Prenatal Care During Pregnancy

Prenatal care in medicine is treatment received during pregnancy. Your doctor reviews your health and your developing baby at every appointment. As soon as you find out you are pregnant, schedule your first prenatal care visit by calling your physician. And show up for all of your prenatal visits, even if you feel well.

Regular early prenatal care will enable you to have a healthy pregnancy and a full-term baby. Full-term describes your baby's birth between 37 weeks and 42 weeks. Being born full-term offers your child the correct amount of time they need in the womb to grow and develop.

Talk to your provider about personal matters without fearing consequences. Your doctor must know everything about you so they can offer the finest care for you and your unborn child. They probe you, your partner, and your families extensively. Your medical records and anything you tell them are private. They cannot thus share them with anybody without your consent. Let them know about everything related to you and your partner's health, including past drug usage, smoking or alcohol consumption.

Prenatal Visit

At the first prenatal checkup, your doctor will:

• Inquire about your past medical history including surgery, infections, or past pregnancies
• Find out about your family's medical history
• Do a thorough physical examination involving a pelvic exam and a Pap test
• For lab tests, collect your urine and blood
• Measure your weight, height, and blood pressure
• Find your due date via calculation
• Address your questions

You should talk about any pregnancy-related concerns during the initial appointment. Research everything you can about maintaining health.

Later prenatal checkups will generally be brief. Your doctor will go over your health and ensure the baby is developing as predicted. Most prenatal visits will feature:

• Taking your blood pressure
• Comparing your weight increase
• Once you start to show, measuring your abdomen to help you monitor the development of your baby
• Looking at the baby's heart rate

Common Complications

Throughout your pregnancy, you will also undergo certain standard tests, such as those for anaemia, and dangerous infections.

You also will undergo some regular testing while pregnant. All women should be tested for several things, including blood testing to screen for anaemia, blood type, HIV, and other conditions. Depending on your age, personal or family health history, ethnic origin, or the findings of recent regular tests you have undergone, more tests might be recommended.

Work together with your doctor to manage your healthcare effectively. Attend all of your appointments; each one is crucial! Ask questions and read to learn more about this wonderful time.

How often do you get checked out for pregnancy care?

This is a plan that most pregnant women can stick to:

• From week 4 to week 28 of pregnancy, get checked out every four weeks, or once a month
• After 28 weeks and before 36 weeks, get checked out every two weeks, or twice a month
• From 36 to 41 weeks of pregnancy, get checked out once a week

If something goes wrong with your pregnancy, your doctor may want to see you more often.
When you get your prenatal checkups, you can bring your partner, a friend or a family member who can help you feel better.

Prenatal testing

During pregnancy, tests are conducted to monitor the health of both you and your baby. During your first prenatal appointment, your doctor will utilise tests to screen for a variety of things, including:

• Your blood type and Rh factor
• Anaemia
• Sexually transmitted illnesses (STIs), such as hepatitis B, syphilis and HIV

Throughout your pregnancy, your doctor may recommend a variety of different tests. Some tests are recommended for all women, including testing for gestational diabetes, Down syndrome, and HIV. Additional exams might be conducted based on your:

• Age
• Personal or family health history
• Ethnic background
• Results of routine tests

Some tests are screening tests. They discover potential health concerns in you or your child. Based on the findings of the screening tests, your doctor may recommend diagnostic testing. Diagnostic tests confirm or rule out medical issues in you or your baby.

Prenatal Screenings

Biochemical and ultrasound data may help doctors detect pregnancies with a high risk of birth abnormalities. The findings allow healthcare practitioners to quantify the particular risks of Down's syndrome, a genetic disease that causes moderate to severe intellectual impairment and affects around one in every 700 newborns. A test is also available to rule out trisomy 18 and 13, a serious genetic condition, as well as spinal birth abnormalities.

Prenatal testing includes both screening and diagnostic tests. Screening tests aren't diagnostic. They may offer information on the likelihood of a baby having a certain ailment or condition. Only diagnostic testing can determine if a newborn has a birth defect.

Which tests are used to identify probable birth defects?

First-trimester Screen (nuchal translucency, hCG, and PAPP-A)

This test is often conducted between weeks 11 and 13 of pregnancy. This non-invasive test combines an ultrasound of the baby with a blood check for the mother. It includes nuchal translucency, which may help detect other possible problems, like heart disease. It is primarily designed to detect chromosomal abnormalities such as Down syndrome or Trisomy 18.

Chorionic Villus Sampling (CVS)

This test may be done between weeks 10 and 13 of pregnancy. A sample of placental tissue is collected and tested to detect chromosomal abnormalities and other hereditary illnesses such as Down syndrome and cystic fibrosis.

Second-Trimester Quad Screen (AFP, hCG, Estriol, Inhibin-A), Integrated Screening

This screening may be done between weeks 16 and 18 of pregnancy. This blood test detects levels of alpha-fetoprotein (AFP), a protein generated by the foetus; human chorionic gonadotropin (hCG), a hormone produced by the placenta; oestriol, an oestrogen produced by both the mother and the placenta; and inhibin-A, a protein produced by the placenta and the ovaries. It checks for Down syndrome, Trisomy 18, and other chromosomal disorders. It may also assist in assessing the likelihood of neural tube anomalies, such as spina bifida, and abdominal wall problems, such as omphalocele.

Amniocentesis (also known as the amniotic fluid test or AFT)

This diagnostic procedure is conducted between weeks 15-20 of pregnancy. A small quantity of amniotic fluid is drawn from the sac that surrounds the foetus.

Monitor Your Baby's Activities

After 28 weeks, monitor your baby's movement. This can help you detect if your child is moving slower than usual, which might indicate that they are in discomfort and need medical attention. The "count-to-10" strategy is a simple way to do this. Count your baby's movements in the evening, when the foetus is most active. If you are having problems feeling your baby move, lie down. Most women count ten motions in roughly 20 minutes.

However, it is uncommon for a woman to count fewer than ten movements within two hours when the baby is active. Count your baby's movements every day to determine what is typical for you. If you count less than ten movements in two hours or see your baby moving less than usual, call your doctor. If your baby isn't moving at all, contact your doctor immediately.

Education on Diet, Lifestyle Modifications, Birth Planning

To guarantee both personal and family well-being, one must educate themselves on food, lifestyle changes, and pregnancy planning. Every one of these areas is vital for health and quality of life, hence thorough education helps people and their families to have better results.

Education on Diet

The following summarises every element:

• Diet Education: Fundamentally, people should be taught the need for a balanced diet. This covers knowledge of macronutrients like carbohydrates, proteins, and fats as well as micronutrients like vitamins and minerals and their functions in preserving health.

• Dietary Guidelines: Knowledge of dietary guidelines, which national health organisations offer helps people choose their foods wisely. This may include suggestions on lean meats, fruits, vegetables, whole grains, and good fats as well as on portion amounts.

Education should also address certain dietary requirements such as those for people with diabetes, hypertension, or food allergies. Knowing how to control these diseases with nutrition can help to significantly enhance general health outcomes.

Learning mindful eating, meal planning, and the value of consistent meals can help prevent overindulgence and enhance general nutrition.

Changes in lifestyle

• Physical Activity: It is essential to learn the advantages of consistent exercise including mental wellness, muscular strength, and cardiovascular health. Finding fun activities and knowing various forms of exercises like aerobics, weight training, and flexibility helps people include physical activity in their daily routines.

• Sleep: A major component of lifestyle education is encouraging proper sleeping patterns. This covers realising the need for a consistent sleep routine, designing a peaceful surrounding, and treating problems like insomnia.

• Maintaining mental health and general well-being depends critically on methods for stress management including mindfulness, meditation, and relaxation activities.

• Other lifestyle habits: One should also learn about the dangers connected to smoking, too much alcohol intake, and drug usage. It is crucial to have access to tools and help for either cutting down on or stopping harmful habits.

Education on birth planning

It helps one to grasp the many choices for labour and delivery, namely, natural birth, epidurals, cesarean sections, etc. Knowing every possibility enables expecting parents to make wise choices.

• Learning about how to construct a birth plan would enable people to clearly state their choices for labour, delivery, and postpartum care. This covers choices for initial birth care, pain treatment, and support staff.
• Birth planning is also being ready for life after the birth of the baby. Do thorough research on infant care, nursing, and the need for postnatal assistance for both physical and psychological aspects.
• You should also find out about when and how to get medical aid if necessary as well as how to be ready for any issues or emergencies during delivery.

Vaccinations

In general, vaccinations containing dead viruses, also known as inactivated viruses, may be administered during pregnancy. Vaccines containing live viruses are not advised during pregnancy.

The following vaccines are safe and recommended during pregnancy:

• Flu shot: This is also known as the influenza vaccination. It is advised for pregnant women during flu season. The flu vaccine is created from a dead virus, so it is safe for both you and your baby. Do not get the influenza nasal spray vaccination. It is derived from a living virus.

• Tetanus, diphtheria, and pertussis vaccines. This is also called Tdap. Tdap vaccination is recommended once each pregnancy. That is true regardless of when you had your previous Tdap immunisation. Getting the Tdap vaccination during pregnancy protects your infant against whooping cough, often known as pertussis. Aim to get the immunisation between 27 and 36 weeks of pregnancy.

• COVID-19 Vaccine. Whether or not you have previously been vaccinated against COVID-19, an updated COVID-19 vaccination is recommended and safe during pregnancy. According to studies, COVID-19 immunizations provide no significant harm to pregnant women or their newborns. If you get pregnant after receiving the first dose of a COVID-19 vaccination that needs two doses, you should obtain the second injection. It is also suggested that pregnant women have a COVID-19 booster injection when it is necessary. People who cohabit with you should, if feasible, be immunised against COVID-19. This helps to avoid the spread of diseases.

High-risk Pregnancy

If your pregnancy is classified as high-risk, it indicates that you or your baby are more likely than normal to have health issues before, during, or after birth.

Because of this risk, you may need additional medical checkups or testing during your pregnancy. At these consultations, your healthcare team checks to see if you are developing any health concerns and addresses them as soon as they arise.

Pregnancy Complications

Some health issues that arise during pregnancy might create complications. Examples include:

• The placenta was found in an unusual position
• The foetal growth rate is quite low. Typically, foetal growth or foetal abdominal size less than the 10th percentile for gestational age are grounds for worry. This disease is known as foetal growth limitation
• Rh sensitisation. This occurs when a pregnant person's blood type is Rh-negative while the foetus's blood group is Rh-positive

Regular appointments with your healthcare team throughout pregnancy enable them to monitor both your and your baby's health. You may be referred to a specialist. Depending on your needs, you may consult a specialist in maternal-foetal medicine, genetics, paediatrics, or another field.

Medically approved by Dr Prathamesh Lanjewar, Research Associate, Department of Obstetrics and Gynaecology, NIIMS (Noida International Institute of Medical Sciences College & Hospital)