A Woman's Guide to Prenatal Care

Dean Health Plan (DHP) has established minimum guidelines for prenatal care. Following these recommended guidelines can help detect medical problems early, when treatment is most effective. Check with your healthcare provider about additional procedures he or she recommends for you.

Ideally, you should visit your healthcare provider during the first three months of pregnancy. DHP recommends the following care during your pregnancy: Blood pressure check. High blood pressure can lead to serious problems during pregnancy. Have your blood pressure checked during every visit to your healthcare provider.

Pap test. A Pap test checks for cancer of the cervix (the opening to the uterus). A Pap test may be done during your first prenatal visit, depending on when the last one was performed.

Blood and other lab tests. Hemoglobin and hematocrit tests (for iron in the blood) should be done periodically to check for anemia (low iron in the blood).

Hepatitis B screening. Hepatitis B is a viral infection that can be passed from mother to baby during childbirth. Hepatitis B can harm both mother and baby. Pregnant women should have a blood test to screen for hepatitis B.

Syphilis, chlamydia and gonorrhea screenings. Syphilis is a sexually transmitted disease that can be passed from the infected mother to her baby. Left untreated, syphilis can harm both. Syphilis can be detected early with a blood test, and treatment can begin. Testing for chlamydia and gonorrhea can also be done during the first visit.

Rubella screening. This is a blood test for German measles. If you have had a rubella shot in the past, you may not need this blood test. Check with your healthcare provider.

Flu shot. This shot is recommended in the second or third trimester to all pregnant women during flu season.

Rh blood typing. This test determines whether a woman is at risk for problems because her blood type is different from her baby’s. An antibody blood test should also be done to make sure there are no other problems.

Maternal serum alpha-fetoprotein (MSAFP) blood test. This test may be offered in the 15th to 18th week of pregnancy to see whether you are at risk for having a baby with potential problems.

One-hour glucose tolerance test. This test for sugar in the blood should be done between the 24th and 28th week of pregnancy.

Urine test. This test is done during the first visit.

HIV/AIDS screening. Both testing and counseling should be offered, and medical care should follow if the mother and baby are at risk or test positive for HIV.

Chorionic villus sampling and amniocentesis. Women who will be older than age 35 at delivery may be offered a chorionic villus sampling (a test of the placenta that surrounds the baby) or an amniocentesis (a test of the fluid that surrounds the baby). These tests help determine whether the baby is healthy. Chorionic villus sampling should be done before the 13th week of pregnancy. Amniocentesis is recommended during the 14th to 20th week of pregnancy.

Genetic screening. Tests may be offered to look for cystic fibrosis or high-risk ethnic or racial disorders that could affect the health of the mother or baby during pregnancy. Genetic counseling may also be offered to help women understand these risks.

Counseling in these areas can improve your chance of having a healthy baby:

Nutrition. Eating well is important during pregnancy. A varied diet can help keep you and your baby healthy.

Alcohol, tobacco and other drugs. Don’t smoke when you are pregnant. It increases the risk of having a premature, low-birth-weight baby. Secondhand smoke can also be harmful. Use of alcohol and other drugs can increase the risk for miscarriage and mental and growth retardation.

Childbirth and child-care classes. These classes can help you prepare for the birth of your baby and help with any questions you may have about caring for your newborn.

Breast-feeding. This has been proven to be healthy for mother and child. A breast-feeding class may help you successfully nurse your baby.

Sexually transmitted disease prevention. Safe sex can prevent the spread of sexually transmitted diseases.

Seat belts. Using a seat belt when you are in a moving vehicle is strongly recommended.

Follow-up visit. There should be at least one office visit within 21 to 56 days after your baby is born.

These tests are recommended for pregnant women based on their race or ethnic background:

• Women of African-American or Mediterranean ethnicity should receive a hemoglobin electrophoresis screening to test the different types of hemoglobin in the blood, if not previously done.
• Women of Southeast-Asian ethnicity should receive a complete blood count to look for a profoundly anemic state, among other things.
• Women of Jewish heritage should receive screening for Tay-sachs, Gaucher and Canavan’s disease, if not previously done.

This is not a complete list of ethnic or racial specific tests. However, it is important to be aware that such tests may be necessary based on your ethnic background or race.

Prenatal Guidelines
Screening	First Trimester (1–13 weeks)	Second Trimester (14–28 weeks)	Third Trimester (29–40 weeks)
Blood Pressure	X	X	X
Pap Test	X
Anemia	X	X	X
Hepatitis B	X
Syphilis/Chlamydia/Gonorrhea	X
Rubella	X
Rh Blood Typing	X
MSAFP, Multiple Marker		X
One-Hour Glucose		X
Urine	X
HIV/AIDS	X
Special Screening
Chorionic Villus Sampling	X
Amniocentesis		X
Genetic Testing (if appropriate)	X
Counseling/Prevention
Nutrition	X	X	X
Substance Abuse	X	X	X
Childbirth Classes	X	X	X
Breast-Feeding	X	X	X
Sexually Transmitted Disease Prevention	X	X	X
Child-Care Classes	X	X	X
Injury Prevention	X	X	X
Flu Shot (during season)	X	X	X

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