Antenatal care during pregnancy

Antenatal Care

Early and regular antenatal care is recommended to ensure a healthy pregnancy. Recommendations include antenatal visits, nutritional care, education and other patient-specific issues.

Pre-conception Care

  • Ideally, antenatal care begins before conception.
  • Healthy women should begin folic acid supplementation (400 micrograms/day), at least 3 months before conception and continue at least until 12 weeks of pregnancy
  • A history of substance use, tobacco and alcohol consumption, medical conditions, medications for other ailments and psycho social concerns (depression, domestic violence) is considered in this period to counsel the mother-to-be, on the effects of these factors on pregnancy. For example, women with diabetes will be counseled on controlling their sugar levels and pregnancy will be planned only when control is achieved
  • Immunizations for Rubella, Varicella and Hepatitis B will be given and women will be advised to avoid pregnancy for 1 month after receiving Rubella or Varicella vaccines

Antenatal Visits

Initial Visit

  • It is recommended that a woman visits a doctor as soon as she misses a period to confirm her pregnancy
  • The first visit will include a comprehensive history, clinical examination, laboratory tests and education about pregnancy health. Height and weight is recorded to calculate BMI, which enables the doctor to determine weight gain guidelines that is patient specific.

Subsequent Visits

  • At the second visit, a review of laboratory results will help plan the care during pregnancy
  • Antenatal care visits will be scheduled at appropriate intervals to ensure time-sensitive testing and screenings, administration of anti-D immunoglobulin if needed, and monitoring for common complications
  • Typical frequency of visits in an uncomplicated pregnancy:
  • Every 4 weeks for the first 28 weeks
  • Every 2 weeks between 28 and 36 weeks
  • Weekly after 36 weeks.
  • More frequent visits may be advised in high risk pregnancies
  • Typical visits include evaluation of blood pressure, weight, testing urine for protein levels, whether the height of uterus corresponds to the gestational age of the foetus and checking the foetal heart rate
  • Expectant mothers are asked regarding pain, foetal movement, contraction frequency, vaginal bleeding, loss of fluid or discharge, other symptoms of pre-term labour, and pre-eclampsia symptoms at appropriate gestation intervals, in addition to any other complaints or concerns

Nutritional Counseling

  • Nutrition education will be given on a well-balanced, varied, nutritional food plan consistent with the patient's food preferences
  • Using BMI as a guideline, appropriate weight gain will be discussed
Category Pre pregnancy BMI Weight gain Weight gain 2nd & 3rd trimester (lbs/week)
Underweight < 18.5 28-40 1 (1- 1.3)
Normal weight 18.5 – 24.9 25-35 1 ( 0.8 -1)
Overweight 25.0-29.9 15-25 0.6 (0.5 -0.7)
Obese >/= 30 11-20 0.5 (0.4- 0.6)
  • Calculations assume 0.5 – 2 kg weight gain in the 1st trimester
  • A nutrition consultation will be offered to all obese women. Typical recommendations for caloric intake are estimated using 25 to 35 kcal/kg of optimal body weight with an additional 100 to 200 kcal per day during pregnancy
  • Weight gain and caloric intake recommendations are higher for women pregnant with twins or multiple pregnancies. The daily recommended caloric intake for women with a normal BMI, who are pregnant with twins, is 40-45 kcal/kg daily. Additional iron, folate, calcium, magnesium and zinc supplementation may also be required for patients carrying multiple foetuses
  • Fish intake should be no more than 340 g per week of fish or shellfish, low in mercury content.
  • Daily vitamins containing folate (400 micrograms per day) are recommended as tolerated throughout pregnancy and at least through the first 3 months of pregnancy. Some patients, such as those whose prior pregnancy was complicated by fetal defect, require higher-dose folate intake of 4 milligrams per day.
  • Moderate caffeine intake does not have negative effects on pregnancy; however, caffeine intake should be limited to <200 mg daily

Information on healthy behaviors

  • Nutrition and dental care
  • Sexual activity on advise of doctor
  • Chewing and smoking of tobacco to be avoided
  • If the patient has had a prior caesarean delivery, the risks and benefits of a trial of labour versus repeat caesarean delivery will be discussed
  • Alcohol consumption is contraindicated in pregnancy
  • Specific issues that are discussed:
  • Breastfeeding: Throughout antenatal care, the patient will be provided with information about the benefits of breastfeeding and breast care.
  • Working: women with an uncomplicated pregnancy can continue working until the onset of labour. Women with medical complications, jobs involving excessive physical work, prolonged standing or significant stress, will need some adjustments
  • Air travel: women with uncomplicated pregnancies can fly safely until 36 weeks. Pregnant women who undertake long flights need to take precautions (support stockings, movement of lower extremities, hydration).
  • Exercise: women will be encouraged to continue or begin a moderate aerobic exercise program during pregnancy.
  • Parent craft: Attendance in childbirth education classes is encouraged. These sessions teach the expectant mother and husband, about labour and delivery, pain relief options, potential obstetric complications and procedures, normal newborn care and postpartum adjustment. Supportive information will be provided regarding the benefits of breastfeeding
 

 

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