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Prenatal care: Initial assessment

Charles J Lockwood, MD, MHCM
Urania Magriples, MD
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


This topic will discuss the initial prenatal assessment (which may require more than one visit) in the United States. Most of these issues are common to pregnancies worldwide. Preconception care and ongoing prenatal care after the initial prenatal visit are discussed separately. (See "The preconception office visit" and "Prenatal care: Second and third trimesters".)


The major goal of prenatal care is to help ensure the birth of a healthy baby while minimizing risk to the mother. There are several components involved in achieving this objective:

Early, accurate estimation of gestational age

Identification of pregnancies at increased risk for maternal or fetal morbidity and mortality

Ongoing evaluation of maternal and fetal health status

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Literature review current through: Nov 2017. | This topic last updated: Dec 12, 2017.
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  1. Downe S, Finlayson K, Tunçalp Ӧ, Metin Gülmezoglu A. What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women. BJOG 2016; 123:529.
  2. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Child Health USA 2013. U.S. Department of Health and Human Services; Rockville, MD 2013.
  3. Moller AB, Petzold M, Chou D, Say L. Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013. Lancet Glob Health 2017; 5:e977.
  4. Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; 4:CD004667.
  5. Malouf R, Redshaw M. Specialist antenatal clinics for women at high risk of preterm birth: a systematic review of qualitative and quantitative research. BMC Pregnancy Childbirth 2017; 17:51.
  6. American College of Obstetricians and Gynecologists Committee on Health Care for Undeserved Women. ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol 2006; 108:469.
  7. ACOG Committee Opinion No. 518: Intimate partner violence. Obstet Gynecol 2012; 119:412.
  8. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 554: reproductive and sexual coercion. Obstet Gynecol 2013; 121:411.
  9. American College of Obstetricians and Gynecologists. Committee on Health Care for Underserved Women. Committee opinion no. 498: Adult manifestations of childhood sexual abuse. Obstet Gynecol 2011; 118:392. Reaffirmed 2017.
  10. Shah PS, Shah J, Knowledge Synthesis Group on Determinants of Preterm/LBW Births. Maternal exposure to domestic violence and pregnancy and birth outcomes: a systematic review and meta-analyses. J Womens Health (Larchmt) 2010; 19:2017.
  11. Kiely M, El-Mohandes AA, El-Khorazaty MN, et al. An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial. Obstet Gynecol 2010; 115:273.
  12. White A. Responding to prenatal disclosure of past sexual abuse. Obstet Gynecol 2014; 123:1344.
  13. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 88, December 2007. Invasive prenatal testing for aneuploidy. Obstet Gynecol 2007; 110:1459.
  14. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol 2007; 109:217.
  15. Committee on Genetics. Committee Opinion No. 690: Carrier Screening in the Age of Genomic Medicine. Obstet Gynecol 2017; 129:e35.
  16. Ross LF. A re-examination of the use of ethnicity in prenatal carrier testing. Am J Med Genet A 2012; 158A:19.
  17. Ryan K, Bain BJ, Worthington D, et al. Significant haemoglobinopathies: guidelines for screening and diagnosis. Br J Haematol 2010; 149:35.
  18. American Academy of Pediatrics Committee on Fetus and Newborn and Amercian College of Obstetricians and Gynecologists Committee on Obstetric Practice. Guidelines for Perinatal Care, 8th, Kilpatrick SJ, Papile L (Eds), 2017.
  19. Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1.
  20. American College of Obstetrics and Gynecology Committee on Obstetric Practice. ACOG Committee Opinion No. 418: Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2008; 112:739.
  21. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  22. SOGC clinical practice guideline. HIV screening in pregnancy. https://sogc.org/wp-content/uploads/2013/01/185E-CPG-December2006.pdf (Accessed on March 27, 2017).
  23. Royal College of Obstetricians and Gynaecologists. HIV in pregnancy, Management (Green-top 39). http://www.rcog.org.uk/womens-health/clinical-guidance/management-hiv-pregnancy-green-top-39 (Accessed on April 23, 2012).
  24. Walmsley S. Opt in or opt out: what is optimal for prenatal screening for HIV infection? CMAJ 2003; 168:707.
  25. Breese P, Burman W, Shlay J, Guinn D. The effectiveness of a verbal opt-out system for human immunodeficiency virus screening during pregnancy. Obstet Gynecol 2004; 104:134.
  26. LeFevre ML, U.S. Preventive Services Task Force. Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161:902.
  27. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med 2005; 142:914.
  28. Canadian Agency for Drugs and Technologies in Health. Urine-based testing for gonorrhea and chlamydia: A review of diagnostic accuracy, cost-effectiveness, and compliance, 2009. http://www.cadth.ca/media/pdf/L0124_Urine_Based_Testing_for_Gonorrhea_and_Chlamydia_final.pdf (Accessed on April 01, 2011).
  29. Expert consultation meeting summary report January 13 to 15, 2009. Atlanta, GA. Laboratory diagnostic testing for Chlamydia trachomatis and Neisseria gonorrhoeae. http://www.aphl.org/aphlprograms/infectious/std/Documents/CTGCLabGuidelinesMeetingReport.pdf (Accessed on April 01, 2011).
  30. National Chlamydia Coalition. Developments in STD screening: Chlamydia testing, 2010. http://www.prevent.org/data/files/ncc/research%20brief%201%20std%20testing.pdf (Accessed on April 01, 2011).
  31. Roberts SW, Sheffield JS, McIntire DD, Alexander JM. Urine screening for Chlamydia trachomatis during pregnancy. Obstet Gynecol 2011; 117:883.
  32. Committee on Patient Safety and Quality Improvement, Committee on Professional Liability. ACOG Committee Opinion No. 381: Subclinical hypothyroidism in pregnancy. Obstet Gynecol 2007; 110:959.
  33. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2543.
  34. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315.
  35. Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding? J Clin Endocrinol Metab 2007; 92:203.
  36. Horacek J, Spitalnikova S, Dlabalova B, et al. Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding. Eur J Endocrinol 2010; 163:645.
  37. Chang DL, Leung AM, Braverman LE, Pearce EN. Thyroid testing during pregnancy at an academic Boston Area Medical Center. J Clin Endocrinol Metab 2011; 96:E1452.
  38. Granfors M, Åkerud H, Skogö J, et al. Targeted thyroid testing during pregnancy in clinical practice. Obstet Gynecol 2014; 124:10.
  39. Brent GA. Diagnosing thyroid dysfunction in pregnant women: Is case finding enough? J Clin Endocrinol Metab 2007; 92:39.
  40. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S13.
  41. Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 180: Gestational Diabetes Mellitus. Obstet Gynecol 2017; 130:e17.
  42. Moyer VA, U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160:414.
  43. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, Hughes BL, Page CM, Kuller JA. Hepatitis C in pregnancy: screening, treatment, and management. Am J Obstet Gynecol 2017; 217:B2.
  44. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep 2000; 49:1.
  45. Coonrod DV, Jack BW, Stubblefield PG, et al. The clinical content of preconception care: infectious diseases in preconception care. Am J Obstet Gynecol 2008; 199:S296.
  46. Baker DA. Risk factors for herpes simplex virus transmission to pregnant women: a couples study. Am J Obstet Gynecol 2005; 193:1887.
  47. Gardella C, Krantz E, Daruthayan C, et al. The acceptance of HSV-testing partners of HSV-2 seronegative pregnant women. Sex Transm Dis 2009; 36:211.
  48. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. No. 82 June 2007. Management of herpes in pregnancy. Obstet Gynecol 2007; 109:1489.
  49. Brown ZA, Wald A, Morrow RA, et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003; 289:203.
  50. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316:2525.
  51. Thung SF, Grobman WA. The cost-effectiveness of routine antenatal screening for maternal herpes simplex virus-1 and -2 antibodies. Am J Obstet Gynecol 2005; 192:483.
  52. Cleary KL, Paré E, Stamilio D, Macones GA. Type-specific screening for asymptomatic herpes infection in pregnancy: a decision analysis. BJOG 2005; 112:731.
  53. Rouse DJ, Stringer JS. An appraisal of screening for maternal type-specific herpes simplex virus antibodies to prevent neonatal herpes. Am J Obstet Gynecol 2000; 183:400.
  54. Tita AT, Grobman WA, Rouse DJ. Antenatal herpes serologic screening: an appraisal of the evidence. Obstet Gynecol 2006; 108:1247.
  55. www.ahrq.gov/clinic/cps3dix.htm (Accessed on May 22, 2006).
  56. American College of Obstetricians and Gynecologists. Practice bulletin no. 151: Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Obstet Gynecol 2015; 125:1510. Reaffirmed 2017.
  57. Society for Maternal-Fetal Medicine (SMFM), Hughes BL, Gyamfi-Bannerman C. Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016; 214:B5.
  58. Verani JR, Montgomery SP, Schulkin J, et al. Survey of obstetrician-gynecologists in the United States about Chagas disease. Am J Trop Med Hyg 2010; 83:891.
  59. Buekens P, Almendares O, Carlier Y, et al. Mother-to-child transmission of Chagas' disease in North America: why don't we do more? Matern Child Health J 2008; 12:283.
  60. Ramos JM, Milla A, Sánchez V, et al. [Prenatal screening for Trypanosoma cruzi and human T lymphotropic virus types 1 and 2 in pregnant Latin American women]. Enferm Infecc Microbiol Clin 2009; 27:165.
  61. Ettinger AS, Gurthrie Wengrovitz A. Guidelines for the identification and management of lead exposure in pregnant and lactating women. National Center for Environmental Health/Agency for Toxic Substances and Disease Registry; Centers for Disease Control and Prevention, Atlanta, GA 2010.
  62. Committee on Obstetric Practice. Committee opinion No. 533: lead screening during pregnancy and lactation. Obstet Gynecol 2012; 120:416.
  63. Rischitelli G, Nygren P, Bougatsos C. Screening for elevated lead levels in childhood and pregnancy: Update of a 1996 United States Preventive Services Task Force review. US Preventive Services Task Force Evidence Syntheses, Agency for Healthcare Research and Quality, Rockville, MD 2006.
  64. Interactive site for clinicians serving women with disabilities. http://www.acog.org/About_ACOG/ACOG_Departments/Women_with_Disabilities/Interactive_site_for_clinicians_serving_women_with_disabilities (Accessed on April 20, 2012).
  65. American College of Obstetricians and Gynecologists. www.acog.org (Accessed on May 01, 2012).
  66. The Management of Uncomplicated Pregnancy Working Group. DoD/VA clinical practice guideline for the management of uncomplicated pregnancy. Department of Defense and Veterans Administration, Washington, DC 2002.
  67. Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care. www.aafp.org (Accessed on March 27, 2017).
  68. National Institute for Health and Clinical Excellence. Antenatal care: Routine care for the healthy pregnant woman. www.nice.org.uk (Accessed on April 19, 2012).
  69. Society of Obstetricians and Gynaecologists of Canada. Clinical practice guidelines: Obstetrics. www.sogc.org (Accessed on May 01, 2012).
  70. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva, Switzerland, 2016 http://apps.who.int/iris/bitstream/10665/250796/1/9789241549912-eng.pdf?ua=1 (Accessed on April 28, 2017).
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