Definition and Overview
Prenatal follow-up care refers to multiple visits with different physicians particularly obstetricians-gynecologists during pregnancy.
Maternal care is important not only for the baby but also for the mother. Because the body undergoes many changes throughout the gestation period, different types of complications and risks can arise. According to the World Health Organization (WHO), maternal mortality (death) has dropped by as much as 44% between 1990 and 2015. However, more than 800 of pregnant women still die every day due to causes that could have been prevented if only they undergo prenatal follow-up. For this reason, the WHO has made it part of its Sustainable Development Agenda to reduce the overall mortality rate by no more than 70 per 100,000 live births within between 2016 and 2030.
Who Should Undergo and Expected Results
Generally, prenatal follow-up is required to all pregnant women, more so if:
They have certain conditions – These conditions may be environmental or genetic in nature. Examples include Tay-Sachs disease, cystic fibrosis, and gestational diabetes, or diabetes that develops during pregnancy. In this case, the hormonal changes during pregnancy tend to increase the level of insulin in the blood. Pregnant women can also be prone to hypertension.
They are obese – It is normal for women to gain weight during pregnancy. In fact, this is advisable to ensure the child and mother’s proper nutrition, as well as sufficient support for fetal growth. New studies, however, suggest that gaining more than the necessary weight increases the risk of premature birth or stillbirth. Babies born to overweight or obese mothers may also be susceptible to obesity and diabetes much earlier than the general population. Pre-natal follow-up helps monitor the mother’s weight throughout the pregnancy.
The initial visit determines pregnancy issues – The follow-up visits are recommended particularly if the doctor has identified pregnancy-related complications and risks such as breech position of the baby, weakening fetal heartbeat, or spotting and bleeding.
The mother is nearing birth – Delivery itself has its own risks and complications, and it is essential that the mother is fully prepared for them physically and mentally.
It is the first trimester – The first trimester is considered to be the most critical phase during pregnancy, as the chances of spontaneous abortion of miscarriage are very high.
The woman wants to get pregnant – Although prenatal follow-up is conducted once the woman is pregnant, it can also be part of pre-pregnancy health checkup, in which case the woman is prepared for pregnancy. Follow-up may be carried out to keep track and promote fertility, as well as prepare the woman’s body for conception and delivery.
Prenatal follow-up offers the following benefits to both mother and child:
- Proper fetal growth and development through continuous monitoring and nourishment of the mother (e.g., ideal diet and supplementation)
- Reduction of risks and complications associated with pregnancy and delivery
- Preparation of the pregnant woman for motherhood
- Management of pregnancy-related issues such as hypertension, preeclampsia, gestational diabetes, abdominal cramping, or vaginal bleeding
- Screening of the unborn baby, allowing the doctor and the parents to prepare for the possible outcomes of genetic-related issues
How Does the Procedure Work?
Before the follow-up is the initial visit, which can be the longest interaction between the OB/GYN and the mother. During this time, the doctor will perform an extensive exam including pap smear, STD test, and breast examination. He will also take note of the woman’s medical profile, including her weight, age, heart rate, blood pressure, allergies, and preexisting conditions that may affect the baby like anemia, as well as viral or bacterial infections.
The doctor may then offer recommendations for a healthier pregnancy. These may involve a proper diet, exercise, a more active lifestyle that’s safe during pregnancy, and supplementation. He then creates the follow-up plan.
Usually, the interval of the visits depends on the gestational period. For the first trimester (0 to 28 weeks), follow-up is carried out every four weeks or once a month. During the second trimester (29 to 35 weeks), it is every two to three weeks. As the mother enters the last trimester (at least 36 weeks), she needs to see her doctor every week.
In each of the follow-up visit, the mother is expected to go through tests and interviews that would help determine:
- The actual gestational age of the baby
- Size of the uterus and the cervix opening
- Blood pressure
- Heart rate of the fetus
- Presence of glucose in the urine, which may indicate gestational diabetes
- Fetal position and activity
The doctor also needs to assess the level of risk of the mother every visit, as well as any sign of pre-term labor. Genetic screening may be performed as early as the baby’s eighth week.
During the follow-up, it’s expected that the patient shares all her concerns and unusual changes in her body such as bleeding or cramping.
Possible Risks and Complications
Although highly important, prenatal follow-up is not easily followed, especially by mothers who live in developing countries. According to WHO, 99% of the world’s maternal deaths occur in areas like sub-Saharan Africa. Many factors, including lack of access to good health care, poverty, and personal beliefs prevent women from getting the care they need.
Moreover, some women may be less motivated to follow through with their succeeding visits due to cost, time, and effort needed. This can be a huge problem as the doctor cannot manage conditions or mitigate risks promptly. It can be helpful if the doctor takes a more aggressive approach, reminding the mother not only the schedule of follow-up visits but also the full benefits of timely prenatal care.
Cunningham FG, Leveno KJ, Bloom SL, et al. Prenatal care. In: Cunningham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2014:chap 9.
Cunningham FG, Leveno KJ, Bloom SL, et al. Prenatal diagnosis and fetal care. In: Cunningham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill; 2014:chap 14.
McDuffie RS Jr, Beck A, Bischoff K, Cross J, Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA. 1996 Mar 20;275(11):847-51. PMID: 8596222 www.ncbi.nlm.nih.gov/pubmed/8596222.