Routine prenatal care

Overview

Introduction

Prenatal care is a key component of a healthy pregnancy. Regular prenatal care helps to identify and treat complications and promote health and wellness. Outcome data suggest that babies born to mothers who do not receive prenatal care are three times more likely to be of low birth weight, and five times more likely to die, compared with babies born to mothers who receive prenatal care.US Department of Health and Human Services: prenatal care fact sheet In addition to medical care, prenatal care includes counseling, education, and addressing unmet social needs that can affect health outcomes directly and through limiting access to care.[1] This topic provides an overview of the prenatal management of average-risk pregnancies: singleton pregnancies without medical comorbidities or pregnancy complications. Key medical comorbidities and pregnancy complications are summarized below and links to relevant BMJ Best Practice condition topics provided for more detailed information.

Preconception care

Ideally, prenatal care begins before conception. Preconception care has been defined as a set of interventions to identify and modify biomedical, behavioral, and psychosocial risks to a woman's health or pregnancy outcome through prevention and management. Preconception care should be considered not as a single visit, but as a continuum of care throughout a woman's reproductive life.[2] Because a significant proportion of pregnancies are unintended, opportunities to prevent adverse exposures and outcomes that affect fetal development early in pregnancy should be maximized. All routine healthcare encounters during a woman's reproductive years should include counseling on family planning, medical care, and healthy behaviors to optimize pregnancy timing and outcome.[2] [3] For example, healthy women should begin folic acid supplementation, ideally at least 3 months before conception and continue until at least 12 weeks' gestation.[2] [3] [4] [5] [6]

Factors affecting pregnancy outcome should include consideration of age, family history, genetic history, nutritional status, folic acid intake, environmental and occupational exposures, and teratogens. A history of substance use/substance use disorders, tobacco and alcohol consumption, medical conditions, pharmaceutical drugs, immunization status, risk factors for sexually transmitted infections (STIs), psychosocial concerns (depression, domestic violence), and pregnancy spacing is also important.[3] Women with diabetes or chronic hypertension should be counseled on optimizing glycemic or blood pressure control prior to pregnancy. Shared decision-making should be used to identify the best timing for pregnancy, and referral to a specialist for advice on the risks and benefits of treatment should be offered.[7] [8]

Women who are planning a pregnancy should review prescription and nonprescription drugs with their physician. Counseling should include the relative risks and benefits of drug therapy for medical and mental health conditions in pregnancy. Discussions should include the drug-specific risks, available alternatives, and risks of untreated maternal disease.[3] [9] [10] [11]

Before becoming pregnant, women should have an up-to-date vaccination record, including measles-mumps-rubella (MMR), hepatitis B, human papillomavirus (HPV), and chickenpox (varicella). Pregnant women should receive tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap), influenza, respiratory syncytial virus (RSV), and coronavirus disease 2019 (COVID-19) vaccinations consistent with current guidance.[3] Women should avoid pregnancy for 1 month after receiving a live attenuated vaccine (e.g., rubella or varicella).[12] CDC: guidelines for vaccinating pregnant womenCDC: adult immunization schedule by age

Prenatal care

Early and regular prenatal care is recommended to improve pregnancy outcomes. Structured records assist in ensuring comprehensive, evidence-based care.[13] In addition to scheduled routine visits, pregnant women should have access to unscheduled or emergency visits on a 24-hour basis.

Prenatal care addresses three goals:

Medical care: screening and management of chronic conditions and pregnancy complications
Anticipatory guidance: education on pregnancy, birth, postpartum, and parenting
Social determinants of health: identifying and addressing factors that affect access to and engagement in prenatal care

Ideally, prenatal care supports the timely completion of evidence-based services known to improve outcomes. Historically, prenatal care was delivered using a schedule of 12-14 in-person visits for all women.[1] The American College of Obstetricians and Gynecologists (ACOG) has updated this guidance to recommend tailoring prenatal care to women's medical and social needs, as well as preferences.[14] Care can be tailored in three key areas:

Visit frequency: women with average-risk pregnancies can receive the traditional visit schedule (12-14 visits) or the targeted visit schedule (8-9 visits). Multiple systematic reviews support the safety of the targeted visit schedule in average-risk pregnancies.[15] [16] Pregnant women with chronic conditions or comorbidities should receive the traditional visit schedule. Visits should be timed to streamline important evidence-based services (e.g., laboratory tests, ultrasounds). Monitoring of routine pregnancy parameters (e.g., blood pressure, weight) should typically follow routine visit schedules. More frequent assessment may be appropriate in pregnant women with chronic conditions (e.g., hypertension) or pregnancy complications (e.g., gestational hypertension).
Visit modality: visit modality should be selected on the basis of the services needed for a specific appointment. Prenatal visits can be completed in person, virtually, or through group prenatal care, as determined by the pregnant woman and clinician together. A systematic review documented the safety of telemedicine, but data are still nascent on utilization, outcomes, and experience outside of the COVID-19 pandemic.[17] Group prenatal care may be particularly beneficial for improving knowledge and satisfaction, particularly for pregnant women with chronic conditions or from marginalized groups.[18]
Social determinants of health: health systems should follow the National Academy of Medicine model for addressing social determinants of health, including conducting routine screening for social determinants of health, providing assistance (resources to address the unmet need), and adjustment (modifications to care delivery to make it more accessible).[19]

It is recommended that pregnant women initiate prenatal care by 10-12 weeks' gestation, or as soon as possible after first presentation if >10 weeks.[20] The initial prenatal visit should include the following:

A comprehensive history, laboratory work, and education about pregnancy health.
Height and weight should be recorded to calculate body mass index (BMI), which provides information to determine weight gain guidelines.[21]
The clinician and pregnant women can discuss a comprehensive exam, including a pelvic exam to complete cervical cancer screening.
Clinicians should screen for female genital mutilation/cutting (FGM/C). Because FGM/C may adversely affect birth outcomes and increase risk for obstetric complications, these women may have special intrapartum care needs.[22]
Psychosocial assessment and depression screening may help to identify women at risk of perinatal mental health disorders and support early intervention and referral planning.
- Screening for depression, which is common during pregnancy and in the first 12 months after delivery, may be beneficial, particularly in women with a history of major depression. This enables the recognition of patients that may benefit from targeted therapy. Undiagnosed and untreated psychiatric illness is a risk to both the mother and fetus.[23] [24] See Postpartum depression .
Time for a private, one-to-one discussion with the pregnant woman to ask sensitively about potential exposure to domestic abuse (assaultive and/or coercive behavior).[25] [26] [27] [28] Women in the military or women veterans have a significantly increased risk of exposure to interpersonal violence, including sexual assault or abuse, and intimate partner violence.[29]

Subsequent routine prenatal visits should comprise the following:

Evaluation of blood pressure, weight, assessment of fetal well-being, and assessment of fetal growth (e.g., fundal height). Routine testing for urine protein is no longer recommended.
Mothers are questioned regarding pain, fetal movement, contraction frequency, vaginal bleeding, loss of fluid or discharge, other symptoms of preterm labor, and preeclampsia symptoms at appropriate gestation intervals, in addition to any other patient-provided complaints or concerns.[25]
Psychosocial screening should be repeated at least once each trimester to help to identify issues that may require further evaluation, intervention, or outside referral.
Review of frequency of visits. More frequent visits may occur at the prenatal care provider's discretion or the pregnant woman's request.

Vaccination

The American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) recommend that adults receive an annual influenza vaccine and women who are or will be pregnant through the influenza season (October through May) undergo (inactivated or recombinant) influenza vaccination as soon as it is available.[30]
Those women who are pregnant in the respiratory syncytial virus (RSV) season (September through January) and have not been previously vaccinated against RSV are also recommended to have a single dose of the maternal RSV vaccine between 32+0 and 36+6 weeks of gestation, to protect infants ages <6 months against RSV-associated lower respiratory tract infections.[31] [32]
The ACOG and the CDC recommend tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for pregnant women, as early as possible between 27 and 36 weeks of gestation to maximize passive antibody transfer to the baby.[33] CDC: adult immunization schedule by age
US and UK guidelines recommend that all eligible individuals >6 months of age, including pregnant and lactating women, should be vaccinated against COVID-19.[34] [35] [36] [37] [38] CDC: adult immunization schedule by age

Weight gain

Using BMI as a guideline, appropriate weight gain should be discussed.[39] [40] [41]
Diet and physical activity-based interventions in pregnancy are beneficial and can reduce gestational weight gain, as well as the rate of cesarean delivery.[42]

Vitamins/supplements

Nutrition education should focus on a well-balanced, varied, nutritional food plan consistent with the patient's food preferences and culture.
A nutrition consultation may be offered.
Daily prenatal vitamins containing folate are recommended throughout pregnancy, and at least through the first 3 months of pregnancy.[3] [6] Ideally, women should start folate supplementation 12 weeks prior to conception.[6] Selected presentations, such as a prior pregnancy complicated by fetal neural tube defect, require higher-dose folate intake.[43] When started preconceptually and continued through pregnancy, folic acid supplementation may reduce risk of small-for-gestational-age neonates at birth.[44]
Preterm birth is associated with lower levels of the omega-3 fatty acid docosahexaenoic acid (DHA), which has an important role in neurodevelopment. While observational data suggest that DHA supplementation has a beneficial effect on pediatric neurodevelopmental outcomes, randomized controlled trials have yielded conflicting results.[45] [46] There is insufficient evidence to support DHA supplementation to prevent preterm birth.[47] There is also no evidence that such supplementation reduces the risk of preeclampsia or gestational diabetes mellitus.[48]

Vitamin C and E supplementation during pregnancy does not prevent preeclampsia.[49] While it may potentially have some benefit for the prevention of placental abruption and preterm premature rupture of membranes (PPROM), vitamin C alone or in combination with other supplements is unproven to reduce risk of fetal or neonatal death, poor fetal growth, preeclampsia, or preterm birth.[50]

Nutrition/dietary precautions

The Food and Drug Administration has made specific recommendations about fish intake for women of childbearing age.FDA: eating fish - what pregnant women and parents should know
Listeriosis is a bacterial illness that can be particularly harmful to pregnant women, possibly resulting in miscarriage or stillbirth. To prevent listeriosis, pregnant women should avoid unpasteurized milk, soft cheeses, raw sprouts, some types of cold smoked fish, and some types of pâté.[3] [51] Additionally, pregnant women can reduce their risk of salmonella infection by avoiding raw or partially cooked eggs or food that may contain them (e.g., mayonnaise) and raw or partially cooked meat, especially poultry.
Moderate caffeine intake does not seem to have negative effects on pregnancy; however, caffeine intake should be limited to <200 mg daily.[52]

Reducing teratogens/negative exposures

If women use tobacco products, smoking cessation should be encouraged and support provided.[53] [54]

Alcohol consumption is contraindicated in pregnancy. In the UK, Department of Health guidelines recommend that for pregnant women and women planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to the baby to a minimum.[55] In the US there are no accepted guidelines regarding an acceptable alcohol intake in pregnancy. Prenatal drinking poses potentially serious consequences to both mother and fetus. Brief standardised screening questionnaires (Tolerance, Annoyance, Cut down, Eye opener [T-ACE], Alcohol Use Disorders Identification Test [AUDIT-C], Tolerance, Worried, Eye-opener, Amnesia, Cut down [TWEAK]) show promise as screening tools to identify risk drinking in pregnant women, although further investigation is required.[56]
Identify and treat women who regularly misuse recreational drugs, over-the-counter drugs, prescription drugs, volatile substances (such as solvents or inhalants) to an extent whereby physical dependence or harm is a risk to themselves and/or their unborn baby.[57] All pregnant women should be screened for substance use in pregnancy using a validated screening tool (e.g., NIDA Quick Screen). Patients with a positive Screening should receive Brief Intervention and Referral for Treatment (SBIRT). Urine drug testing should not be performed without the explicit consent of the patient.[10] [58]
Pregnant women should be advised that cannabis use in pregnancy has been associated with preterm birth, low birth weight, and adverse neurodevelopmental effects in children. Pregnant women should be advised to discontinue cannabis use and offered safer therapies to address any symptoms managed with cannabis (e.g., sleep, anxiety, nausea).[59]
Pregnancy provides an important opportunity to identify and treat women with an opioid use disorder. Opioid use during pregnancy is associated with an increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor, and intrauterine passage of meconium. It can lead to neonatal abstinence syndrome in some newborns.[10]

Education and counseling[14]

Education to promote maternal and fetal health and safety is a significant component of prenatal care.
At every prenatal appointment the women should be asked about their general health and well-being and healthy behaviors should be promoted, but also consider these specific issues:[20] [25]
- Women with an uncomplicated pregnancy can typically continue working until the onset of labor. Women with medical complications or other pregnancy complications, may need to make adjustments.
- Women with uncomplicated pregnancies can fly safely until 36 weeks' gestation.ACOG: travel during pregnancy Pregnant women who are planning to fly should be informed about the increased risks of venous thromboembolism from the combination of pregnancy and venous stasis, and instructed to take appropriate precautions (support stockings, movement of lower extremities, hydration).[60]
- Women should be encouraged to continue or begin a moderate aerobic exercise program during pregnancy.[61] [62] Although the limited available randomized controlled trial data do not clearly support a benefit of exercise during pregnancy for the prevention of glucose intolerance or gestational diabetes mellitus, there may be other physical and psychological benefits derived from aerobic exercise in pregnancy.[63] Structured physical exercise has been demonstrated to significantly reduce the risk of delivering a macrosomic or large-for-gestational-age newborn without influencing the risk of having a small newborn.[64] If not otherwise contraindicated, physical exercise during pregnancy may reduce risk of cesarean delivery.[65] Potential risks from contact sports, high-impact sports, activities with risk of abdominal trauma, and scuba diving should also be discussed.
- Attendance in childbirth education classes may be considered. Classes teach expectant mothers about the relative risks and benefits of home versus hospital birth, labor and delivery, pain relief options, potential obstetric complications and procedures, normal newborn care, and postpartum adjustment.[66]
- If the woman has had a prior cesarean delivery, provide counseling on the risks and benefits of a trial of labor versus repeat cesarean delivery.[67] Candidacy for a trial of labor after cesarean should also be considered.
- Throughout prenatal care, healthcare providers should provide information about the benefits of breastfeeding and breastfeeding support should be provided.[68]
- Other educational issues to discuss during the antepartum period include dental care, nutrition, wearing a seat belt, minimal use of hot tubs or saunas, hazardous-chemical exposure, sleep position, sexual activity, postpartum contraception, and circumcision of male infants.
Weight gain during pregnancy
Adapted from Institute of Medicine. Weight gain during pregnancy: re-examining the guidelines. 2009

Routine screening tests

Appropriate fetal growth can be screened by measuring fundal height (symphysis to uterine fundus) from 24 to 38 weeks' gestation.[69] Fundal height in centimeters is approximately equal to the gestational age in weeks. Discrepancies of >2-3 cm should prompt ultrasound evaluation of amniotic fluid index and fetal growth.[70] The prenatal care provider should keep in mind that fundal height measurements can be influenced by numerous factors, including maternal size, bladder filling, uterine fibroids, multiple gestations, and fetal presentation.[69] [71]
All pregnant women, regardless of age or risk of aneuploidy, who present for prenatal care should be offered aneuploidy screening.[72] See Ultrasonography and Screening for genetic abnormalities.
All pregnant women should have their blood pressure (BP) measured at every routine prenatal appointment.[7] [25] [73] [74] [75] Routine testing for urine protein is no longer recommended. See Screening for hypertensive disorders of pregnancy.
All pregnant women should be screened at 36+0 to 37+6 weeks' gestation for vaginal-rectal group B streptococcus (GBS) colonization, unless intrapartum prophylaxis is indicated.[76] See Screening for group B streptococcus (GBS).
Routine screening for bacterial vaginosis in asymptomatic women and women not at risk for preterm delivery is not recommended.[77] [78] [79]

Routine laboratory tests

Initial prenatal laboratory tests include complete blood count, ABO blood group, Rh D status, erythrocyte antibody screen, rubella status, hepatitis B screening, hepatitis C screening, screening for STIs (syphilis, HIV, gonorrhea, and chlamydia), and hemoglobinopathy testing.[14] [25] [80][81] [82] [83] [84] [85] [86]
Aneuploidy screening may be completed between 10 and 18 weeks' gestation and can include noninvasive prenatal genetic testing (e.g., cell-free DNA), ultrasound imaging, or other tests.[14] [72][87] See Screening for genetic abnormalities.
Screening for gestational diabetes mellitus with a glucose tolerance test is usually performed at 24-28 weeks' gestation.[8] [14][88] [89] See Screening for gestational diabetes mellitus.
Group B streptococcus (GBS) screening is recommended for all pregnant women between 36 and 38 weeks' gestation.[14] [76] See Screening for group B streptococcus (GBS).
Other investigations may be performed, as indicated.

Recommended routine testing

From the collection of Dr L.M. Szymanski and Dr J.L. Bienstock, amended by Dr M.E. D'Alton and Dr R.S. Miller

Citations

Key Articles

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 762: prepregnancy counseling. Jan 2019 [internet publication].[Full Text]
National Institute for Health and Care Excellence. Antenatal care. Aug 2021 [internet publication].[Full Text]
American College of Obstetricians and Gynecologists. Screening for fetal chromosomal abnormalities. Jan 2026 [internet publication].[Abstract][Full Text]
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 175: ultrasound in pregnancy. Dec 2016 [internet publication].[Full Text]

Other Online Resources

US Department of Health and Human Services: prenatal care fact sheet
CDC: guidelines for vaccinating pregnant women
CDC: adult immunization schedule by age
FDA: eating fish - what pregnant women and parents should know
ACOG: travel during pregnancy
FMF: risk for preeclampsia assessment

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77. Yudin MH, Money DM. No. 211-screening and management of bacterial vaginosis in pregnancy. J Obstet Gynaecol Can. 2017 Aug;39(8):e184-91.[Abstract]
78. US Preventive Services Task Force. Bacterial vaginosis in pregnant persons to prevent preterm delivery: screening. Apr 2020 [internet publication].[Full Text]
79. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication].[Full Text]
80. American College of Obstetricians and Gynecologists. Practice bulletin no. 181: prevention of Rh D alloimmunization. Aug 2017 [internet publication].[Full Text]
81. Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and testing for hepatitis B virus infection: CDC recommendations-United States, 2023. MMWR Recomm Rep 2023;72(No. RR-1):1-25.[Abstract][Full Text]
82. US Preventive Services Task Force. Hepatitis B virus infection in pregnant women: screening. Jul 2019 [internet publication].[Full Text]
83. US Preventive Services Task Force. Asymptomatic bacteriuria in adults: screening. Sep 2019 [internet publication].[Full Text]
84. American College of Obstetricians and Gynecologists. ACOG practice advisory: screening for syphilis in pregnancy. Apr 2024 [internet publication].[Full Text]
85. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 78: hemoglobinopathies in pregnancy. Aug 2022 [internet publication].[Full Text]
86. US Preventive Services Task Force. Syphilis infection during pregnancy: screening. May 2025 [internet publication].[Full Text]
87. Society for Maternal-Fetal Medicine (SMFM), Rink BR, Dugoff L, et al. Society for Maternal-Fetal Medicine Consult Series #74: cell-free DNA screening for aneuploidies: updated guidance 2025 Sep;1(6): e70139.[Full Text]
88. US Preventive Services Task Force. Gestational diabetes: screening. Aug 2021 [internet publication].[Full Text]
89. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 190: gestational diabetes mellitus. Feb 2018 [internet publication].[Full Text]
90. ACOG Committee on Obstetric Practice. ACOG committee opinion no. 495: vitamin D: screening and supplementation during pregnancy. Jul 2011 [internet publication].[Abstract][Full Text]
91. Endocrine Society. Clinical practice guideline: vitamin D for the prevention of disease guideline resources. Jun 2024 [internet publication].[Full Text]
92. Ross AC, Taylor CL, Yaktine AL, et al. Dietary reference intakes for calcium and vitamin D. 1st ed. Washington, DC; 2011.[Abstract][Full Text]
93. National Institute for Health and Care Excellence. Vitamin D: supplement use in specific population groups. Aug 2017 [internet publication].[Full Text]
94. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 223: thyroid disease in pregnancy. Jun 2020 [internet publication].[Full Text]
95. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012 Feb 9;366(6):493-501.[Abstract][Full Text]
96. Casey BM, Thom EA, Peaceman AM, et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017 Mar 2;376(9):815-25.[Abstract][Full Text]
97. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 691: carrier screening for genetic conditions. Mar 2017 [internet publication].[Full Text]
98. American College of Obstetricians and Gynecologists. Committee opinion no. 690: carrier screening in the age of genomic medicine. Mar 2017 [internet publication].[Full Text]
99. American College of Radiology. ACR appropriateness criteria: multiple gestations. 2024 [internet publication].[Full Text]
100. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 700: methods for estimating the due date. May 2017 [internet publication].[Full Text]
101. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 175: ultrasound in pregnancy. Dec 2016 [internet publication].[Full Text]
102. American Institute of Ultrasound in Medicine. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. J Ultrasound Med. 2021 May;40(5):E1-E16.[Abstract][Full Text]
103. International Society of Ultrasound in Obstetrics and Gynecology, Bilardo CM, Chaoui R, et al. ISUOG practice guidelines (updated): performance of 11-14-week ultrasound scan. Ultrasound Obstet Gynecol. 2023 Jan;61(1):127-43.[Abstract][Full Text]
104. Driscoll DA, Gross S. Clinical practice: prenatal screening for aneuploidy. N Engl J Med. 2009 Jun 11;360(24):2556-62.[Abstract]
105. Levi S. Ultrasound in prenatal diagnosis: polemics around routine ultrasound screening for second trimester fetal malformations. Prenat Diagn. 2002 Apr;22(4):285-95.[Abstract]
106. AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the performance of standard diagnostic obstetric ultrasound examinations. J Ultrasound Med. 2018 Nov;37(11):E13-24.[Abstract][Full Text]
107. Wood SL, Owen J, Jenkins SM, et al. The utility of repeat midtrimester anatomy ultrasound for anomaly detection. Am J Perinatol. 2018 Dec;35(14):1346-51.[Abstract]
108. Getahun D, Oyelese Y, Salihu HM, et al. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006 Apr;107(4):771-8.[Abstract]
109. Loto O, Onile TG. Placenta praevia at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. A ten year analysis. Niger J Clin Pract. 2008 Jun;11(2):130-3.[Abstract]
110. Yang Q, Wu Wen S, Caughey S, et al. Placenta previa: its relationship with race and the country of origin among Asian women. Acta Obstet Gynecol Scand. 2008;87(6):612-6.[Abstract][Full Text]
111. Oppenheimer L, Holmes P, Simpson N, et al. Diagnosis of low-lying placenta: can migration in the third trimester predict outcome? Ultrasound Obstet Gynecol. 2001 Aug;18(2):100-2.[Abstract]
112. Oyelese Y. Placenta previa: the evolving role of ultrasound. Ultrasound Obstet Gynecol. 2009 Aug;34(2):123-6.[Abstract]
113. Jain V, Bos H, Bujold E. Guideline no. 402: diagnosis and management of placenta previa. J Obstet Gynaecol Can. 2020 Jul;42(7):906-17.e1.[Abstract]
114. Royal College of Obstetricians and Gynaecologists. Placenta praevia and placenta accreta: diagnosis and management (green-top guideline no. 27a). Sep 2018 [internet publication].[Full Text]
115. American College of Obstetricians and Gynecologists. Committee opinion no. 688: management of suboptimally dated pregnancies. Mar 2017 [internet publication].[Full Text]
116. Cargill Y, Morin L, Bly S, et al. Content of a complete routine second trimester obstetrical ultrasound examination and report. J Obstet Gynaecol Can. 2009 Mar;31(3):272-5.[Abstract]
117. International Society of Ultrasound in Obstetrics and Gynecology. Performance of first-trimester fetal ultrasound scan. Nov 2025 [internet publication].[Full Text]
118. Torloni MR, Vedmedovska N, Merialdi M, et al; ISUOG-WHO Fetal Growth Study Group. Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis. Ultrasound Obstet Gynecol. 2009 May;33(5):599-608.[Abstract][Full Text]
119. Stalberg K, Axelsson O, Haglund B, et al. Prenatal ultrasound exposure and children's school performance at age 15-16: follow-up of a randomized controlled trial. Ultrasound Obstetr Gynecol. 2009 Sep;34(3):297-303.[Abstract][Full Text]
120. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 162: prenatal diagnostic testing for genetic disorders. May 2016 [internet publication].[Full Text]
121. American College of Obstetricians and Gynecologists. ACOG obstetric care consensus no. 11: pregnancy at age 35 years or older. Aug 2022 [internet publication].[Abstract][Full Text]
122. Driscoll DA, Gross SJ; Professional Practice and Guidelines Committee. First trimester diagnosis and screening for fetal aneuploidy. Genet Med. 2008 Jan;10(1):73-5.[Abstract]
123. Palomaki GE, Lee JE, Canick JA, et al; ACMG Laboratory Quality Assurance Committee. Technical standards and guidelines: prenatal screening for Down syndrome that includes first-trimester biochemistry and/or ultrasound measurements. Genet Med. 2009 Sep;11(9):669-81.[Abstract]
124. Dugoff L, Society for Maternal-Fetal Medicine. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol. 2010 May;115(5):1052-61.[Abstract]
125. Wapner RJ, Martin CL, Levy B, et al. Chromosomal microarray versus karyotyping for prenatal diagnosis. N Engl J Med. 2012 Dec 6;367(23):2175-84.[Abstract][Full Text]
126. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 682: microarrays and next-generation sequencing technology: the use of advanced genetic diagnostic tools in obstetrics and gynecology. Dec 2016 [internet publication].[Full Text]
127. Cameron M, Moran P. Prenatal screening and diagnosis of neural tube defects. Prenat Diagn. 2009 Apr;29(4):402-11.[Abstract]
128. Kuc S, Wortelboer EJ, van Rijn BB, et al. Evaluation of 7 serum biomarkers and uterine artery Doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstet Gynecol Surv. 2011 Apr;66(4):225-39.[Abstract]
129. Skråstad RB, Hov GG, Blaas HG, et al. Risk assessment for preeclampsia in nulliparous women at 11-13 weeks gestational age: prospective evaluation of two algorithms. BJOG. 2015 Dec;122(13):1781-8.[Abstract]
130. National Institute for Health and Care Excellence. PLGF-based testing to help diagnose suspected preterm pre-eclampsia. Jul 2022 [internet publication].[Full Text]
131. Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019 May;145 (Suppl 1):1-33.[Abstract][Full Text]
132. Amylidi S, Mosimann B, Stettler C, et al. First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes. Acta Obstet Gynecol Scand. 2016 Jan;95(1):93-7.[Abstract][Full Text]
133. National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication].[Full Text]
134. American College of Obstetricians and Gynecologists. ACOG clinical practice update: Rh D immune globulin administration after abortion or pregnancy loss at less than 12 weeks of gestation. Obstet Gynecol. 2024 Dec 1;144(6):e140-3.[Abstract]
135. American College of Obstetricians and Gynecologists. Rho(D) immune globulin shortages. Mar 2024 [internet publication].[Full Text]
136. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 233: anemia in pregnancy. Aug 2021 [internet publication].[Full Text]
137. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998;47:1-36.[Abstract][Full Text]
138. Finkelstein JL, Cuthbert A, Weeks J, et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2024 Aug 15;8(8):CD004736.[Abstract][Full Text]
139. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 230: obesity in pregnancy. Jun 2021 [internet publication].
140. Maxwell C, Gaudet L, Cassir G, et al. SOGC clinical practice guidelines: guideline no. 391-pregnancy and maternal obesity part 1: pre-conception and prenatal care. J Obstet Gynaecol Can. 2019 Nov;41(11):1623-40[Abstract]
141. Sui Z, Grivell RM, Dodd JM. Antenatal exercise to improve outcomes in overweight or obese women: a systematic review. Acta Obstet Gynecol Scand. 2012 May;91(5):538-45.[Abstract]
142. Quinlivan JA, Julania S, Lam L. Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: a meta-analysis. Obstet Gynecol. 2011 Dec;118(6):1395-401.[Abstract]
143. Larsen TB, Sørensen HT, Gislum M, et al. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res. 2007;120(4):505-9.[Abstract]
144. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 196: thromboembolism in pregnancy. Jul 2018 [internet publication].[Full Text]
145. Racusin D, Stevens B, Campbell G, et al. Obesity and the risk and detection of fetal malformations. Semin Perinatol. 2012 Jun;36(3):213-21.[Abstract]
146. Hendler I, Blackwell SC, Bujold E, et al. Suboptimal second-trimester ultrasonographic visualization of the fetal heart in obese women: should we repeat the examination? J Ultrasound Med. 2005 Sep;24(9):1205-9; quiz 1210-1.[Abstract]
147. Romary L, Sinkovskaya E, Ali S, et al. The role of early gestation ultrasound in the assessment of fetal anatomy in maternal obesity. J Ultrasound Med. 2017 Jun;36(6):1161-8.[Abstract]
148. Goodnight W, Newman R, Society of Maternal-Fetal Medicine. Optimal nutrition for improved twin pregnancy outcome. Obstet Gynecol. 2009 Nov;114(5):1121-34. [Abstract]
149. National Institute for Health and Care Excellence. Twin and triplet pregnancy. Apr 2024 [internet publication].[Full Text]
150. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 579: definition of term pregnancy. Nov 2013 [internet publication].[Full Text]
151. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 146: management of late-term and postterm pregnancies. Aug 2014 [internet publication].[Full Text]
152. Wennerholm UB, Saltvedt S, Wessberg A, et al. Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial. BMJ. 2019 Nov 20;367:l6131.[Abstract][Full Text]
153. Delaney M, Roggensack A. No. 214-guidelines for the management of pregnancy at 41+0 to 42+0 weeks. J Obstet Gynaecol Can. 2017 Aug;39(8):e164-e174.[Abstract]
154. National Institute for Health and Care Excellence. Inducing labour. Nov 2021 [internet publication].[Full Text]
155. World Health Organization. WHO recommendations on induction of labour, at or beyond term. Oct 2022 [internet publication].[Full Text]

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