Most women come for their first prenatal visit around 8-10 weeks.  

• Interview: Review of past medical history

  • Review of past obstetric history

  • Review of family medical history including identification of possible genetic disorders and congenital anomalies

  • Review of medications being taken—Evaluate pregnancy category:

    • A and B: No concerns

    • C: Benefit outweighs risk

    • D: Fetal risk has been shown—benefit significantly outweighs risk

    • X: Do not use in pregnancy

  • Review of social history including support systems, smoking, drug use, and assessment for intimate partner violence

  • Review of infection history including sexually transmitted infections (specifically, genital HSV) and immunizations (specifically, rubella and varicella)

  • Psychological assessment

  • Emotional assessment: Feelings and emotions, is pregnancy planned, relationships with those around her

  • Maternal age - Mothers who are over 35-years-old are at more risk for genetic disorders in the newborn and medical conditions.  Mothers who are teenagers or over 40-years-old are a higher risk for pregnancy complications. 

  • Maternal nutrition status (especially if vegetarian or a history of eating disorders), folic acid intake

  • Review of systems

• Other labs:

  • Illicit drug screen

  • Tuberculosis screen

  • TORCH infections (Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes simplex)

  • Lead levels

  • Hemoglobin A1c (HbA1c) or early 1-hour glucose screen at 16 weeks (if high risk for gestational diabetes)

  • Comprehensive metabolic panel (CMP) (if hypertensive)

After the first visit, women will come for prenatal visits every four weeks until 28 weeks, then every two weeks until 36 weeks, and then weekly until delivery

Interview: 

• • Interview of how she is feeling and any symptoms

  • Confirm Gestational Age

  • Check for fetal movement if greater than 20 weeks gestation

Medications:  

• 28–36 weeks: Tdap vaccine

• 28 weeks: RhoGAM if Rh-negative blood type

• Flu vaccine (inactivated) at any time in pregnancy

• COVID-19 vaccine at any time in pregnancy

• 32-36 weeks: Respiratory Syncytial Virus (RSV) vaccine 

• Hepatitis B vaccine and Pneumococcal vaccine if an individual is high-risk for infection

• Rubella, Varicella, and Gardasil vaccines should be avoided in pregnancy

Vaccines given during pregnancy can give passive immunity through the placenta to the newborn for several months after delivery.