A healthy pregnancy: antenatal care and warning signs

What is it?

Prenatal (antenatal) care is the health care you get while pregnant — checkups and tests. It helps keep mother and baby healthy, finds problems early, and gives a chance to ask questions and prepare for the birth (MedlinePlus).

Contact maternity services as soon as you know you are pregnant, and contact them at any time if you are worried about your health or your baby's, without waiting for the next appointment (NHS).

Why it matters

WHO recommends at least eight antenatal contacts instead of four, the first in the first 12 weeks, and says eight or more contacts can reduce perinatal deaths by up to 8 per 1000 births compared with four visits.

The CDC says more than 80% of pregnancy-related deaths in the United States could be prevented, and that they happen during pregnancy or in the year after birth — which is why knowing the warning signs matters.

Key points

• Folic acid: 400 micrograms a day for anyone who could become pregnant, starting at least a month before pregnancy (CDC); the NHS advises it until 12 weeks. A doctor may prescribe a higher amount for some women (CDC and NHS).
• No alcohol and no smoking; stopping smoking helps at any stage of pregnancy (NHS).
• Do not start or stop any medicine — including painkillers, over-the-counter products and 'natural' remedies — without asking a pharmacist or doctor (NHS).
• There is no need to 'eat for two', even with twins (NHS).
• If the baby is moving less or the pattern changes, call the midwife or maternity unit at once, without waiting until the next day (NHS).

Visits and tests

Schedules differ between countries, and your doctor or maternity service sets yours. Examples from the sources:

• WHO: at least eight contacts — the first before 12 weeks, then at 20, 26, 30, 34, 36, 38 and 40 weeks.
• A typical U.S. schedule: monthly from week 4 to 28, twice a month from 28 to 36, then weekly until birth; women over 35 or with high-risk conditions such as diabetes or high blood pressure may need more visits (MedlinePlus).
• UK: at least 10 appointments in a first pregnancy and at least 7 if you have given birth before (NHS).

At visits, blood pressure and weight are measured, urine is tested, the bump and the baby's heart rate are checked, and you are asked about swelling, the baby's movements and your mental health (MedlinePlus and NHS).

Screening tests are optional: you can have all, some or none of them, though some must be done at certain times (NHS).

• Oral glucose tolerance testLab test
• Complete blood count (CBC)Lab test
• Ultrasound (sonography)Procedure

Nutrition, weight and activity

There is no need to 'eat for two' (NHS). According to the CDC, the first trimester generally needs no extra calories, the second about 340 extra a day and the third about 450.

A varied diet: at least 5 portions of fruit and vegetables a day, starchy foods (preferably wholegrain) as about a third of what you eat, some protein every day, and fish twice a week including one oily fish (NHS).

Vitamin D: the NHS advises 10 micrograms a day in pregnancy without exceeding 100 micrograms a day; do not take supplements containing vitamin A (retinol) or cod liver oil, because too much vitamin A can harm the baby (NHS). See vitamin D.

Iron: low iron causes tiredness and anaemia; it is found in lean meat, green leafy vegetables, dried fruit and nuts, and the doctor will advise a supplement if it is low (NHS).

Activity: 150 minutes a week of moderate activity (you can talk but not sing) and 2 muscle-strengthening sessions; avoid sports with a risk of falling or blows to the bump, scuba diving, starting new vigorous activity and lying flat on your back for long in later pregnancy (NHS).

Risks and cautions

• Alcohol: the NHS advises not drinking at all when pregnant or planning a pregnancy; it can cause miscarriage, premature birth, low birthweight and fetal alcohol spectrum disorder (NHS).
• Smoking: raises the risk of complications, stillbirth, premature birth, low birthweight and sudden infant death syndrome, and second-hand smoke also harms (NHS). See quitting smoking.
• Food safety: avoid unpasteurised milk products, raw or undercooked meat and fish, and liver and liver products; cook soft mould-ripened cheeses thoroughly; wash fruit and vegetables (NHS).
• Fish: avoid swordfish, shark and marlin, and have no more than 2 portions of oily fish a week (NHS).
• Caffeine: no more than 200mg a day (a mug of instant coffee about 100mg, a mug of tea about 75mg), and no more than 4 cups of herbal tea a day, avoiding those containing liquorice root (NHS).
• Medicines and herbal remedies: most medicines cross the placenta, and some 'natural' remedies can contain harmful substances such as lead; ask a pharmacist or doctor before any medicine (NHS).

Vaccines recommended in pregnancy according to the NHS: flu, whooping cough (usually at 20 weeks, possible from 16 weeks) and RSV (around 28 weeks). Live vaccines are usually delayed until after birth. Ask your doctor about the schedule used in your country, and see vaccines for adults.

Special groups

Ramadan fasting: pregnant and breastfeeding women are not usually expected to fast, and it is a personal decision; it is not certain that fasting is safe in pregnancy, and it may be linked to dehydration and tiredness. It matters most not to fast with complications such as gestational diabetes, and anyone choosing to fast should talk to their midwife or doctor first (Tommy's, a UK charity). See fasting with a chronic condition.

Women over 35 or with high-risk conditions such as diabetes or high blood pressure may need more frequent visits (MedlinePlus).

Pre-eclampsia is most likely from 20 weeks and can also happen in the days or weeks after birth; this is why blood pressure and urine are checked at every visit (NHS).

After birth: warning signs still matter for a year after delivery, and you should tell any health care provider that you were pregnant in the past year (CDC). Anyone who feels something is not right or has symptoms of postnatal depression should see their doctor (HSE).

Limits of this information

The schedules of visits and tests on this page come from UK, U.S. and WHO sources, and practice differs between countries; follow the schedule set by your doctor or maternity service.

We found no official WHO, NHS or CDC source on Ramadan fasting in pregnancy; the only source here is a UK charity, so ask your doctor about your situation and religious scholars about the ruling.

This page is educational for a typical pregnancy; it does not replace medical care and does not cover high-risk pregnancy in detail.

Common questions