Live virus vaccines: Rubella, Measles, Mumps, Vericella, Yellow fever contraindicated Rabies, hepatitis A vaccines given at non pregnant state. If already taken within last 3 yrs, booster at 36 wks. Folic acid- 5 mg during 1st trimester Femg Fe and ca started at 13 wks continued for 3 months after pregnancy. Exercise should be simple. Walking is ideal, but long period of walking should be avoided.
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General principles[ 1 ] Keeping women informed Care should be centred on the pregnant woman; the aim should be to keep her fully informed on the progress of her pregnancy and to provide her with evidence-based information and support to make informed decisions.
At first contact with a health professional, she should be given: Information on where antenatal care will be offered and by whom, including choice of providers where available and information about antenatal screening.
Information about folic acid supplementation. Lifestyle advice including: Food hygiene and safe eating in pregnancy.
Smoking cessation. Advice about avoidance of alcohol and illicit drugs in pregnancy. Medication advice review of safety of any current medication in pregnancy and avoidance of over-the-counter OTC medication which may not be used in pregnancy. At booking, she should be given: Information about the development of the baby during pregnancy.
The choice of attending antenatal classes. Written information about antenatal care - for example, the book "The Pregnancy Book" available from Health Departments[ 2 ]. Patients with loss of sight or hearing, learning difficulties or poor comprehension of English should have the information provided in a way that is understandable to them.
Advice about exercise. Information and choice regarding the place of birth. Information regarding nutrition and diet. Information about breastfeeding. Further explanation of antenatal screening. The opportunity to discuss any mental health issues.
Before or at 36 weeks, she should be given: Information about breastfeeding. Information to prepare her for labour and birth birth plan, pain relief options, how to recognise the onset of active labour. Information about care of the new baby and preparations needed. Information about routine procedures such as newborn screening and vitamin K prophylaxis. Advice about postnatal self-care, along with information about postnatal depression and "baby blues".
At 38 weeks, she should be given: Information about management options for prolonged pregnancy. The patient should be seen by a small group of professionals who provide continuity of care.
Antenatal care should be readily and easily accessible and should be in an environment which enables women to discuss confidential issues such as domestic violence, sexually transmitted infections, mental health problems or recreational drug use. Allow women the time and space to bring up issues of concern to them. Ask about the home situation and the support they have in pregnancy and will have in the immediate postnatal period.
Establish if there are other children at home. Patients should carry their own notes. Maternity records should be structured to help provide the required level of evidence-based care. Assessment of gestational age should be based on an early ultrasound scan rather than the last menstrual period. Such scans should be offered to all women between 10 and 13 weeks and help to ensure: Consistency of gestational age assessments.
Multiple pregnancy is picked up early. Sensible decisions on induction of labour after 41 weeks. Mental health[ 3 ] Be alert to mental health problems - current or potential. Ask about any past or present severe mental illness. Ask about past or present treatment by a specialist mental health service, including inpatient care Ask about any severe perinatal mental illness in a first-degree relative.
In women with established mental health issues, consider the needs of partners, families and carers that might affect a woman with a mental health problem in pregnancy and the postnatal period. These include: The welfare of the baby and other dependent children and adults.
The role of the partner, family or carer in providing support. Advise on maternity rights and benefits. Pregnant women have the right to: Paid time off for antenatal care and classes. Maternity leave. Maternity pay or maternity allowance. Protection against unfair treatment, discrimination or dismissal. Contracts cannot be changed without agreement.
Note that Maternity Leave and Statutory Maternity Pay will start automatically if the employee is off work for a pregnancy-related illness in the four weeks before the baby is due. For most women, it is safe to continue working in pregnancy, so reassure where appropriate.
However, ask about occupation and consider potential exposure to harmful agents. If a risk is established, it is their responsibility to find alternative duties or suspend on full pay. Further information for expectant mothers and for employers is available on the Health and Safety Executive website[ 5 ]. It can be signed from 20 weeks before the estimated date of delivery EDD and doctors or midwives are required to sign this free of charge.
Advice: nutrition[ 1 , 2 ] Pregnant women should be encouraged to have a normal, balanced, healthy diet. Because of the dangers of toxoplasmosis and listeriosis, women should avoid: Uncooked meat or fish. Raw or partially cooked eggs, and products such as fresh mayonnaise which may contain raw eggs.
Milk that has not been pasteurised. Soft cheeses which are mould-ripened or made from unpasteurised milk, such as Brie and Camembert, or soft blue-veined cheeses such as Danish Blue. Shark, swordfish and marlin due to high mercury levels. More than two portions per week of oily fish. Unwashed fruit or vegetables. Fruit and vegetables should be washed due to the small risk of toxoplasma from soil. Vegetarians, and especially vegans, may be at risk of nutritional deficiencies and may need to be referred to a dietician for advice about obtaining all nutrients through diet.
Women should be cautioned to avoid many herbal preparations and teas; their use and safety in pregnancy have not been studied. Advice: supplements Folic acid[ 1 , 7 ] All women intending to become pregnant, and those who are, should be advised to take micrograms of folic acid up to 12 weeks of gestation to reduce incidence of fetal neural tube defects NTDs.
Supplementation with folic acid is one of the most significant interventions available. This dose is also recommended for women with diabetes types 1 or 2. This is given for at least one month prior to conception and three months afterwards. Diet alone does not reliably supply an adequate amount of folic acid for this effect. It can be prescribed or bought over-the-counter OTC cheaply. Vitamin D[ 1 , 9 ] Adequate vitamin D stores during pregnancy and breastfeeding are important for the health of both mother and baby.
The following groups are at higher risk and should take 1, units per day: Housebound women or those who have limited exposure to sunlight, such as women who usually remain covered when outdoors.
Women with a high risk of pre-eclampsia should take at least units per day combined with calcium. Caution with vitamin D supplementation is needed in women with sarcoidosis or renal disease. Iron[ 1 , 10 ] Iron should not be offered routinely as it has no benefit to either mother or baby and may cause constipation and other side-effects. Women should be given dietary advice, encouraging dietary intake of iron. Where supplementation is required, this will be picked up on routine blood tests at booking and 28 weeks.
If established, it should be treated with mg of oral elemental iron per day for three months and for at least six weeks postpartum. Other vitamins[ 1 ] Women should be warned that high levels of vitamin A may be teratogenic and therefore that they should avoid extra supplementation. Liver and liver products may contain high levels of vitamin A and should be avoided.
Where using multivitamin preparations, women should use those which are specifically designed for pregnancy. Pregnant women on low incomes can obtain vouchers for vitamins from the Healthy Start programme in the UK[ 11 ].
Advice: medication Advise women to use as few medicines as possible during pregnancy and only when benefit outweighs risk. This includes OTC medication and complementary therapies, as few products have been shown to be definitely safe during pregnancy.
Ideally review any regular medication pre-conception but, if this has not been done, as soon as possible in pregnancy. Advice: lifestyle[ 1 ] Exercise Women who exercise regularly should be advised to continue to do so. Those who are inactive should start a gentle programme of regular exercise.
Moderate exercise has not been shown to cause any harm but the patient should be warned of the dangers of highly energetic and contact sports that would risk damage to the abdomen, falls or excessive joint stress. Scuba diving should be avoided, as it can cause fetal birth defects and fetal decompression disease. Sexual intercourse This has not been shown to cause any harm during pregnancy. It may be advisable to avoid it if there is risk of preterm rupture of membranes or if there is placenta praevia, although evidence is limited[ 12 ].
Alcohol[ 1 ] High levels of alcohol consumption during pregnancy may result in the fetal alcohol syndrome FAS. There are various components including growth restriction, general learning disability, facial anomalies and behavioural problems. Not all women who drink heavily in pregnancy have babies with FAS, so there are other components, which are as yet poorly understood. It is not known how much alcohol is safe to drink in pregnancy.
This is because of the increased risk of miscarriage. For the rest of pregnancy, women are advised ideally not to drink at all; however, if they do, to restrict it to a maximum of one or two units at a maximum of once or twice per week. Smoking in pregnancy is associated with a large number of adverse effects in pregnancy including: Intrauterine growth restriction and low birth weight.
Miscarriage and stillbirth. Premature delivery.
Antenatal Advices and Minor Disorders of Pregnancy
However, global, regional and comparable country reported data are only available for the previous recommendation which was a minimum of four visits. Currently available data indicate that women receive at least 4 antenatal care visits. Globally, while 86 per cent of pregnant women access antenatal care with a skilled health personnel at least once, only two in three 65 per cent receive at least four antenatal visits. In regions with the highest rates of maternal mortality, such as sub-Saharan Africa and South Asia, even fewer women received at least four antenatal visits 52 per cent and 49 per cent, respectively. In viewing the data, it is important to remember that these percentages bear no reflection on either the skill level of the health-care provider or the quality of care, both of which can influence whether such care actually succeeds in bringing about improved maternal and newborn health.
New guidelines on antenatal care for a positive pregnancy experience
By focusing on a positive pregnancy experience, these new guidelines seek to ensure not only a healthy pregnancy for mother and baby, but also an effective transition to positive labour and childbirth and ultimately to a positive experience of motherhood. In , an estimated women died from pregnancy-related causes , 2. An important feature of these guidelines is their comprehensiveness. Not only do they provide recommendations on standard maternal and foetal assessments, but also on nutrition during pregnancy, on prevention and treatment of physiological problems commonly experienced during pregnancy e. The guidelines also include recommendations on counselling and supporting women who may be experiencing intimate partner violence. Guidance on how antenatal care services can be provided more effectively and in different contexts is also included. I welcome these guidelines, which aim to put women at the centre of care, enhancing their experience of pregnancy and ensuring that babies have the best possible start in life.