Prenatal Care and Testing

Every mother-to-be needs prenatal care, which is the regular health care you will receive during pregnancy from your doctor, midwife, or other health care professional. Prenatal care should begin as early as possible, ideally even before you become pregnant (a preconception visit).

The goal of prenatal care is to monitor the progress of your pregnancy and check for any problems that may arise. Women who get prenatal care have healthier babies, and are less likely to have pregnancy-related problems.

Routine Prenatal Care: Your First Pregnancy Visit

You should call to schedule a prenatal visit with your doctor as soon as you realize you are pregnant. After speaking with you, the doctor’s office may suggest seeing you soon, or may suggest a first visit around eight weeks after your last menstrual period.

This first visit will also include a physical examination, during which your doctor will weigh you, check your blood pressure, and do a pelvic examination/ ]]>pap smear]]> to check for cervical cancer and vaginal infections. You will provide blood and urine samples for a variety of tests, including tests for infections and anemia.

Your doctor will also estimate your due date and will likely recommend that you start taking a prenatal vitamin that contains at least 400 micrograms of folic acid, if you are not already.

Routine Prenatal Care: Subsequent Visits

After your first prenatal visit, you will schedule one prenatal visit every 4-6 weeks until about 28 weeks in your pregnancy. During weeks 28-36, you will schedule visits about every 2-3 weeks, and after week 36, you will probably see your healthcare provider every week. Sometimes there are alternate visits with a clinical provider and with a nurse.

At these visits, your healthcare provider will weigh you, check your blood pressure, measure and feel your growing abdomen, check for swelling, listen to your baby’s heartbeat (after week 12), and may perform blood tests, urine tests, and/or ultrasounds.

At each prenatal visit, you should discuss any questions or concerns you have with your doctor.

Prenatal Diagnostic and Screening Tests

The following table describes the most common prenatal tests used to monitor your pregnancy and identify potential problems.

Test	Description
Blood type and antibody screen	Blood tests used to determine your blood type (i.e., A, B, AB, or O), and whether you are Rh positive (i.e., your blood has the Rh antigen) or Rh negative (i.e., your blood lacks the Rh antigen); ]]>if your blood type and Rh status are incompatible with your baby’s]]> , you may need special care during pregnancy
Hematocrit and hemoglobin	Blood tests that check for ]]>anemia]]>
]]>Syphilis]]>	A blood test that checks for the sexually transmitted disease (STD), syphilis, which can be treated so that it will not be transmitted to your baby
]]>Rubella]]>	A blood test to see if you have had rubella (German measles) or a rubella vaccination; if you have not, you will be advised to avoid being exposed to the disease while pregnant
]]>Hepatitis B virus]]>	A blood test to determine if you have hepatitis B, a viral disease that infects the liver; it can be treated with medications, which must also be given to your baby, along with a vaccine, after birth
]]>Human immunodeficiency virus (HIV)]]>	A blood test to determine if you have been infected with the HIV virus, which causes AIDS; if you have, you will be given medications during pregnancy to reduce the risk that you will pass the infection on to your baby. . This test is very valuable because of the power of preventive medications to protect the baby.
Urine tests	A laboratory test to check the levels of sugar and protein in your urine, which can identify diabetes, ]]>urinary tract infection]]> , kidney disease, or ]]>high blood pressure]]> ; urine tests can also check for ]]>bladder]]> and ]]>kidney infections]]>
Cervical tests	A Pap test to check for precancerous cells in your cervix, and swabs to test for the STDs ]]>gonorrhea]]> and ]]>chlamydia]]> .
Multiple marker screening (Quad screen, Triple screen, AFP test)	A maternal serum screening test that measures the levels of the hormones estriol, human chorionic gonadotropin (hCG), Inhibin-A, as well as AFP, in your blood; abnormal results can indicate an increased risk of Down’s syndrome. A maternal serum screening test to check levels of alpha fetoprotein (AFP), a protein made by the fetus; if your level of AFP is high, your baby may be at risk of neural tube defects; if it is low, your baby may be at risk of Down’s syndrome (low levels are interpreted with other three markers)
Ultrasound	An imaging test that uses sound waves to view your fetus; ultrasounds can help determine the age and sex of the fetus and/or confirm a diagnosis
Other tests	Other tests that may be performed include testing the amniotic fluid, examining cells from the placenta, testing your fetus’ genetics, screening for diabetes, testing for streptococcus, and testing for tuberculosis

References:

Parmet S, Lynm C, G RM. Prenatal Care. JAMA . 2004;291(1).

Prenatal care. March of Dimes website. Available at: http://www.marchofdimes.com/pnhec/159_513.asp . Accessed july 21, 2005.

Routine tests during pregnancy. American College of Obstetricians and Gynecologists. Available at: http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ84JKXODC&sub_cat=2005 . Accessed July 21, 2005.

RESOURCES:

American Pregnancy Association
http://www.americanpregnancy.org

March of Dimes
http://www.marchofdimes.com

Last reviewed May 2007 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.