed Gonorrhea and chlamydia for women at high risk for STDs Preterm labor education and prevention Psychosocial risk factors in pregnancy Follow-up modifiable risk factors Work Physiology of pregnancy Preregistration Fetal growth Awareness of fetal movementRho(D) immune globulin if necessary Visit 6, 29–32 weeksWeight Blood pressure Fetal heart monitoring Fundal heightPreterm labor education and prevention Follow-up of modifiable risk factors Travel Contraception Sexuality Pediatric care Episiotomy Labor & delivery issues pregnancy-induced hypertension Counseling in case of potential vaginal birth after Caesarean Visit 7, 36 weeks Weight Blood pressure Fetal heart monitoring Fundal height Cervix exam Confirming fetal position Culture for group B streptococcusFollow-up of modifiable risk factors Postpartum care Management of late pregnancy symptoms Contraception When to call the provider Discussion of postpartum depression Visit 8–11, 38–41 weeksWeight Blood pressure Fetal heart monitoring Fundal height Cervix examFollow-up of modifiable risk factors Postpartum vaccinations Infant CPR Post-term management Labor and delivery update
Pre-conception counseling
Pre-conception counseling in the United States is recommended to include:Health Care Guideline: Routine Prenatal Care. Fourteenth Edition. By the Institute for Clinical Systems Improvement. July 2010. Height and weight to calculate BMI Blood pressure Medical history Abdominal and pelvic examination Rubella screening Varicella screening Domestic violence screening Depression screening Testing for gonorrhea and chlamydia for women at high risk for STDs
Vaccination Vaccine Type Recommendation by CDC Hepatitis A vaccine Inactivated Yes, if indicated Hepatitis B vaccine Inactivated Yes, if indicated HPV vaccine Inactivated No (under study) Influenza vaccine Inactivated Yes Live attenuated No MMR vaccine Live attenuated No Meningococcal vaccine Polysaccharide or conjugate Yes, if indicated Tdap Toxoid or inactivated Yes, during each pregnancy between 27 and 36 weeks of gestation TD vaccine Toxoid Yes, if indicated (Tdap preferred) Varicella vaccine Live attenuated No Anthrax vaccine Subunit No, unless the risk of exposure is significant BCG vaccine Live attenuated No Japanese encephalitis vaccine Inactivated Insufficient data for recommendation Rabies vaccine Inactivated No, unless post-exposure Typhoid vaccine Live attenuated Insufficient data for recommendation Smallpox vaccine Live attenuated No, unless post-exposure Yellow fever vaccine Live attenuated No, unless the risk of exposure is significant RSV vaccine (Abrysvo)Protein subunitYes
Influenza vaccination It is recommended that all pregnant women receive influenza vaccination during flu season. Increased infectious susceptibility in pregnancy may increase the likelihood of influenza complications such as pneumonia, particularly in the third trimester. In addition, the fever, tachycardia, and hypoxemia caused by influenza may be harmful to the developing fetus.
Vaccination with inactivated trivalent influenza vaccine is cost-saving relative to providing supportive care alone in the pregnant population, but a 2009 review concluded that there was insufficient evidence to recommend routine use of it during the first trimester of pregnancy. Inactivated vaccines for influenza are considered safe at any gestational age. On the other hand, live attenuated influenza vaccines such as the nasal spray vaccine are not recommended in pregnancy. Preservative-free vaccines are available in case of hypersensitivity to eggs or to vaccine components.
Rubella