Prenatal Care - Carrying To Term

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PRENATAL CARE, ALSO REFERRED TO AS ANTENATAL CARE, IS THE HEALTH CARE THAT A PREGNANT WOMAN RECEIVES FROM A PROFESSIONAL LIKE AN OBSTETRICIAN, MIDWIFE, OR OTHER SPECIALIST SUCH AS A PERINATOLOGIST.

Prenatal care includes lifestyle advice such as diet and exercise, weight monitoring, testing, and examinations to prevent and detect problems that affect the health and well-being of mother and baby. Early and regular prenatal care is the single most important thing a mother can do to promote a healthy pregnancy.

When doctors see mothers regularly starting in early pregnancy- or even preconception- they are better able to detect health problems. When doctors detect health problems as early in the pregnancy as possible, they are able to either treat the health problem, if possible, or provide parents with the information, tools, and resources they need to navigate health problems that affect mother and baby.

Prenatal care is crucial to a healthy pregnancy and baby, and statistics show that babies born to mothers who did not get prenatal are three times more likely to have a low birth weight and five times more likely to die than those babies born to mothers who did get care early and regularly. While prenatal care does not guarantee a healthy baby or live birth, it does drastically increase the odds for a positive outcome, and it reduces the risk of complications like birth defects, premature birth, and death.

Your doctor and their team are there for you throughout the entire process of getting pregnant, pregnancy, birth, and postpartum care. They are there to inform, equip, and support you as you navigate and embrace this season of your life. It is important to listen and adhere to the advice that your doctor gives you regarding lifestyle, diet, and pregnancy health. Your doctor is there to serve as an expert and sounding board when it comes to preconception, routine prenatal testing, genetic testing, birth plans, and pregnancy continuation in the event of a prenatal diagnosis of a life-limiting condition.

While your doctor is there to provide their expertise, insight, and support, it is important that you also serve as your own advocate, so call with questions or concerns. Reach out if you need emotional support or referrals to specialists. Lean on your care team whether you are navigating a perfectly healthy pregnancy or a carrying to term pregnancy.

Prenatal care has several important components, and this article will cover the topics of: preconception appointments, early and regular prenatal care, what to expect, prenatal vitamins, prenatal testing, and subsequent prenatal care after prior pregnancy loss.

“Prenatal care has several important components, and this blog will cover the topics of: preconception appointments, early and regular prenatal care, what to expect, prenatal vitamins, prenatal testing, and subsequent prenatal care after prior pregnancy loss.”

PRECONCEPTION APPOINTMENTS

Your preconception health is an important part of your future pregnancy health, and when possible, you should prepare your body for pregnancy by adjusting your lifestyle before trying to get pregnant. Preconception health means being aware of the health conditions and risk factors that could affect your health and that of your baby. This includes diet, exercise, habits, medications, health conditions, environmental factors, and even social factors like your support system and relationships.

While it is not always possible to consider your preconception health, whenever possible, you should talk to your doctor before getting pregnant to learn what changes you need to make or what information you need to have to support a healthy future pregnancy and a positive outcome. Preconception appointments are an especially good idea for women in their 30s and 40s, as a woman’s risk of having a baby with a chromosomal abnormality increases with age.

Preconception appointments provide you with the time to make the necessary lifestyle changes to improve fertility and promote positive outcomes such as quitting smoking, drinking, drug use, and attaining a healthy weight. Preconception appointments can also help you get conditions like diabetes, thyroid disease, anxiety, depression, or other medical or mental health issues under control. Preconception appointments also provide you the opportunity to update any immunizations and start taking the vitamins and minerals that support a healthy pregnancy and baby.

For some parents, especially those who have been through infertility, miscarriages, or the death of a baby due to a life-limiting condition, a preconception appointment can be a time to explore and understand family history, undergo genetic testing, and establish a relationship with your care team prior to pregnancy after loss.

EARLY AND REGULAR PRENATAL CARE AND WHAT TO EXPECT

The single most important thing to remember about prenatal care is that it should be sought as early as possible and then continued regularly throughout the entirety of the pregnancy. If you suspect that you might be pregnant, you should schedule an appointment with your provider to start your prenatal care. These early appointments can help prevent complications and provide you with the information you need to be proactive about your health and that of your unborn baby.

At your first prenatal appointment, you can expect your provider to:

Ask questions about your health history including diseases, surgeries, prior pregnancies and losses
Ask questions about your family’s health history
Conduct a physical examination
Run routine labs like blood tests and urinalysis
Track your blood pressure, height, and weight as baseline numbers
Provide you with an estimated due date
Review important information such as food to avoid, healthy lifestyle choices, and safe exercise
Answer any questions you may have

At each subsequent prenatal appointment, you can expect your doctor to continue to monitor your health and that of your unborn baby by:

Monitoring your blood pressure
Tracking your weight gain
Monitoring the baby’s heart rate
Conducting ultrasounds to check on the baby’s growth and development
Running routine tests like urinalysis and blood tests to check for anemia, HIV, group B streptococcus, and other factors as well as determine your blood type
Prenatal testing to rule out genetic, chromosomal, and structural abnormalities
Tracking your cervix length
Monitoring for conditions like gestational diabetes and preeclampsia
Asking questions about your ongoing emotional and physical health
Answer any questions you may have

Early prenatal care, from the moment you suspect you might be pregnant or when you get a positive pregnancy test, drastically reduces your risk for complications that can affect both you and your baby. Regular prenatal care throughout the entirety of the pregnancy allows your providers to monitor you and your baby, detect any health concerns, provide treatment when possible, provide insight and options when there is no treatment, help you prepare for birth, and ensure that all aspects of your lifestyle (diet, exercise, medications and supplements, health conditions, issues like smoking, drinking, or drug use, and personal care products) are managed in ways that promote optimal health for you and your baby.

“The single most important thing to remember about prenatal care is that it should be sought as early as possible and then continued regularly throughout the entirety of the pregnancy.”

PRENATAL VITAMINS

Prenatal vitamins, especially ones containing folic acid (vitamin B9), are incredibly important throughout pregnancy. Ideally, prenatal vitamins and supplements- those approved by your provider- should be started 1-3 months before conception. Birth defects that affect the brain and spine happen very early in the pregnancy, as the baby’s neural cord develops within the first month of pregnancy. It is very important that you are getting enough folate (or folic acid), calcium, and iron from the very beginning of your pregnancy.

Folic acid, a type of B vitamin has been shown to significantly prevent major birth defects, especially those affecting the brain and spinal cord. Folic acid has been shown to prevent neural-tube defects like spina bifida and anencephaly, heart defects, a cleft lip, a cleft palate, and it has recently been linked to the prevention of autism, according to a study conducted by the University of California, Davis. According to the Centers for Disease Control and Prevention, up to 70 percent of all neural tube defects could be prevented if every woman of childbearing age took 400mg folic acid daily, regardless of whether or not they are trying to get pregnant, since so many pregnancies are unexpected. In addition to preventing defects, folic acid is critical for supporting the creation of new red blood cells and the rapid growth of the placenta and the baby.

It is important to understand that there is a difference between folate, the naturally occurring form of vitamin B9, and folic acid, the synthetically produced form of folate. For many women, taking a prenatal vitamin that contains the recommended amount of prenatal folic acid (600 mg) is sufficient. However, for some women, their bodies do not metabolize and convert folic acid into the active form of folate. There are underlying health conditions that cause some women to not metabolize and convert folic acid as well as folate, so it is important to talk to your doctor about which is the best supplement for you.

A diet high in folate-rich foods, such as dark leafy green vegetables, nuts, beans, peas, dairy products, poultry and meat, eggs, seafood, asparagus, lentils, wheat germ, oranges, orange juice, enriched grains like fortified cereals, pasta, rice, and bread is an effective way to ensure that your body is getting enough vitamin B9. Supplementation is almost always recommended, as most women do not eat enough folate-rich foods to get all the folic acid they need to support a healthy pregnancy and the development of their unborn baby. Be sure to talk to your doctor about your folate-rich food consumption as well as your need for additional supplementation.

Additionally, research from the University of Texas Medical Branch at Galveston showed that getting the recommended 400mg of vitamin B9 for at least a year before conceiving may reduce the risk of preterm birth by 50 to 70 percent.

If you have already had a baby with a neural tube defect, be sure to talk with your doctor before getting pregnant again to determine how much folic acid in addition to the recommended dose you should take in preparation for and during your next pregnancy.

PRENATAL TESTING

Throughout pregnancy, you will undergo routine screening tests to monitor and track your health. Routine tests include:

Urine tests to screen for urinary tract infections, bladder and kidney infections, diabetes, dehydration, and preeclampsia
Blood tests to asses your blood type and Rh factor as well as screen for anemia, infections like toxoplasmosis, and sexually transmitted infections like hepatitis B, HIV, syphilis, and chlamydia
Screening tests for gestational diabetes and group B streptococcus
Ultrasound exams and cervix checks

You may also choose to undergo screening tests designed to detect the risk for or signs of potential health problems in your baby. Many of these screening tests are recommended for all women, but some tests may be recommended to you based on your personal or family history, results of preconception genetic testing, age, ethnic background, or the results of your routine tests throughout the pregnancy. These screening tests can include:

First-trimester screen, conducted between 11 and 14 weeks gestation
- This screen detects the risk for chromosomal abnormalities like Down syndrome, trisomy 13, and trisomy 18, as well as heart defects and other conditions.
- The first-trimester screen requires both a blood test to check levels in the mother’s blood and an ultrasound exam, referred to as a nuchal translucency screening, to measure the thickness of the nuchal fold at the back of the baby’s neck.
- Depending on your results, your doctor may request that you undergo further diagnostic testing.
Maternal serum screen, conducted between 15 and 20 weeks gestation
- This screen detects the risk for chromosomal abnormalities like Down syndrome, trisomy 13, and trisomy 18 as well as neural-tube defects like spina bifida and anencephaly.
- The maternal serum screen is a blood test to check levels in the mother’s blood.
- Depending on your results, your doctor may request that you undergo further diagnostic testing.
Ultrasound exams
- Ultrasounds can be utilized at any point in the pregnancy, though it is most common to have one early in the pregnancy to confirm the pregnancy and heartbeat, one later in the first trimester as a part of the first-trimester screen, and one between 18 and 20 weeks to scan and check the entire anatomy and monitor the growth of the baby.
- Depending on your results, your doctor may request that you undergo further diagnostic testing.
Amniocentesis and Chorionic villus sampling (CVS)
- These diagnostic tests can be used following a screening test to diagnose certain birth defects, such as spina bifida, cystic fibrosis, and Down syndrome.
- Amniocentesis and CVS might be suggested in cases where there is a higher risk for genetic disorders.

Prenatal testing is a very personal choice. You have every right to opt out of screening tests for chromosomal abnormalities or diagnostic tests, however, it is important to consider what these tests can provide you with. Ideally, these tests would come back negative, showing no increased risk for any defects, and in that case, you have peace of mind. However, if the tests were to show an increased risk or lead to a diagnosis, you now have the time and information you need to feel fully informed and equipped to navigate a prenatal diagnosis and the option to continue your pregnancy.

Having this information early allows you to gather a care team, ask questions to prepare yourself, navigate pregnancy continuation, create a birth plan, find support, and make the most of the time you have with your precious baby. Learning of the diagnosis early in pregnancy allows you to research and learn everything you can about the diagnosis, inform your family and friends, establish traditions and make memories, connect with other families who have been through something similar, and learn everything you can about the process of continuing your pregnancy after a diagnosis of a life-limiting condition.

“If the tests were to show an increased risk or lead to a diagnosis, you now have the time and information you need to feel fully informed and equipped to navigate a prenatal diagnosis and the option to continue your pregnancy. Having this information early allows you to gather a care team, ask questions to prepare yourself, navigate pregnancy continuation, create a birth plan, find support, and make the most of the time you have with your precious baby.”

SUBSEQUENT PRENATAL CARE AFTER PRIOR PREGNANCY LOSS

Pregnancy after loss is a complicated and emotional process. There is no right timeline for deciding to get pregnant again, and there is no one way to navigate this experience. However, it is important to consider how prenatal care will be difficult in a subsequent pregnancy after loss.

Prenatal care will likely feel different because you have been through the trauma of losing a child. You may find that you have more questions, need more support from your providers and care team, and want to undergo more extensive genetic counseling, and screening or diagnostic tests. You have every right to advocate for yourself and partner with your care team to ensure that your subsequent prenatal care feels right for you.

It is important to express your needs clearly to your doctor and care team. If you change doctors between pregnancies, be sure that your doctor and their team are fully informed and up-to-date on your prior history and experience. Scheduling a preconception appointment with your doctor- whether it is a new doctor or the doctor who cared for you during your loss- can help ensure that you feel aligned with and supported by your provider.

This preconception appointment provides you the opportunity to express concerns, address any lifestyle factors, or undergo any recommended testing prior to conception. This appointment also allows you to lay the foundation for your emotional and logistical needs throughout a subsequent pregnancy, like needing referrals to a licensed professional counselor or licensed clinical social worker, wanting care provided by a high-risk specialist like a perinatologist, or requesting additional Doppler heart rate checks, ultrasound exams, or cervix checks throughout the pregnancy.

Pregnancy after loss is a nuanced experience, and it is important to consider your needs, communicate clearly, gather support, and practice self-care throughout the process of getting pregnant, carrying the baby, laboring and delivering the baby, and transitioning to life with that baby. To help you navigate pregnancy after loss and equip your care team and network of support, we have created a three-part series: Pregnancy After Loss: A Parent’s Guide, Pregnancy After Loss: A Doctor’s Guide, and Pregnancy After Loss: A Friend and Relative’s Guide.

Prenatal care plays a crucial role in healthy pregnancies and positive outcomes. It is important that women seek prenatal care as early and regularly as possible to prevent and detect defects and other complications. Preconception appointments, lifestyle adjustments, and prenatal vitamins all promote a healthy pregnancy and baby by drastically reducing the risk of birth defects and other complications. Prenatal testing is an important part of prenatal care as it provides both the parents and the provider with crucial information to determine the health of the baby, treatment, and management as needed, and preparation in the event of a prenatal diagnosis of a life-limiting condition.

Sources:

American College of Obstetrics and Gynecology

Centers for Disease Control and Prevention

U.S. Department of Health and Human Services