As you enjoy all the fun stuff that goes along with being a mom-to-be, like picking a name and the perfect paint color for your baby’s nursery, make sure you’re on a prenatal appointment schedule. Regular prenatal visits ensure everything is as expected and can help spot any signs of problems early on, when complications are easier to treat. Here’s what you need to know about prenatal
How many prenatal appointments can I expect to have during pregnancy?
Depending on when you find out you’re pregnant and have your first prenatal visit, you’ll have a total of about 10 to 15 appointments. In most complication-free pregnancies, you can expect to have a prenatal appointment:
Please reschedule your appointment if any of the following apply to you now or within the last 14 days:
- Weeks 4 to 28: Once a month
- Weeks 28 to 36: Every other week
- Week 36 until birth: Every week
The frequency of prenatal appointments increases in the third trimester
because pregnancy complications like preeclampsia are more likely to crop
up then. Issues with your baby’s growth also tend to appear later in pregnancy, so your practitioner will also want to measure your weight, belly size and other growth indicators more frequently in the last trimester.
You may see your practitioner more often if you have any risk factors or if you gave birth early or late in a previous pregnancy.
What kinds of tests will I have at my prenatal appointments?
Throughout your pregnancy, you can expect a number of prenatal tests. At every prenatal appointment, your practitioner will:
- Take your blood pressure Weigh you
- Take a urine sample to check for too much protein (a sign of preeclampsia) or sugar (a sign of gestational diabetes)
- Check for swelling in your hands, feet or face
- Listen to your baby’s heartbeat (from week 12 on, though it can be heard on a Doppler device as early as week 10)
Other tests you’ll get during various visits vary according to your risk for certain conditions and may include:
- Pelvic exams
- Breast exams
- Pap smear
- Ultrasounds and Doppler scans
- Blood tests (to check your hCG levels and to screen for Rh factor and anemia, among other conditions)
- Glucose screenings
- Nuchal translucency screening
- Group B strep
- Nonstress tests
- Biophysical profile
Based on your risk factors (usually your age, ethnic background or family history), your practitioner may also recommend one of several prenatal genetic tests and screenings to check for chromosomal abnormalities that cause conditions like Down syndrome. Blood screenings may include noninvasive prenatal testing (NIPT) and the quad screen, both of which indicate whether your baby is at greater risk of a genetic abnormality.
What will I talk about during prenatal visits?
Each time you visit, take this opportunity to stay informed about your pregnancy:
- Ask how you’re doing physically and emotionally
- Answer all of your questions
- Offer tips on caring for yourself and your baby-to-be
- Give you a heads-up about changes to expect and red flags to look for before your next visit
First trimester tests
- Urine tests are not unique to the first trimester. In fact, these will be routine with every prenatal visit. Urine tests are a way to check for infection, dehydration, blood sugar control and urinary tract dysfunction.
- Rh factor testing is part of the first trimester or early pregnancy blood screening. Rh factor is an identifying protein on red blood cells. It is important to know your blood type and Rh factor as Rh negative status has special implications in pregnancy. If you are Rh negative, there is a chance that your baby may have Rh positive status (inherited from the father of the baby.) In such a situation, your body may react to the baby as a foreign entity and initiate an attack on the baby’s ability to generate red blood cells. Women who have antibodies to Rh and are at risk of an affected baby are referred to a High Risk doctor for further evaluation. Women who are not affected are given an injection to neutralize any possible fetal blood that may sensitize her body to react to the Rh positive fetal blood that naturally seeps into her blood stream. This injection is typically administered 26-28 weeks or in case of increased risk of maternal-fetal bleed.
- Initial blood work in the first trimester serves as a baseline for the pregnancy and to test for immunity to disease or active infection of disease.
- PAP specimens in pregnancy are routine and often a base line for some women who do not regularly seek wellness care. This is an opportunity to identify women with risks of HPV changes on pap that put them at added risk of cervical cancer.
What to eat in pregnancy?
Pregnancy is a great time to optimize your eating habits. In general, eat healthy, clean well cooked meals. Minimize your consumption of sugary drinks, process foods and food colors. Avoid alcohol and smoking in pregnancy.
What to avoid eating in pregnancy?
- High mercury fish. This includes shark, king mackerel, tuna (especially albacore), swordfish, and tile fish. Low mercury containing fish are healthy and can be eaten upto 2 times a week.
- Undercooked or raw fish. Do not eat sushi with raw fish or shellfish raw in pregnancy. Consumption of these undercooked or raw fish can cause viral, bacterial or parasitic infections, such as norovirus, vibrio, salmonella and listeria.
- Undercooked, raw and processed meat. Eating undercooked or raw meat increases your risk of infection from several bacteria or parasites, including toxoplasma, E. Coli, Listeria, and Salmonella.
- Raw Eggs can be contaminated with Salmonella.
- Organ meat is a great source of several nutrients, including iron, vitamin B12, vitamin A and copper. However, too much vitamin A in pregnancy is not recommended and may result in birth defects and liver toxicity.
- Caffiene is commonly found in coffee, tea, soft drinks and cocoa.
- Pregnant women should limit their caffeine intake to 200 mg per day or about 2 cups of coffee.
- Raw sprouts including alfalfa, clover, radish and mung bean sprouts may be contaminated with salmonella.
- Unwashed produce or unpeeled fruits and vegetables may be contaminated with bacteria and parasites.
- Unpasteurized Milk, cheese and fruit juice can carry an array of harmful bacteria, including Listeria, Salmonella, E.Coli and Campylobacter.
Ultrasounds and Doppler scans are a means of assessing your baby’s well being. On regular prenatal visits, fetal heart tones will be listened to. In the first trimester, an early ultrasound is often completed to document and confirm your due dates and gestational age. In the second trimester, a level 2 anatomy scan is often completed to evaluate the baby’s anatomy and check system -by- system the baby’s development. Third trimester growth or follow up scans are ordered based on medical necessity and often to follow up on a previous finding or fetal development.
Glucose screenings are conducted in early pregnancy for high risk pregnancies (women over age 35 or with pre-existing diabetes or risk factors). Otherwise, women are screened at 28 weeks for diabetes.
Nuchal translucency screening is an opportunity to evaluate fetal well being early in the first trimester (11-14 weeks.) This test involves a finger stick with maternal markers and a fetal ultrasound. The information is placed in a risk assessment calculator to predict risk of trimsomy 13,18,21 and the ultrasound provides an early anatomy screen.
Group B strep is a bacteria that 30 % of women harbor in their vaginal and rectal areas. This test is collected after 36 weeks so as to identify women who test positive and whose babies may be at risk of acquiring the bacteria as they come through the birth experience. To avoid the infection in babies (since babies do not have an intact immune system) antibiotics are given in labor and this reduces the transmission risk. GBS infection can be dangerous to babies, causing early and late sequelae.
Nonstress tests are tests conducted on fetuses to assess well being. NST are fetal tracings and maternal uterine activity tracings. NSTs are usually conducted after 28 weeks, and the frequency depends on the indication for fetal surveillance.
Biophysical profile is an ultrasound assessment of fetal wellbeing. It is often combined with the NST. Healthy babies have certain expected behaviors in-utero and are evaluated and scored. A good score predicts fetal wellbeing for a period of time. The frequency of BPPs depends on the reason for conduction them.