Prenatal care is the health care provided throughout a pregnancy; it is aimed at optimizing maternal and fetal outcomes. Prenatal visits allow high-risk pregnancies to be identified and are used to monitor maternal health and fetal development. After an initial visit (usually in the first trimester), follow-up prenatal visits generally occur once monthly until 28 weeks' gestation, twice monthly between 28 and 36 weeks, and weekly after 36 weeks. Components of prenatal visits include evaluation of the medical history, physical and gynecological examinations, laboratory testing, and ultrasonography. More frequent assessment may be indicated in pregnancies deemed high-risk for the fetus or pregnant individual. This article covers the general principles of prenatal care, including recommended screening studies, elective prenatal genetic screening, fetal surveillance, and patient education.
For other aspects of peripartum care, see also “Normal labor and delivery,” “Abnormal labor and delivery,” and “Postpartum visit.” For prenatal care for transgender and nonbinary individuals, see “Pregnancy in transgender individuals.”,” “
Ethics of prenatal care 
- Healthcare providers have an ethical obligation to obtain from patients for prenatal care.
- Patients may refuse recommended screening or procedures.
- Use shared-decision making when discussing treatment options with patients in order to:
- Ensure a safe environment for asking questions and addressing concerns
- Encourage voluntary, informed decisions
- Avoid miscommunication
Because pregnancy outcomes are unpredictable, pregnant individuals should be informed about the potential need for obstetric interventions (e.g., cesarean delivery) and encouraged to discuss any concerns ahead of time. 
Legal aspects of prenatal care
- Follow state laws pertaining to induced abortion and mandatory reporting (e.g., of maternal substance use). 
- Regardless of state law, EMTALA allows for provision of emergency abortion to stabilize a patient. 
- In accordance with labor cannot be turned away. , patients in active
- See also “Principles of medical law and ethics.”
Frequency of prenatal visits 
- Visit frequency should be tailored to maternal needs and pregnancy risk factors. 
- Typical timing of routine prenatal visits for an uncomplicated pregnancy:
generally warrant more than the usual number of follow-up visits for maternal and/or fetal surveillance. 
Monitoring fetal growth and wellbeing
General principles 
- Assess growth via physical examinations and ultrasound (US).
- In high-risk pregnancies or if there is concern for fetal well-being, consider:
Gestational age and estimated date of delivery 
- Determination of gestational age and estimated date of delivery is important for:
- Guiding the timing of prenatal screening and fetal monitoring
- Managing postterm pregnancy
- Methods of pregnancy dating include one or both of the following:
- Naegele rule
- Ultrasound: should be performed to estimate gestational age if LMP is unreliable. 
- For a gestational age discrepancy between ultrasound and LMP, use EDD determined by ultrasound if: 
Symphysis-fundal height measurement 
- Measured from the top of the pubic symphysis to the top of the uterus.
- Fundal height can be used to monitor fetal growth or to roughly estimate gestational age in an emergency. 
- Screen all patients > 24 weeks' gestation for fetal growth abnormalities using symphysis fundal height. 
- From 20 weeks, fundal height in centimeters should roughly approximate the week of gestation. 
- If comparison of fundal height and gestational age suggests growth abnormality , perform an ultrasound. 
|Fundal height and gestational age |
|Week of pregnancy||Fundal height during pregnancy|
|12th||Just above the symphysis|
|16th||Between the symphysis and navel|
|32nd||Between the navel and xiphoid|
|36th||Peak: at the costal arch|
|40th||Two finger widths below the costal arch|
Standard examinations 
- First-trimester US is performed to estimate gestational age and assess for complications (e.g., suspected ectopic pregnancy).
- A second-trimester US is recommended between 18–22 weeks to assess fetal anatomy.
- For more information, see “First-trimester ultrasound” and “Second-trimester ultrasound.”
Additional ultrasounds 
Additional US may be performed for further evaluation of potential pregnancy complications, follow-up of abnormal US, and for imaging guidance during procedures.
- US-guided procedures
- Limited US: imaging of a specific area based on clinical concern
Specialized US: detailed US evaluation performed to further evaluate for fetal abnormalities in patients with concerning findings on clinical history and/or examination, laboratory testing, and/or prior ultrasound examination
- Nuchal translucency: as part of prenatal genetic testing
- Fetal echocardiography: in suspected congenital heart disease 
- Biophysical profile: if there is concern for fetal well-being
- Transvaginal measurement of cervical length: if there are concerns for preterm labor
- Doppler ultrasound; : for suspected abnormalities in fetal/placental perfusion or suspected fetal deformities 
|Overview of maternal and fetal vessel doppler ultrasound |
|Vessel||Indication for imaging||Pathological findings|
|Maternal uterine artery|
|Fetal middle cerebral artery|| |
High-risk pregnancies 
- Early identification and management of high-risk pregnancies is essential for the prevention and treatment of associated maternal and fetal complications.
- Assess for risk factors for adverse pregnancy outcomes at each visit.
Risk factors for adverse pregnancy outcomes 
- Maternal factors 
- Fetal-placental factors
- Pregnancy-related factors
Management of high-risk pregnancies
- Refer patients with high-risk pregnancies to specialists as indicated, e.g.:
- Maternal-fetal medicine
- Pediatric specialists
- Consider increased monitoring of maternal and fetal well-being with:
- Discuss the potential impacts of high-risk pregnancy with patients on:
- Mode and timing of delivery
- Need for postpartum and neonatal monitoring after birth
- See also “ .”
- The goal of the initial prenatal visit is to determine gestational age, identify and manage risk factors, and educate patients. 
- The initial prenatal visit usually occurs in the first trimester, unless there has been late entry into prenatal care.
- Components of first-trimester care may occur prior to the initial prenatal visit.
- Some aspects of first-trimester care, e.g., prenatal genetic testing, may require multiple visits.
Initial prenatal visit 
- Assess patient's feelings about the pregnancy.
- Review prior , if any was given.
- Perform a comprehensive clinical assessment, including history and physical examination.
- Take a medication history; if possible, stop or change medications contraindicated in pregnancy.
- Screen for comorbid physical and mental health conditions.
- Inquire about risk factors for lead exposure and send a lead level if any are present. 
- Assess for manage as high-risk pregnancy if present. ;
- Determine (EDD) and perform first-trimester ultrasound, if indicated (see “Gestational age and estimated date of delivery”).
- Offer prenatal aneuploidy and genetic carrier screening (see “Prenatal genetic testing”).
- Assess vaccination status and administer , including: 
- Provide prenatal patient education.
- Arrange follow-up visits and referrals as needed.
History and physical examination 
- Personal medical history, including obstetric history (e.g., , , )
- Family history: maternal and paternal 
- Complete physical examination including: 
|Recommended initial prenatal screening tests |
|Tests||Management of abnormal results|
|Complete blood count to screen for anemia and || |
|Blood typing (ABO and rhesus) and RBC antibody screening to prevent || |
|Urine dipstick to screen for proteinuria |
|Urine culture to screen for |
|Screening for STIs and bloodborne pathogens|||| |
|HBV serology|| |
Patients with select indications
|Prenatal screening studies for patients with select indications|
|Indications||Management of abnormal results|
|Rubella antibody|| |
|Varicella antibody|| || |
|TSH|| || |
|Prenatal chlamydia screening (using NAAT) || || |
| Prenatal gonorrhea screening (using NAAT) |
|Pap smear and/or HPV DNA testing|| || |
| || |
Psychosocial assessments should be performed for all pregnant individuals in the first trimester.
|Recommended prenatal psychosocial screenings |
|Method(s)||Repeat screening||Management of patients with positive screening results|
Peripartum depression 
| || |
|Anxiety || |
|Bipolar disorder || |
|(IPV) || || || |
|Substance use ||Nicotine and tobacco || || || |
|Alcohol || |
|Drugs || |
| Social determinants of health |
| || |
- Confirmation of pregnancy and its location (i.e., exclusion of ectopic pregnancy and gestational trophoblastic disease)
- Determination of EDD
- Evaluation for multiple gestation
- Assessment of fetal cardiac activity
- Evaluation of maternal symptoms (e.g., pelvic pain, vaginal bleeding) or abnormalities on examination (e.g., masses, structural uterine abnormalities)
- Evaluation of for fetal anomalies (e.g., anencephaly)
- Measurement of nuchal translucency as part of aneuploidy screening
- Provision of imaging guidance during procedures (e.g., chorionic villus sampling)
- Visualization of location and contents of gestational sac(s).
- Determination of number of fetuses.
- Evaluation of the embryo or fetus, including:
- Evaluation of maternal pelvic anatomy (e.g., uterus, adnexa, rectouterine pouch)
Offer all patients genetic carrier screening and testing for chromosomal abnormalities.
- Screening should preferably be offered at the initial prenatal visit.
- Provide to all patients.
- For patients interested in carrier screening, see “Genetic carrier screening.”
- For patients interested in testing for chromosomal abnormalities, discuss options for both screening and diagnostic testing:
- Offer appropriate follow-up genetic counseling and/or testing depending on results.
Counseling prior to prenatal genetic testing 
- Inform patients that all prenatal genetic testing is voluntary.
- Explain the differences between screening and diagnostic testing
- Discuss the patient's risk factors for fetal genetic abnormalities.
- Discuss the benefits of early identification of disorders: 
- Review all testing options and associated risks and benefits.
- Use to decide whether to perform a test and the specific testing to perform.
- Inform patients about follow-up options for a positive test result.
Risk factors associated with fetal genetic abnormalities 
- Fetal structural abnormality on ultrasound
- Increased maternal age 
- Increased paternal age
- Parental genetic abnormalities
- Previous child with aneuploidy 
Noninvasive fetal aneuploidy screening tests 
- For patients who elect to have screening for chromosomal abnormalities, select a screening test based on gestational age and patient preference. 
- Communicate results of screening tests to patients and arrange follow-up as necessary.
- No abnormalities on screening: Inform the patient the risk of a genetic abnormality is reduced.
- If screening results are abnormal, offer all of the following:
One-step screening tests
|Overview of one-stop screening tests for fetal chromosomal abnormalities |
|Test||Timing ||Components||Interpretation |
|Cell-free fetal DNA testing (cffDNA)|| |
|Sonographic nuchal translucency (NT screen) || |
|First-trimester combined screening|| || |
|Triple screen test and quad screen test || || |
Multi-step screening tests
|Overview of multi-step screening tests for fetal chromosomal abnormalities |
|Test||Timing ||Components||Interpretation |
|Integrated screen || || |
|Sequential integrated screening || || |
Interpretation of test results
Results of first-trimester combined screening test
|Overview of first-trimester combined screening test results |
|Trisomy 21||↑||↓|| |
Results of quad screening and triple screening
|Overview of quad and triple screening test results |
|Condition||HCG||AFP||Estriol||Inhibin A (quad test only)|
|Trisomy 18||↓||↓↓||↓↓||↔︎ or ↓|
|Neural tube defects||↔︎||↑||↔︎|
|Abdominal wall defects|
Invasive prenatal diagnostic testing 
- Invasive prenatal diagnostic testing is typically performed through chorionic villus sampling (CVS) or amniocentesis.
Chromosomal testing of specimens collected through diagnostic procedures may include: 
- Direct detection of specific DNA mutations
|Overview of invasive prenatal diagnostic tests |
|Chorionic villus sampling (CVS)||Amniocentesis||Cordocentesis |
|Timing|| || |
- Routine clinical assessment, including:
- Assessment for symptoms of
- Focused physical examination
- Obstetric ultrasound for fetal anatomy screening. 
- Screening for anemia and gestational diabetes at 24–28 weeks' gestation.
- COVID-19 vaccine and inactivated influenza vaccination, if not administered earlier in pregnancy
- Prenatal counseling, including labor precautions
- Assessment for manage as high-risk pregnancy if present. ;
In uncomplicated pregnancies dated with a reliable last menstrual period, a single obstetric ultrasound may be performed, preferably at 18–22 weeks' gestation, to evaluate fetal anatomy and the EDD. 
Routine prenatal clinical assessment 
- Ask all patients about:
- Perform physical examination, including:
- Consider urine dipstick analysis. 
|Recommended laboratory screening studies at 24–28 weeks' gestation|
|Test||Indication||Purpose||Management of abnormal results|
|CBC || || |
|Oral glucose tests || || || |
Fetal anatomy scan 
- A scan offered at 18–22 weeks' gestation to all patients to assess for:
- Fetal anomalies, e.g., abnormal growth or anatomic abnormalities 
- Estimation of gestational age (if not already performed) 
- If possible, the anatomy scan should be offered well in advance of the legal limit for pregnancy termination. 
- Transabdominal ultrasound: usually initial modality
- Transvaginal or transperineal ultrasound: if the transabdominal approach is suboptimal for evaluation
- Evaluation of fetus, including:
- Number of fetuses
- Fetal presentation
- Cardiac activity
- Anatomy survey, including assessment for structural abnormalities and sex
Fetal biometric parameters ; 
- Biparietal diameter
- Fetal femoral length
- Abdominal circumference
- Head circumference
- Evaluation of amniotic fluid volume and placenta (e.g., location, appearance, cord insertion)
- Evaluation of maternal pelvic anatomy, including cervix 
Third-trimester care is focused on monitoring maternal and fetal well-being and preparing for delivery.
- Monitoring of fetal growth with symphysis-fundal height and ultrasounds as indicated
- Assess for manage as high-risk pregnancy if present. ;
- Screening for hypertensive pregnancy disorders 
- Measures to prevent neonatal infection
Screening for rhesus antibody in Rh-negative nonsensitized individuals 
- Perform at 28 weeks' gestation.
- Administer Anti-D immunoglobulin as needed.
- See “Management of rhesus-negative individuals without anti-D antibodies” for further information.
- Screening for anemia and gestational diabetes, if not already performed (see “Second-trimester laboratory studies”).
- Preparation for delivery
In the third trimester, prenatal visits usually increase in frequency to every 2 weeks between 28–36 weeks and weekly thereafter. 
Third-trimester screening for sexually-transmitted infections (STI) 
|Indications for third-trimester STI screening |
|STI||Indications for screening||Timing|
|Prenatal chlamydia screening|| || |
|Prenatal gonorrhea screening|
|HIV screening|| |
|Prenatal syphilis screening|
|Hepatitis B screening|| || |
Leopold maneuvers 
The Leopold maneuvers consist of four abdominal palpation maneuvers used to determine fetal lie, fetal presentation, and fetal position in utero.
- Use both hands to palpate the uterine fundus, fetal head, and buttocks to assess:
- Fetal lie (longitudinal/oblique/transverse)
- Fundal height
- Place each hand on either side of the maternal abdomen to determine the location of the fetal back.
- Grasp the lower maternal abdomen above the symphysis to determine the fetal presenting part and if it is engaged.
- Facing the mother's feet, use both hands to determine:
- Use both hands to palpate the uterine fundus, fetal head, and buttocks to assess:
- If abnormal presentation (e.g., breech) is suspected or fetal position cannot be accurately determined, proceed to ultrasound. 
General principles 
Indications for antepartum fetal surveillance 
- High-risk pregnancy (e.g., maternal medical conditions or fetal conditions associated with increased risk of fetal hypoxic injury or death)
- Perceived reduction in fetal movement by mother
- Options include:
- A combination of modalities may be utilized. 
Results and ongoing management
|Overview of management of antepartum fetal test results |
|Result of test||Next steps|
|Normal||Resolved indication for testing|| |
|Ongoing indication for testing|| |
|NST or modified biophysical profile|
|CST or BPP|| |
Kick counts 
- Maternal counting of the number of fetal movements within a particular time period (e.g., 1 or 2 hours).
- Number of kicks reduced compared to prior assessments: Perform additional antepartum surveillance testing.
- Limitations 
- No consensus on the optimal duration of monitoring or abnormal number of counts
- Limited evidence monitoring kick counts affects perinatal adverse outcomes.
Nonstress test (NST) 
- Perform over a minimum of 20 minutes.
- Review the FHR tracing for FHR accelerations and decelerations. 
If no FHR accelerations are observed within the first 20 minutes:
- Perform vibroacoustic stimulation.
- Continue with the NST for another 20–40 minutes.
Reactive nonstress test: a normal NST that shows ≥ 2 FHR accelerations over the course of 20 minutes
- If the indication for testing has resolved, offer reassurance; further testing is not required.
- If the indication persists, repeat the test (usually at weekly intervals).
- Nonreactive nonstress test: an abnormal NST that shows < 2 FHR accelerations over the course of 20 minutes (after at least 40 minutes of monitoring) 
- Concerning decelerations : Consider further monitoring or delivery.
Contraction stress test (CST) 
- CST is a test that measures how FHR responds to uterine contractions.
- Can be safely performed, provided there are no contraindications to labor or vaginal delivery. 
- Perform to assess both FHR and uterine contractions.
- If < 3 contractions lasting at least 40 seconds are observed over 10 minutes, induce contractions using either:
- Negative: absence of late decelerations or significant variable decelerations
- Late decelerations after ≥ 50 % of contractions
- Consider repeat testing or delivery.
- Tracing uninterpretable or insufficient number of contractions (< 3 in 10 minutes).
- Repeat with an alternative form of contraction stimulation. 
Biophysical profile (BPP) 
- An ultrasound examination is performed over 30 minutes to assess the following four parameters:
- Fetal movement
- Fetal tone
- Fetal breathing
- Amniotic fluid volume
- An NST is then performed if any ultrasound parameter is abnormal but may be omitted if all are normal.
- Each parameter of the ultrasound examination and the NST is given a score of either 0 (abnormal) or 2 (normal)
|Biophysical profile scoring criteria |
Normal results (= 2 points)
|Fetal movement|| |
|Fetal tone|| |
|Fetal breathing|| |
|Amniotic fluid volume|| |
- The maximum total score on the biophysical profile is 10 (if NST performed) or 8 (if NST not performed).
- Follow-up recommendations vary based on total score and the presence of oligohydramnios.
|Interpretation and follow-up of biophysical profile results|
|Oligohydramnios absent||Oligohydramnios present|
|≥ 8 points|| || |
|6 points|| |
|≤ 4 points|| |
Modified biophysical profile 
- Description: NST plus amniotic fluid measurement by ultrasound 
- Method: Use one of two methods of assessing amniotic fluid volume.
- Next steps: For abnormal results, obtain a BPP or CST. 
General principles 
- Maternal colonization with group B streptococcus; (GBS) is the most significant risk factor for .
- Routine prenatal screening combined with targeted IV intrapartum prophylactic antibiotics has decreased:
- GBS of
- The number of
Prenatal screening for GBS 
- Routine screening for all women from 36+0 to 37+6 weeks' gestation, regardless of planned delivery method, unless prophylaxis is already indicated, e.g.: 
- Urgently: women in labor or with ruptured membranes with unknown GBS culture status
Regardless of whether a cesarean or vaginal delivery is planned, screen all pregnant women with indications for GBS screening in order to guide management if unexpected early labor or rupture of membranes occurs. 
Method of collection
- Swab the lower vagina and introitus, followed by the rectum.
- Use a single flocked swab without a speculum. 
- All patients: GBS culture
- Pregnant individuals with history of clindamycin susceptibility testing.  : Add reflex
- For urgent indications: Consider adding a rapid nucleic acid amplification test (NAAT). 
- Positive GBS culture: See “ .”
- Negative GBS culture: Consider repeat testing if the patient is still pregnant in 5 weeks. 
Prophylaxis for neonatal GBS infection 
- Required for all patients presenting with ruptured membranes or in labor with any indications for GBS prophylaxis.
- Not required if indications are absent or the patient is undergoing a pre-labor cesarean delivery with no rupture of the membranes.
Indications for GBS prophylaxis
- History of early-onset GBS infection in a previous newborn
- Documented GBS colonization during the current pregnancy, i.e.:
Unknown GBS status in current pregnancy PLUS any of the following are present:
- Any maternal risk factors for neonatal early-onset GBS infection
- Positive intrapartum NAAT
- Positive GBS status ; confirmed via culture or bacteriuria in a previous pregnancy 
Antibiotics should ideally be initiated at least 4 hours prior to delivery.
- No penicillin reaction: IV β-lactam antibiotics, i.e., IV penicillin G; (off-label) OR IV ampicillin (off-label) 
- Penicillin allergy: Tailor based on susceptibility testing and allergy severity.
While administration of antibiotics for at least 4 hours prior to delivery is preferred, it should not delay any necessary obstetric interventions. 
GBS prophylaxis considerations in preterm labor
- Manage patients in consultation with an obstetrician. 
- Start intrapartum prophylactic antibiotics for GBS.
- If GBS status is unknown, collect the GBS culture and NAAT prior to starting antibiotics.
- If preterm labor is arrested, GBS prophylaxis may be discontinued.
- If previously arrested preterm labor resumes:
Prenatal patient education
Beginning in early pregnancy and continuing throughout pregnancy, educate patients on factors related to maternal and fetal health, including: 
- Nutrition and weight gain during pregnancy
- Physical activity during pregnancy
- Dental care, travel, use of medications, and work during pregnancy (see “Other health and safety counseling during pregnancy”).
- In the second and third trimesters, provide . 
General principles 
- Dietary intake during pregnancy should be optimized to meet the demands of both the mother and the fetus. 
- Appropriate weight gain and nutrition should be assessed on an individual basis.
- Encourage pregnant women to follow a well-balanced diet and avoid restrictive diet plans.
- A daily multivitamin that includes folic acid is generally recommended for the duration of pregnancy. 
- For patients with special dietary needs (e.g., those with diabetes, vegetarians), consider referral to a nutritionist. 
Recommended dietary intake and supplementation 
- Calories: Average daily calorie requirements increase in the second and third trimesters.
- Protein: 71 grams/day is recommended. 
- Carbohydrates: 175 grams/day is recommended, including 25–36 grams of fiber per day. 
- It is recommended that 20–35% of daily calorie intake come from fats. 
- Adequate intake of Omega‐3 fatty acids is recommended. 
Micronutrients during pregnancy
|Recommended vitamin and mineral supplementation in pregnancy |
|Supplementation||Reason for increased demand||Consequences of deficiency|
|Folic acid |
|Vitamin B12 || || || |
|Iron || || |
|Calcium || |
|Iodine || || || |
Dietary restrictions during pregnancy 
- Limit caffeine: to < 200 mg daily (∼ 2 cups of coffee or ∼ 4 cups of caffeinated tea) 
- Avoid alcohol use throughout pregnancy. 
Avoid foods associated with higher risk of foodborne illness, e.g.: 
- Raw or undercooked seafood: risk of contamination with parasites and norovirus
- Raw or undercooked meat: risk of Listeria and Toxoplasma contamination
- Deli meats and hot dogs: risk of Listeria contamination
- Raw eggs: risk of Salmonella contamination
- Unwashed fruits and vegetables: risk of Listeria and Toxoplasma contamination
- Unpasteurized dairy products: risk of Listeria and Toxoplasma contamination
- Avoid seafood with possibly high levels of methylmercury: such as tilefish, swordfish, shark, mackerel, and bigeye tuna. 
Consumption of raw or undercooked meats, unpasteurized dairy products, and unwashed fruits and vegetables by pregnant women can increase the risk of and and should be avoided. 
Recommended weight gain during pregnancy 
- Total recommended weight gain is determined by BMI prior to pregnancy. 
- Singleton pregnancies
- Twin pregnancies
- Both excessive and inadequate gestational weight gain can impact fetal and maternal outcomes. 
|Risk factors and outcomes of inadequate or excessive gestational weight gain|
|Inadequate weight gain||Excessive weight gain|
|Fetal outcomes |
|Maternal outcomes || |
During the second and third trimesters, recommended weekly weight gain is 0.5 lb/week if pre-pregnancy BMI ≥ 30, 0.6 lb/week if pre-pregnancy BMI 25–29.9, and 1 lb/week if pre-pregnancy BMI < 25. 
General principles 
- Evaluate all patients for prior to recommending physical activity.
Regular physical activity is recommended during most pregnancies.
- Educate patients on safe and unsafe activities and advise activity avoidance or modification as needed. 
- Patients should aim for ≥ 20–30 minutes of aerobic and/or strength-training exercise most days of the week. 
- In the absence of medical or surgical complications, physical activity may resume soon after delivery. 
- Consider occupational accommodations for women with jobs requiring high levels of physical effort or potentially unsafe activities. 
Contraindications to aerobic exercise in pregnancy 
- Restrictive lung disease
- Hemodynamically significant heart disease
- Severe anemia 
- Cervical insufficiency
- Premature rupture of membranes or premature labor
- Gestational hypertension or preeclampsia
- Placenta previa or vaginal bleeding
Safe and unsafe sports during pregnancy 
|Safety of physical activity during pregnancy |
|Safe activities||High impact training|| |
|Low impact training|| |
Unsafe activities 
Physical activity should be stopped and the patient should notify their provider in the event of any the following: antepartum or postpartum hemorrhage, uterine contractions, amniotic fluid leakage, chest pain, dyspnea before exertion, dizziness, headaches, calf pain/swelling, and/or muscle weakness with impaired balance. 
Dental care during pregnancy 
- Poor oral health may be associated with preterm delivery.
- Encourage regular brushing, flossing, and cleanings.
- Educate patients about common dental problems seen in pregnancy.
Travel during pregnancy
- Encourage pregnant individuals to always wear a seatbelt. 
- Provide counseling before travel. Discuss: 
- Avoiding travel if risk factors for adverse pregnancy outcomes are present
- Infection prevention and control
- Planned activities (see “Safe and unsafe sports during pregnancy”)
- Risk of VTE with long-haul travel 
- Airline and cruise ship restrictions on travel in late pregnancy
- Importance of travel insurance and carrying a copy of medical records
Pregnant women should be informed that the most common obstetric emergencies occur in the first and third trimesters and they may, therefore, prefer to restrict travel to the second trimester. 
Medications and substance use 
- Advise the patient to avoid tobacco, alcohol, and recreational drugs.
- Ensure all prescribing clinicians are aware the patient is pregnant.
- Have the patient check with a healthcare professional before taking over-the-counter medications, supplements, or herbal preparations.
Work during pregnancy 
- Educate patients on occupational hazards, e.g.:
- Known hazards: toxic exposures (e.g., heavy metals, pesticides, ionizing radiation)
- Suspected hazards
- Standing/walking for long periods of time (> 3 hours a day)
- Heavy lifting
- Working > 40 hours a week
- Support patients in seeking workplace accommodations where appropriate.
When writing a work accommodation note for pregnant patients, make sure to be specific and outline reasonable limitations to avoid the note being used as grounds for dismissal. 
- Inform patients about and , and when to seek medical care.
- Review any maternal birth expectations and provide counseling on options, including: 
- If complex delivery is anticipated, discuss options with the patient, e.g.: 
- Encourage patients and other individuals who will be involved in the childbirth to attend educational classes.
- Advise patients to find an infant healthcare provider prior to delivery.
- Discuss neonatal procedures that may be performed prior to hospital discharge, e.g.:
- Provide basic counseling on .
- Offer guidance on contraception in postpartum individuals.