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Pregnancy after 35: advanced maternal age.

Last Updated June 2023 | This article was created by familydoctor.org editorial staff and reviewed by Robert "Chuck" Rich, Jr., MD, FAAFP

If you are 35 or older and pregnant or thinking about becoming pregnant, there are some things you should know. At age 35, you are considered to be of advanced maternal age. Your doctor uses this age as a guide to understand certain risk factors you may have that a younger woman may not. These include risks of health problems, pregnancy complications, and birth defects.

Here are some of the special concerns you may have if you are over 35 and pregnant.

Before pregnancy

• It could take longer to get pregnant . You are born with all the eggs you will ever have. By the time you’re in your mid-30s, you have fewer eggs. The eggs you do have left are older and don’t have the same quality as newer eggs. This can make it harder for them to be fertilized.
• You could have other health conditions. Some conditions are more common as you get older. These include diabetes and high blood pressure. Both of these conditions can cause complications during pregnancy.

During pregnancy

• Gestational diabetes . The older you are, the more likely you are to develop gestational diabetes. This is a special kind of diabetes that some women get during pregnancy. Uncontrolled diabetes can cause preterm labor or birth. It can also cause your baby to be too big.
• Preeclampsia . This condition causes you to have high blood pressure during pregnancy. It could also indicate that some of your organs aren’t working properly.
• Being pregnant with multiples (such as twins ). Older women are naturally more likely to become pregnant with multiples. Fertility treatments that some older women get can also increase the likelihood. Having multiple fetuses can cause complications during pregnancy. These include preeclampsia, gestational diabetes, and preterm birth.
• Birth defects. The risk of your baby having birth defects increases as you age. Birth defects could include chromosomal abnormalities such as Down syndrome .
• Miscarriage . This is when the baby dies before you reach 20 weeks of pregnancy. There are many causes of miscarriage. Advanced age increases your risk.
• Premature birth. This is when your baby is born before 37 weeks of pregnancy. Premature babies are more likely to have health problems at birth. This is because the babies didn’t have enough time to develop in the womb.
• Low birthweight. Older mothers are more likely to have a baby that weighs less than 5 lbs., 8 oz. at birth. Babies with a low birthweight are more likely to have health problems.
• Need for a C-section. A C-section, or a caesarean section, is when you have surgery to have your baby. Your doctor opens your uterus and takes the baby out. There are more risks with C-sections. These include infection or a bad reaction to anesthesia. The older you are, the more likely you’ll develop complications that would require a C-section birth.

Path to improved health

There are many things you can do to increase your chances of having a healthy baby when you’re 35 or older.

• Get a checkup. Make sure you are healthy before you get pregnant. Get any vaccines you need. Discuss your health history and your family history with your doctor. They may be able to spot a health condition that runs in your family that could affect your pregnancy.
• Get treatment. If you have any health conditions, make sure they are being treated. This includes physical conditions such as diabetes or high blood pressure. It also includes mental conditions such as depression.
• Check your medicines. Tell your doctor about every medicine you take. This includes prescriptions, over-the-counter medicines, and supplements. Some are not safe to take during pregnancy. Your doctor may need to change some of your medicines.
• Take folic acid. Folic acid is a vitamin that helps with growth and development. Take it before you get pregnant and while you are pregnant. It can help prevent birth defects in your baby.
• Maintain a healthy weight. If you are overweight or underweight, you’re more likely to have health problems during pregnancy. Try to get to a healthy weight and maintain it before you get pregnant.
• Stay away from toxic substances. Don’t use unsafe chemicals at home or at work. Don’t use tobacco, drink alcohol, or use street drugs before getting pregnant.
• Reduce stress. Stress can have a negative effect on your body. Learn stress-management skills before you get pregnant so that stress doesn’t affect your baby.  
• Get prenatal checkups. Schedule regular appointments with your doctor and go to all of them. They will be able to monitor your pregnancy. With regular visits, they will be able to spot any problems earlier. You’ll be more likely to have a good outcome.
• Keep up with treatment. Continue treating any health conditions you had before pregnancy. Make sure your doctor knows what medicines you’re taking. They will know if they are safe for your baby.
• Gain the best amount of weight. How much weight you should gain depends on how much you weighed before pregnancy. Your doctor will tell you what a good range is for you. Eat a healthy diet and be as active as you can.
• Don’t smoke, drink alcohol, or use drugs. Tobacco, alcohol, and drugs can be very harmful to you and your baby when you are pregnant.

Things t o consider

When you are of advanced maternal age, your doctor may want to do extra prenatal testing. This will allow them to test for specific abnormalities that you are at higher risk for because of your age. A noninvasive blood test looks at fetal DNA in your bloodstream. It can tell if your baby is at risk of certain chromosomal abnormalities, such as Down syndrome.

Further testing may be necessary if your doctor determines you are at increased risk. It also could include chorionic villus sampling (CVS) or amniocentesis. These tests can diagnose a chromosomal abnormality. But they can also slightly increase the risk of miscarriage. Talk to your doctor about getting any of these extra tests.

Questions to ask your doctor

• What increased risks will I have if I get pregnant after age 35? After age 40?
• If I am otherwise healthy, am I still considered to be of advanced maternal age if I’m over 35?
• Why does age put me at increased risk of complications?
• How old is too old to have a baby?
• Should I get extra testing to measure my risk for complications?
• What can I do to reduce my risks of complications such as preterm birth?
• Testing found that my baby has an increased risk of a chromosomal abnormality. What do I do now?

American Family Physician: How to Prepare for Pregnancy

The American College of Obstetricians and Gynecologists: Having a Baby After 35: How Aging Affects Fertility and Pregnancy

Last Updated: August 18, 2022

This article was contributed by familydoctor.org editorial staff.

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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Pregnancy Guide For Women 35 and Older

Doctors use a woman's age of 35 and older as one of the key points in determining whether or not she will need advanced medical care during pregnancy due to a potential increase in pregnancy risk. Most women over the age of 35 do not have  complicated pregnancies , but doctors remain on high alert throughout the pregnancy, just in case.  The key to a healthy pregnancy at any age starts with learning all you can about prenatal and pregnancy care — from preconception to postpartum . Here's how to get started!

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Today, women over age 35 years are a growing demographic in the birth rate. However, due to increased pregnancy complications, the mom is considered to be of advanced maternal age. There are certain biological changes that make pregnancy at 35+ a little trickier. It's often  more difficult to get pregnant as you get older , and it may take you longer to get pregnant. In addition, once you get pregnant, there is an increased risk of pregnancy complications such as more miscarriages, more premature births, and increased medical complications, such as high blood pressure and diabetes.

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What are some health risks with advanced maternal age?

As women age, they are more likely to suffer from diseases and conditions associated with aging, such as miscarriage, diabetes, high blood pressure, and arthritis. Some of these conditions and the age of the body, in general, may increase the risk of  gestational diabetes , pregnancy-induced hypertension, and premature labor.

Is there an increased risk of having fraternal twins?

With advanced maternal age comes an increased chance of fraternal twin pregnancy . In addition to age, the number of pregnancies also comes into play. For example, if a woman over 35 becomes pregnant and has had four pregnancies prior to the current pregnancy, she is three times more likely to conceive fraternal twins.

Birth Rates at Their Lowest in 32 Years!

Can preterm birth be a possibility?

Several studies have shown a relationship between preterm birth (PTB) and advanced maternal age. In a  large retrospective, Canadian study  women over 40 years of age had increased risk factors for PTB such as chronic hypertension, use of assisted reproductive technology (ART), pre-gestational and gestational diabetes, invasive procedures during pregnancy, and placenta previa. Their risk of PTB was 20 percent higher when compared to those aged 30-34 years. 

Does invasive testing such as amniocentesis or chorionic villus sampling (CVS) increase the risk of miscarriage?

The two most common invasive tests for women of advanced maternal age are CVS and amniocentesis. The risk of complications from these tests is less than one percent. The tests are often done as a follow up when a cell-free DNA blood test is abnormal.

Over the last decade, both amniocentesis and CVS have been mostly replaced as diagnostic screening tests by so-called "noninvasive tests" that can provide information on risks of the fetus having certain chromosomal conditions. If the cell-free DNA test is abnormal, then a diagnostic test such as amniocentesis or CVS is recommended.

• Cell-free DNA , a simple a blood test done as early as 10 weeks
• Nuchal translucency screening : a test done between 11 and 15 weeks that includes both a sonogram and a blood test. The blood test checks for levels of two substances: pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotropin. A special ultrasound, called a nuchal translucency screening, measures your baby's fluid at the back of your baby's neck, the neck's thickness. 

Will my baby be at an increased risk of Down syndrome?

One of the most notable pregnancy risks for women of advanced maternal age is Down syndrome.  Down syndrome is a chromosomal defect thought to be associated with aging eggs.  By the age of 40, about one in 100 women are at  risk of having an infant with down syndrome . Past the age of 40, the risk of down syndrome increases exponentially. By the advanced maternal age of 49, about one in 12 women are at risk. Doctors will often recommend the cell-free DNA test as an initial screening tests, and then recommend an amniocentesis or chorionic villus sampling (CVS) as a diagnostic test to determine the risk of Down syndrome in the fetus.

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Advanced Maternal Age

TLC Perinatal PA

Maternal fetal medicine & perinatal specialist located in silver spring, germantown, and hagerstown, maryland.

If you’re pregnant or planning to be pregnant and are over 35, you’re considered to be of advanced maternal age. The team of expert perinatologists at TLC Perinatal PA offer specialized preconception counseling and testing for older mothers at their offices in Silver Spring, Hagerstown, and Germantown, Maryland. Have your obstetrician refer you to TLC Perinatal, then call or schedule an appointment online for personalized maternal-fetal medicine expertise.

Advanced Maternal Age Q & A

What is advanced maternal age.

Even though you still feel, and are, young at 35, medically you’re considered to be of advanced maternal age. If you get pregnant when you’re 35 or older, your pregnancy is classified as high-risk.

Most women have perfectly healthy babies after 35; you just receive additional prenatal monitoring and testing. Your age is an indicator of an increased risk for certain complications, and your OB/GYN will take steps, including referring you to the maternal-fetal medicine specialists at TLC Perinatal PA to make sure you and your developing child are carefully monitored If an issue arises, TLC Perinatal PA in consultation with your obstetrician can offer the testing and treatment you need.

Why does advanced maternal age affect pregnancy?

While every woman is different, medically 35 is the age where statistically your risks of certain pregnancy complications begin to increase.

For example, it might take you longer to get pregnant. As you age, your ovarian reserves – the number of quality eggs you have left – decreases. Your eggs might not be as easily fertilized and your risk of chromosomal abnormalities increases, which also makes it more likely that you’ll experience pregnancy loss.

Other risks associated with advanced maternal age include:

• Gestational diabetes
• High blood pressure during pregnancy
• Premature birth
• Low birth weight
• Need for cesarean delivery

Additionally, as you age, it’s more likely that your body will release multiple eggs during your menstrual cycles, which increases your chances of having twins, triplets, or more.

What should I do if I am of advanced maternal age?

While the risks associated with advanced maternal age sound scary, remember that most women of advanced maternal age have healthy babies. The doctors at TLC Perinatal PA offer expert testing and consultation with obstetricians with patients of all ages .

For example, if you are of advanced maternal age, you have more frequent prenatal checkups. Generally, women have monthly appointments until their 28th week of pregnancy, then bi-weekly checkups until week 36, and finally weekly appointments until their baby is born. If you are 35 or older, you could have bi-weekly appointments from the beginning of your pregnancy.

In addition to the extra prenatal checkups, your obstetrician could recommend additional prenatal genetic screenings as well as early tests for gestational diabetes, which is where a referral to TLC Perinatal PA comes in.

The team at TLC Perinatal PA can help you have a healthy pregnancy at any age. Have your obstetrician refer you, then call or schedule an appointment online.

Routine and High-Risk Pregnancy Consultation Prenatal Diagnosis

• Ultrasound screening for fetal abnormalities
• Computerized fetal growth analysis and reports
• Pulsed wave and color doppler
• 3D/4D Imaging
• Fetal Echocardiography
• First Trimester Screening and Risk Assessment
• Non-Invasive Prenatal Testing
• Amniocentesis
• Chorionic Villus Sampling
• Genetic Counseling and Testing (maternal serum screening and invasive diagnostic testing)
• Cervical assessment by transvaginal ultrasound
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Jessica Grose

Expecting or Planning? There’s Nothing Magic About Age 35.

By Jessica Grose

Opinion Writer

Many of the decisions I made around my pregnancies were based on the looming specter of “advanced maternal age,” which is typically defined as 35 or older . Rudely, this used to be called a “ geriatric pregnancy ,” but that term is thankfully now out of fashion. In my head, my 35th birthday was some kind of Cinderella clock, but instead of my coach turning back into a pumpkin, it had me imagining that my eggs would shrivel up and die.

I had my first kid at 30, and I was anxious to have my second before that 35-year-old deadline. I was concerned that it would be more difficult to get pregnant after that and my pregnancy would be much riskier. I had a miscarriage at 32 and had a not-insignificant amount of stress about getting pregnant again as soon as possible. It would take about a year before I conceived, and I had my second child at 34 and precisely 4 months.

Considering how much stock I put in 35 as a marker, I was intrigued reading a new study from researchers at Harvard that suggests that women who are just over 35 may have slightly better pregnancy outcomes than women just under 35.

As Jessica Cohen, an associate professor of global health at Harvard’s T.H. Chan School of Public Health and a co-author of the study, told me, the choice of 35 as the cutoff for advanced maternal age was somewhat arbitrary in the first place. “Age 35 became a guideline in the ’70s for when to offer invasive genetic testing for Down syndrome,” she explained. After that, “age 35 became a guideline for a bunch of other things, and not really necessarily based on anything. Your risk of Down, your risk of stillbirth, pre-eclampsia — none of those change abruptly at 35,” she said.

Cohen noticed that she received subtly different treatment for the pregnancy she had before 35 and the one she had after that age. For example, during both her pregnancies, her blood pressure started creeping up above normal toward the end. When she was under 35, her health care providers just checked her blood pressure more regularly, but when she was over 35, she got an ultrasound, an amniotic fluid check and a nonstress test .

While Cohen noted that the American College of Obstetricians and Gynecologists does not explicitly say to do a certain set of tests once a woman is over 35, “the age influences what the provider recommends,” and it affects what kinds of testing insurance companies might pay for .

Because she’s an economist, Cohen said, she looks for natural experiments , and so with her colleagues she looked at over 50,000 pregnancies by using data from a large commercial insurer. About half of the women included in the study were 34.7 to 34.9 years old, and about half were 35.0 to 35.3 years old at the expected date of delivery.

The study found that women over 35 received more maternal-fetal medicine visits, more ultrasounds and more antepartum surveillance. There was also a 0.39 percentage point decline in perinatal mortality (defined in this study as a fetal death at or after 28 weeks’ gestation or an infant death up to a week postpartum). But the study found no significant difference in maternal mortality, preterm birth or low birth weight.

The takeaway isn’t that every pregnant person who’s just under 35 also needs more ultrasounds or more doctor visits, Cohen said. And it certainly isn’t that age doesn’t matter at all ; fertility does decline over time , and maternal age may be a factor for certain conditions. Rather, the takeaway is that there’s nothing magical about age 35. “A lot of our prenatal care management is relics and risk aversions,” she said, and it should be based on more precise evidence.

Just as age 35 was somewhat arbitrarily designated as “advanced maternal age,” the number of prenatal visits that women received up until the Covid pandemic began was based on a schedule that was established in 1930 “without supporting evidence,” according to a 2020 paper published in The American Journal of Obstetrics and Gynecology. The pandemic turned out to be another natural experiment in prenatal care, with experts reassessing whether all pregnant people need the 12 to 14 in-person office visits they may have been getting prepandemic.

What we should be aiming for is what experts call right-sized prenatal care, which means the right amount of care for each person. Right-sized care incorporates medical as well as psychological wellness and also the need for additional social supports. Neel Shah, an assistant professor at Harvard Medical School and the chief medical officer of Maven Clinic, has researched right-sized maternity care and told me, “We need to improve the precision in the way we manage people, which is the thing that medicine, surprisingly, has not invested in.”

According to a study co-written by Shah , “By our back-of-the-envelope calculation, for a patient participating in routine prenatal care, the full complement of 12 to 14 visits — including travel time, parking and additional laboratory testing and imaging — equates to almost one full week of missed work or child care, before integrating additional psychosocial support. This may be too much care for some, not enough for others and the wrong kind of care for patients with diverse support needs.”

It’s unclear if a specific aspect of care is leading to better outcomes for women just over 35, Cohen said, and her study doesn’t drill down on that. It was primarily concerned with what was happening for mothers around age 35 and babies, rather than why. “It may have to do with taking women’s concerns more seriously at the end of pregnancy, if you’re feeling something’s not right,” she speculated. Which seems like the kind of right-sized care every mother, and child, deserves, no matter her age.

Want More on Pregnancy Over 30?

In 2013 in The Atlantic, Jean M. Twenge wrote about the way fertility declines in your 30s and found that you may have more time than you think .

In The Times, Reyhan Harmanci wrote “ The Truth About Pregnancy Over 40 .”

In some big U.S. cities, the average age of first-time mothers is over 30 , and in 2017, Perri Klass reported “ Good News for Older Mothers .”

Certain types of prenatal testing for rare genetic disorders might not be very accurate , according to new reporting from Sarah Kliff and Aatish Bhatia in The Times.

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Your Guide to Prenatal Appointments

Medical review policy, latest update:.

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Typical prenatal appointment schedule

Read this next, what happens during a prenatal care appointment, what tests will i receive at my prenatal appointments, what will i talk about with my practitioner at prenatal care appointments , first trimester prenatal appointments: what to expect, second trimester prenatal appointments: what to expect, third trimester prenatal appointments: what to expect, questions to ask during prenatal appointments  .

Prenatal care visits are chock-full of tests, measurements, questions and concerns, but know that throughout the process your and your baby’s wellbeing are the main focus. Keep your schedule organized so you don’t miss any appointments and jot down anything you want to discuss with your doctor and your prenatal experience should end up being both positive and rewarding.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. American College of Obstetricians and Gynecologists,  Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy , 2020. American College of Obstetricians and Gynecologists,  Routine Tests During Pregnancy , 2020. US Department of Health & Human Services, Office on Women’s Health,  Prenatal Care and Tests , January 2019. Journal of Perinatology ,  Number of Prenatal Visits and Pregnancy Outcomes in Low-risk wWomen , June 2016. Mayo Clinic,  Edema , October 2017. Mayo Clinic,  Prenatal Care: 2nd Trimester Visits , August 2020. Mayo Clinic,  Prenatal Care: 3rd Trimester Visits , August 2020. Jennifer Leighdon Wu, M.D., Women’s Health of Manhattan, New York, NY. WhatToExpect.com, Preeclampsia: Symptoms, Risk Factors and Treatment , April 2019. WhatToExpect.com, Prenatal Testing During Pregnancy , March 2019. WhatToExpect.com,  Urine Tests During Pregnancy , May 2019. WhatToExpect.com,  Fetal Heartbeat: The Development of Baby’s Circulatory System , April 2019. WhatToExpect.com,  Amniocentesis , Mary 2019. WhatToExpect.com,  Ultrasound During Pregnancy , April 2019. WhatToExpect.com,  Rh Factor Testing , June 2019. WhatToExpect.com,  Glucose Screening and Glucose Tolerance Test , April 2019. WhatToExpect.com, Nuchal Translucency Screening , April 2019. WhatToExpect.com, Group B Strep Testing During Pregnancy , August 2019. WhatToExpect.com,  The Nonstress Test During Pregnancy , April 2019. WhatToExpect.com,  Biophysical Profile (BPP) , May 2019. WhatToExpect.com,  Noninvasive Prenatal Testing , (NIPT), April 2019. WhatToExpect.com,  The Quad Screen , February 2019. WhatToExpect.com,  Chorionic Villus Sampling (CVS) , February 2019. WhatToExpect.com,  The First Prenatal Appointment , June 2019. WhatToExpect.com,  Breech Birth: What it Means for You , September 2018.

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High-risk pregnancy: Know what to expect

If your pregnancy is high-risk, you might have questions. Will you need special care? Will your baby be OK? Get the facts about how to have a healthy pregnancy.

If your pregnancy is considered high-risk, it means that you or your baby might be more likely than usual to develop health problems before, during or after delivery.

Due to that risk, you may need extra medical appointments or tests during your pregnancy. At those appointments, your healthcare team checks to see if you may be developing any health problems and treats them quickly if they happen.

Learn about what it means to have a high-risk pregnancy. And find out what you can do to take care of yourself and your baby.

What makes a pregnancy high-risk?

Sometimes a high-risk pregnancy can happen due to a medical condition you have before pregnancy. Or a medical condition may develop during pregnancy that raises the risk of problems. The following factors could lead to a high-risk pregnancy.

Pregnancy risks tend to be higher for pregnant people who are younger than 20 or who are older than 35.

Lifestyle choices

A variety of lifestyle choices can put a pregnancy at risk. Examples include:

• Drinking alcohol.
• Smoking cigarettes, vaping or using other tobacco products.
• Using illegal drugs.

Health problems

Some medical conditions in a pregnant person can raise pregnancy risks, including:

• High blood pressure.
• Thyroid disease.
• Heart or blood disorders.
• Poorly controlled asthma.
• Infections.

Pregnancy complications

Some health problems that develop during pregnancy can cause problems. Examples include:

• Unusual location of the placenta.
• Very low fetal growth. Usually, overall fetal growth or a fetal abdomen size that's less than the 10th percentile for gestational age is cause for concern. This condition is called fetal growth restriction.
• Rh sensitization. This happens when a pregnant person's blood group is Rh negative and the fetus's blood group is Rh positive.

Pregnancy with multiples

Risks to both a pregnant person and the fetuses are higher when a pregnancy includes more than one fetus.

The likelihood of having more than one fetus is higher in people who have gone through infertility treatments to get pregnant. Those treatments also are called assisted reproductive technologies (ART). One common type of ART is in vitro fertilization. The use of ART may raise the risk of some medical concerns during pregnancy, such as diabetes or high blood pressure.

Pregnancy history

Medical problems that happened during a previous pregnancy may raise the risk of having the same problems again. Examples include:

• Conditions during pregnancy related to high blood pressure, such as preeclampsia.
• Giving birth early. This is called preterm delivery.
• Having a baby born with a genetic condition.
• Having a miscarriage or stillbirth.

It's important to tell your healthcare professional about any medical problems that you had during other pregnancies.

What steps can I take for a healthy pregnancy?

You may know ahead of time that you'll have a high-risk pregnancy. Or you might want to do what you can to prevent a high-risk pregnancy. Either way, take the following steps.

Schedule an appointment before you get pregnant

If you're thinking about becoming pregnant, make an appointment to see your healthcare professional. During that appointment, you'll likely talk about:

• Taking a daily prenatal vitamin with folic acid.
• How to best manage any medical conditions you may have.
• All medicines you take, including those without a prescription.
• Vaccinations you may need.
• Your family and personal medical history.
• Your risk of having a baby with a genetic condition.
• Your partner's health.
• How you can prepare for a healthy pregnancy. For example, quitting smoking and being at a healthy weight before you become pregnant can lower some risks.

Get the care you need during pregnancy

Appointments with your healthcare team on a regular basis during pregnancy allows the team to follow your health and your baby's health. You might be referred to a specialist. Depending on your situation, you may see a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.

Avoid risky substances

If you use any form of tobacco or e-cigarettes, quit. Don't drink alcohol or take illegal drugs during pregnancy. Tell your healthcare professional about any medicines or supplements you take.

Do I need special tests?

Depending on the circumstances, your healthcare professional might suggest certain tests. The following are examples of tests that may be part of care during a high-risk pregnancy. The decision to get these tests is up to you. Talk about the risks and benefits with your healthcare professional.

Specialized ultrasounds

An ultrasound is an imaging test that uses high-frequency sound waves to make images of a fetus on a screen. Ultrasound is safe for both pregnant people and fetuses.

The following kinds of ultrasound may be helpful during a high-risk pregnancy:

• Three-dimensional (3D) or 4-dimensional (4D) ultrasounds can be used to pinpoint a suspected problem, such as fetal development that's not typical.
• Ultrasound to measure the length of the cervix can help determine if you're at risk for going into labor early.
• A biophysical profile is an ultrasound that can be used to check a fetus's health. Depending on the ultrasound results, your team also may check a fetus's heart rate. That procedure is called a nonstress test.

Cell-free DNA screening

This test sometimes is called cfDNA . It uses a blood sample from you to provide the healthcare team with your DNA and the fetus's DNA. A small amount of DNA from the fetus goes into a pregnant person's blood stream during pregnancy. Through the blood sample, the fetus's DNA is checked to see if there's a higher chance of certain chromosome problems. If so, those problems could signal a genetic condition.

Other genetic tests

Your healthcare professional might suggest amniocentesis or chorionic villus sampling (CVS). These tests can help find genetic conditions. They also can be used to confirm results from cell-free DNA screening.

• Amniocentesis. During amniocentesis, a sample of the fluid that surrounds and protects a fetus during pregnancy is taken from the uterus. The medical term for that fluid is amniotic fluid. Usually done after week 15 of pregnancy, the test can identify some genetic conditions. It also can find serious problems of the brain or spinal cord. Those conditions are called neural tube defects.
• CVS . During CVS , a sample of cells is taken from the placenta. It's usually done between weeks 10 and 13 of pregnancy.

Your healthcare team can run lab tests on a blood or urine sample from you to check for infections, anemia and diabetes. The tests also can be used to identify a higher risk of genetic conditions.

What else do I need to know about high-risk pregnancy?

Talk to your healthcare professional about how to manage any medical conditions you have during pregnancy. Ask how those conditions could affect labor and delivery.

Contact a member of your healthcare team right away if you have:

• Vaginal bleeding.
• Watery vaginal discharge.
• Pain or cramping in your abdomen or pelvis area.
• Less fetal activity than usual.
• Severe headaches.
• Pain or burning when you urinate.
• Changes in vision, including blurred vision.
• Sudden or severe swelling in the face, hands or fingers.
• Fever or chills.
• Vomiting or frequent nausea.
• Chest pain or shortness of breath.
• Extreme tiredness.
• Nervousness or worry that makes it hard for you to do your daily activities.
• Overwhelming feelings of sadness or sadness that lasts.
• Thoughts of harming yourself or your baby.

Having a high-risk pregnancy may be stressful and cause you to worry about your baby's health. Try to do what you can to ensure a healthy pregnancy. Throughout your pregnancy, talk to a member of your healthcare team if you have questions or need support. After pregnancy, discuss with your healthcare professional how medical conditions during pregnancy might affect your long-term health.

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• DeCherney AH, et al., eds. Assessment of at-risk pregnancy. In: Current Diagnosis &Treatment: Obstetrics & Gynecology. 12th ed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. Accessed Oct. 24, 2023.
• Preconception health. Office on Women's Health. https://www.womenshealth.gov/pregnancy/you-get-pregnant/preconception-health. Accessed Oct. 24, 2023.
• Pregnancy complications. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-complications.html. Accessed Oct. 24, 2023.
• Prager S, et al. Pregnancy loss (miscarriage): Clinical presentations, diagnosis, and initial evaluation. https://www.uptodate.com/contents/search. Accessed Oct. 25, 2023.
• FAQs: Prenatal genetic diagnostic tests. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/prenatal-genetic-diagnostic-tests. Accessed Oct. 25, 2023.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed Oct. 25, 2023.

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How Often Should I See My Doctor During Pregnancy?

Ensure you’re giving your baby the best possible start by maintaining the recommended schedule of prenatal visits during your pregnancy . While it may be challenging to fit ongoing office appointments into your busy schedule, prenatal visits are the best way to protect your health and the health of your baby. 

In addition to providing support for physical changes, prenatal visits are also a good opportunity to address your questions and concerns about your body, your baby’s development, and the upcoming birth. 

Your prenatal provider is an important resource for treatment, education, and support throughout your pregnancy. Our OB/GYNs at The Association for Women’s Health Care have the expertise necessary to care for you and your unborn baby whether you have a normal or high-risk pregnancy. 

Our team of pregnancy specialists provides comprehensive pregnancy services, from routine examinations to diagnostic testing, through all stages of pregnancy.

Start as early as possible

Contact our office to arrange your first prenatal visit as soon as your pregnancy is confirmed. While most women start their prenatal visits at about eight weeks of pregnancy, we may recommend that you begin your visits earlier if your pregnancy is considered high-risk due to:

• Advanced maternal age
• An existing medical condition
• A history of pregnancy complications
• Symptoms such as abdominal pain or vaginal bleeding 

Your first appointment is typically longer than other prenatal visits. It includes a comprehensive physical exam, pelvic exam, and medical history. You may also have a Pap smear and other tests such as a blood test, STD test, and urine test. 

At this early stage of pregnancy, we give you lifestyle guidelines, such as maintaining proper nutrition, exercising daily, and taking prenatal vitamins to support your health and the healthy development of your baby. 

Follow your recommended schedule of visits

If your pregnancy is free of complications and your overall health is normal, you’re likely to have about 15 prenatal visits during your pregnancy. Your visits are scheduled closer together as your pregnancy progresses. 

Most women have a schedule of prenatal visits that follows this timing:

• One visit every four weeks during weeks 4-28 of pregnancy
• One visit every two weeks during weeks 28-36 of pregnancy
• One visit every week during weeks 36-40 of pregnancy

This schedule is only a guide. We may require more appointments with less time between visits if you have preexisting medical conditions or other issues associated with a high risk of complications. 

Understand what to expect

After your first appointment, your prenatal visits include a physical exam and tests specific to your medical condition and stage of pregnancy. As you progress through your pregnancy, your visits may change to monitor specific medical conditions or physical changes affecting you or your baby.

A typical prenatal visit includes:

• Measurement of your weight and blood pressure
• Urine test for signs of complications including gestational diabetes, preeclampsia, and urinary tract infections
• Measurement of your abdomen to chart your baby’s growth
• Doppler ultrasound to monitor your baby’s heart rate

Protect your baby’s health

Even if you’re feeling well and your pregnancy is free of complications, regular prenatal visits can make a difference in supporting a smooth birth and healthy baby.

If you go through pregnancy without appropriate prenatal care, your baby has a risk of low birth weight that’s three times higher than babies born to mothers who received prenatal care. Without prenatal care, your baby is also five times more likely to die than a baby whose mother was routinely monitored during pregnancy. 

Premature birth — before the 37th week of pregnancy — and fetal growth restriction, which prevents a baby from gaining adequate weight in the womb, are the two most common causes of low birth weight . 

At recommended prenatal visits, we monitor your baby’s growth to identify the risk of low birth weight and reduce the possibility of these complications. 

Prenatal visits also allow us the opportunity to observe your body for signs of conditions like gestational diabetes, anemia, or high blood pressure, all of which could damage your health and the health of your baby.

Give your baby the best possible start. Contact our Chicago or Northbrook, Illinois, office today to schedule an appointment.

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SARAH INÉS RAMÍREZ, MD, FAAFP

Am Fam Physician. 2023;108(2):139-150

Related AFP Community Blog:   Practice Ancestry-Based Medicine, not Racial Essentialism

Related editorial:   Perinatal Care of Transgender Patients, Adolescent Patients, and Patients With Opioid Use Disorder

Author disclosure: No relevant financial relationships.

Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater satisfaction, and lower pregnancy-associated morbidity and mortality. Care initiated at 10 weeks or earlier improves outcomes. Identification and treatment of periodontal disease decreases preterm delivery risk. A prepregnancy body mass index greater than 25 kg per m 2 is associated with gestational diabetes mellitus, hypertension, miscarriage, and stillbirth. Advanced maternal and paternal age (35 years or older) is associated with gestational diabetes, hypertension, miscarriage, intrauterine growth restriction, aneuploidy, birth defects, and stillbirth. Rh o (D) immune globulin decreases alloimmunization risk in a patient who is RhD-negative carrying a fetus who is RhD-positive. Treatment of iron deficiency anemia decreases the risk of preterm delivery, intrauterine growth restriction, and perinatal depression. Ancestry-based genetic risk stratification using family history can inform genetic screening. Folic acid supplementation (400 to 800 mcg daily) decreases the risk of neural tube defects. All pregnant patients should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella and should receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines. Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection. Because of the impact of social determinants of health on outcomes, universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy. Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients. People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks. Chronic hypertension should be treated to a blood pressure of less than 140/90 mm Hg.

Family physicians provide family-centered care for individuals and families before, during, and after the birth of a child. Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater care satisfaction, improved perinatal outcomes, and mitigates pregnancy-associated morbidity and mortality. 1 Family physicians are uniquely positioned to address social determinants of health while ensuring quality of care.

Prenatal Care Visits

Initiation of care between six and 10 weeks allows for identification of preexisting conditions that negatively affect maternal-fetal outcomes (e.g., diabetes mellitus, hypertension, obesity) 2 ; however, 22% of pregnant patients do not receive care during this time. 2 The COVID-19 pandemic resulted in a reevaluation of the number of physician visits needed, with an emphasis on increased flexibility, allowing for a combination of virtual and in-person visits depending on risk. 3 Table 1 outlines the components of prenatal care. 1 , 4 – 22 Table 2 provides opportunities for educating pregnant patients during prenatal care visits. 6 , 8 , 14 – 19 , 23 – 29

PHYSICAL EXAMINATION

Weight, height, and blood pressure should be measured at the first prenatal visit. Early identification of periodontal disease and treatment decreases adverse pregnancy outcomes. 7 Treatment may be performed in the second trimester, and emergent treatment may be completed at any time during pregnancy. 7 A bimanual pelvic examination has poor predictive value for clinical pelvimetry and screening for disease (i.e., sexually transmitted infections and cancer) but may be used as a diagnostic aid in patients with a discrepancy between uterine size and gestational age, which warrants ultrasonography assessment. 30 A pelvic examination is also useful in a symptomatic patient for evaluating spontaneous labor (e.g., cervical dilation, rupture of amniotic membranes). The clinical breast examination is a diagnostic aid in the symptomatic patient and addresses breastfeeding concerns or barriers but does not demonstrate benefit in patients already receiving screening mammograms and does not decrease mortality. 31 – 33

MATERNAL WEIGHT GAIN AND NUTRITION

A prepregnancy body mass index (BMI) greater than 25 kg per m 2 is associated with preterm delivery, gestational diabetes, gestational hypertension, and preeclampsia. A BMI greater than 30 kg per m 2 is also associated with an increased risk of miscarriage, stillbirth, and obstructive sleep apnea. 6 Prepregnancy BMI informs the timing of fetal surveillance, nutritional counseling, and goals for gestational weight gain. Table 3 lists general dietary guidelines for pregnant people. 8 , 17 , 34 , 35 For Black and Hispanic people, a prepregnancy BMI greater than 25 kg per m 2 and the associated poor outcomes are worse compared with non-Hispanic White people. 36

PARENTAL AGE AT CONCEPTION

Advanced maternal and paternal age (35 years and older) is associated with poor outcomes (i.e., aneuploidy, birth defects, gestational diabetes, hypertension, intrauterine growth restriction [IUGR], miscarriage, and stillbirth). Activities focused on improving perinatal outcomes for this group, such as a detailed fetal anatomic screening on ultrasonography, may decrease morbidity and mortality. 37

PREGNANCY DATING AND ULTRASONOGRAPHY

Accurate gestational age estimation is critical to quality care because it enables more precise timing of interventions (e.g., aspirin for preeclampsia prevention, steroids for fetal lung maturity), screening tests, and delivery. Up to 40% of people estimate their last menstrual period incorrectly; therefore, ultrasonography is recommended if uncertainty exists and for patients with irregular menstrual cycles, irregular bleeding, and discrepancy between uterine size and gestational age. 1 , 38 Ultrasonography before 24 weeks decreases missed multiple gestations and post-term inductions. 39 Although routine third-trimester ultrasonography may increase detection of IUGR, it does not improve outcomes. 40 If malpresentation is suspected on physical examination, confirmation with ultrasonography is recommended. 4

ALLOIMMUNIZATION

For patients who are RhD-negative and carrying a fetus who is RhD-positive, the alloimmunization risk is 1.5% to 2% in the setting of spontaneous abortion and 4% to 5% with dilation and curettage. The risk is decreased by 80% to 90% with anti-D immune globulin. 41 Testing for the ABO blood group and RhD antibodies should be performed early in pregnancy. A 300-mcg dose of anti-D immune globulin is recommended for RhD-negative pregnant patients at 28 weeks and again within 72 hours of delivery if the infant is RhD-positive. 41

Iron deficiency anemia increases the risk of preterm delivery, IUGR, and perinatal depression. The U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for anemia in pregnancy. 42 Screening is recommended by the American College of Obstetricians and Gynecologists early in pregnancy, with iron treatment if deficient. 43 Intravenous iron should be considered for patients who cannot tolerate oral iron or in whom oral iron has been ineffective at correcting the deficiency. 43 Patients with non–iron deficiency anemia, or if iron repletion is ineffective within six weeks, should be referred to a hematologist for further evaluation. Iron supplementation in the first trimester decreases the prevalence of iron deficiency. 43

INHERITED CONDITIONS

Pregnant patients should be counseled and offered aneuploidy (extra or missing chromosomes) screening in early pregnancy, regardless of age. 44 In the United States, 1 in 150 infants has a chromosomal condition, the most common being trisomy 21 (Down syndrome). 44 Table 4 compares screening tests for Down syndrome. 1 , 45 , 46 If a screening test is positive, amniocentesis at 15 weeks or more or chorionic villous sampling between 11 and 13 weeks is recommended. Both procedures have similar rates of fetal loss. 47 At 35 years of age, the risk of Down syndrome (1 in 294 births) is similar to that of fetal loss from amniocentesis. 47 Serum and nuchal translucency testing can screen for other trisomies, including 13 and 18, the protocols for which have lower sensitivities and higher specificities compared with screening protocols for trisomy 21 because they are rarer. 47

Additional genetic screening should be based on maternal and paternal personal and family histories. Race is a social construct, necessitating a shift in genetic risk stratification from race-based to ancestry-based. Sickle cell disease affects up to 100,000 people in the United States, but its inheritance pattern (1:10) is based on people with African ancestry, which includes much of the world. 48 Cystic fibrosis is inherited mainly by people of European ancestry (1:25), but ignoring the possibility of European ancestry in certain racial and ethnic groups results in an underestimation of its prevalence: African (1:61), Hispanic (1:40), and Mediterranean (1:29). 49

NEURAL TUBE DEFECTS

In the United States, neural tube defects affect approximately 2,600 infants per year, with the highest prevalence in Hispanic populations. 35 , 50 All pregnant patients should be counseled and offered screening with maternal serum alpha fetoprotein. 35 Folic acid, 400 to 800 mcg daily, started at least one month before conception and continued until the end of the first trimester, decreases the incidence of neural tube defects by nearly 78%. 35 Patients taking folic acid antagonists (e.g., carbamazepine, methotrexate, trimethoprim) or who have a history of carrying a fetus with a neural tube defect should take 4 mg of folic acid daily, starting at least three months before conception. 35

THYROID DISORDERS

There is no evidence that screening for thyroid disorders improves pregnancy outcomes. Thyroid-stimulating hormone levels should be measured if there is a history of thyroid disease or symptoms of disease. If the level is abnormal, a free thyroxine test helps determine the etiology. 51 Hypothyroidism complicates 1 to 3 per 1,000 pregnancies and increases the risk of fetal loss, preeclampsia, IUGR, and stillbirth. Hyperthyroidism occurs in 2 per 1,000 pregnancies and is associated with miscarriage, preeclampsia, IUGR, preterm delivery, thyroid storm, and congestive heart failure. 51 The effect of subclinical hypothyroidism on a child's neurocognitive development is not well understood, and the effectiveness of treatment with levothyroxine is unproven. 51

CERVICAL CANCER

Intervals for cervical cancer screening are based on patient age, cytology history, and history of the presence of high-risk human papillomavirus (HPV). Routine screening for people at average risk of cervical cancer should begin at 21 years of age. Screening can be performed with either cytology alone every three years, HPV screening alone every five years, or cytology plus HPV screening every five years starting at 25 years of age. Screening is not indicated for people 65 years and older with negative screening in the previous 10 years, and no history of cervical intraepithelial neoplasia grade 2 or higher in the past 25 years. 52 Colposcopy is indicated when the risk of cervical intraepithelial neoplasia grade 3 is greater than 4%. Surveillance of high-grade lesions should be performed every 12 to 24 weeks. 52 , 53 Although colposcopy and cervical biopsy can be safely performed during pregnancy, endocervical sampling should be deferred until postpartum. 53

Infectious Disease

Bacteriuria.

Asymptomatic bacteriuria complicates up to 15% of pregnancies in the United States, 30% of which progress to pyelonephritis if untreated. 54 All pregnant patients should be screened for bacteriuria at the first prenatal visit. 54 A culture from a midstream or clean-catch sample with greater than 100,000 colony-forming units per mL of a single pathogen is considered positive and treated to decrease the risk of pyelonephritis and subsequent preterm delivery. 54

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections can affect prenatal outcomes. 55 – 57 Table 5 lists routine screening and treatment for sexually transmitted infections in pregnancy. 55 , 56

Rubella immunity screening during the first prenatal visit is recommended. Postpartum vaccination should also be offered if the patient is not immune to prevent congenital rubella syndrome in subsequent pregnancies. 1 , 58 The presence of rubella immunoglobulin G should be interpreted with caution in patients recently migrating from areas where rubella is endemic because this may indicate a recent infection. 58 Rubella is a live vaccine and should not be administered during pregnancy but is safe during lactation after delivery. 59 , 60

Maternal varicella can result in congenital varicella syndrome (i.e., IUGR and limb, ophthalmologic, and neurologic abnormalities) and neonatal varicella; infection can occur from approximately five days before to two days after birth. A negative history of varicella infection or vaccination warrants serologic testing, and if immunoglobulin G is negative, varicella exposure should be avoided. Postpartum vaccination should be offered. 61

Although tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination is recommended for anyone in close contact with the infant, only antenatal maternal vaccination ensures increased protection against neonatal pertussis. 62 Pregnant patients should receive a Tdap vaccine beginning at 27 weeks to maximize time for passive immunity to the fetus through the placental transfer of maternal antibodies; vaccination is recommended in each subsequent pregnancy. 62

INFLUENZA AND COVID-19

Influenza and COVID-19 infection in pregnancy increase the risk of intensive care unit admission, preterm delivery, stillbirth, and maternal death. 63 , 64 COVID-19 infection almost doubles the risk of developing preeclampsia 64 ; therefore, initiating low-dose aspirin (81 mg daily) starting at 12 weeks should be considered. 5 Pregnant patients and their household contacts should be vaccinated for influenza and COVID-19. 63 , 64

GROUP B STREPTOCOCCUS

In the United States, group B Streptococcus (GBS) is the leading cause of infection in the first three months of life; 25% of all pregnant patients are GBS carriers. 65 , 66 Screening with a vaginal-rectal swab for culture between 36 and 37 weeks is recommended. 67 Intrapartum antibiotic prophylaxis decreases neonatal mortality. Antibiotics are recommended when there is GBS bacteriuria with the current pregnancy, a history of a previous infant affected by GBS (e.g., septicemia, meningitis, pneumonia, death), or unknown GBS status and risk factors (e.g., preterm labor, rupture of membranes more than 18 hours before delivery, GBS in previous pregnancy). 67 Patients with GBS bacteriuria in the current pregnancy are assumed to be colonized and do not need subsequent screening. 67

Social Determinants of Health

Social determinants of health represent up to 80% of the factors that directly affect a person's health. 68 Physicians who provide prenatal care play a critical role in mitigating the burden that social determinants of health play on maternal-child health without compromising the quality of care delivered. 69 An increased burden from social determinants of health increases the risk of depression, anxiety, intimate partner violence, substance use, and food insecurity 70 , 71 ; therefore, universal screening is recommended early in pregnancy.

DEPRESSION AND ANXIETY-RELATED DISORDERS

After the COVID-19 pandemic, rates of perinatal depression and anxiety have increased. People who are non-White, 24 years or younger, or who have 12 years or less of education, lower socioeconomic status, or a history of intimate partner violence or sexual trauma are at higher risk. 11 , 72 , 73 If untreated, depression and anxiety-related disorders increase the risk of preeclampsia, preterm delivery, IUGR, substance use, maternal suicide, infanticide, psychosis, and homicide. 11

INTIMATE PARTNER VIOLENCE

Intimate partner–related homicide is the leading cause of death in the United States in pregnancy. Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes, IUGR, and preterm delivery. 13 Family physicians should be aware of the signs of intimate partner violence (e.g., frequent sexually transmitted infections, repeated requests for pregnancy tests when pregnancy is not desired, fear of asking a partner to use a condom), the effect of violence on health, and the increased risk of child abuse after delivery. 13

SUBSTANCE USE

Substance use during pregnancy increases the risk of IUGR, preterm delivery, stillbirth, fetal malformations, and maternal death. 74 The use of prescription opioids complicates 7% of pregnancies in the United States; of these, 20% of patients report misuse. 75 Opioid use in pregnancy increased by 131% from 2010 to 2017 in the United States, and the incidence of babies born with withdrawal symptoms in that time increased by 82%. 76 Fetal alcohol exposure is the leading cause of preventable neurodevelopmental disorders in the United States. 14 However, 14% of pregnant patients report current drinking, and 5% report binge drinking in the past 30 days. 77 Exposure to cigarette smoking in utero increases the risk of sudden intrauterine and infant death. 15

FOOD INSECURITY

Maternal food insecurity increases the risk of poor outcomes (e.g., IUGR, preterm delivery, gestational diabetes, hypertension, depression, anxiety). However, few patients disclose this due to concerns about social stigma; therefore, a universal approach to screening is encouraged. The Hunger Vital Sign tool may be used. 12

Complications of Pregnancy

Gestational diabetes.

Gestational diabetes complicates up to 14% of U.S. pregnancies, with up to 67% of patients developing type 2 diabetes later in life. 78 Racial and ethnic minorities are at the highest risk. 79 Gestational diabetes is associated with hypertension, macrosomia, shoulder dystocia, and cesarean deliveries. 80 Screening for undiagnosed type 2 diabetes at the initial prenatal visit is recommended for people at increased risk 80 ( Table 6 5 , 80 ) . Universal screening for gestational diabetes should occur between 24 and 28 weeks with a one-hour (50-g) glucose tolerance test and, if results are abnormal, should be followed by a confirmatory, fasting, three-hour (100-g) test. 80

HYPERTENSION

Blood pressure should be monitored at each prenatal visit, and education should be provided on preeclampsia warning signs. 5 Patients at increased risk of preeclampsia should be screened for thrombocytopenia, transaminitis, and renal insufficiency, including proteinuria, during the first or second trimester and started on prophylactic daily low-dose aspirin (81 mg) between 12 and 16 weeks 5 , 85 ( Table 6 5 , 80 ) . [Updated] Screening for proteinuria in isolation has little predictive value for detecting preeclampsia. 5 Chronic hypertension (hypertension before 20 weeks) is treated to less than 140/90 mm Hg. 81

PRETERM DELIVERY

Preterm delivery (between 20 and 37 weeks) is a significant cause of neonatal morbidity and mortality, complicating 10.5% of U.S. pregnancies. 2 Modifiable risk factors include prepregnancy BMI (less than 18.5 kg per m 2 and greater than 25 kg per m 2 ), substance use, and short interval between pregnancies (i.e., less than 18 months). 82 Several options are available for the prevention of preterm labor in a singleton pregnancy. 82 Patients with a previous preterm delivery before 34 weeks should have a cervical length assessment starting at 16 weeks through 24 weeks. 82 These patients should be treated with progesterone supplementation (vaginal or intramuscular). In the asymptomatic patient with a short cervix and without a history of spontaneous birth before 34 weeks, vaginal progesterone (200 mg) started between 16 and 20 weeks and continued through 36 weeks is recommended. 82

POST-TERM DELIVERY

Stillbirth complicates 3 per 1,000 post-term (42 weeks or greater) pregnancies. 20 Antenatal testing should be initiated at 41 weeks; if the results are not reassuring, induction of labor is recommended. 20 , 21

Cultural Considerations

Maternity care improves outcomes; however, vulnerable populations (i.e., racial, ethnic, and religious minorities) are less likely to engage in care if it is not culturally centered, which acknowledges the effect of culture on health conditions (e.g., depression) and enhances patient-physician trust. 83 Addressing cultural needs (e.g., doula, community health workers, interpreters) throughout pregnancy helps mitigate barriers and improves outcomes.

This article updates previous articles on this topic by Zolotor and Carlough 1 ; Kirkham, et al. 17 ; and Kirkham, et al. 84

Data Sources: A search was completed using the key terms prenatal care, COVID-19, oral health, pelvic examination, prepregnancy body mass index, pregnancy dating and ultrasound, maternal and paternal age and impact on pregnancy outcomes, aneuploidy screening, inheritance patterns of sickle cell disease and cystic fibrosis, anemia, cell-free DNA analysis, thyroid disease, cervical cancer screening, management of abnormal cervical cytology, screening guidelines for sexually transmitted infections in pregnancy, group B Streptococcus screening, social determinants of health and prenatal outcomes, intimate partner violence, polysubstance abuse, food insecurity, maternity care deserts, hypertension in pregnancy, progesterone for preterm birth prevention, post-term delivery, and preconception care. Also searched were PubMed, Essential Evidence Plus, the Cochrane database, U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Cancer Society, American Family Physician , and reference lists of retrieved articles. Search dates: July 1, 2022; February 19, 2023; and June 16, 2023.

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Osterman MJK, Hamilton BE, Martin JA, et al. Births: final data for 2021. Natl Vital Stat Rep. 2023;72(1):1-53.

Peahl AF, Zahn CM, Turrentine M, et al. The Michigan Plan for appropriate tailored healthcare in pregnancy prenatal care recommendations. Obstet Gynecol. 2021;138(4):593-602.

Superville SS, Siccardi MA. Leopold maneuvers. StatPearls . StatPearls Publishing. February 19, 2023. Accessed October 16, 2022. https://www.ncbi.nlm.nih.gov/books/NBK560814

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Gestational hypertension and preeclampsia: practice bulletin, no. 222. Obstet Gynecol. 2020;135(6):e237-e260.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Obesity in pregnancy: practice bulletin, no. 230. Obstet Gynecol. 2021;137(6):e128-e144.

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American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Smoking cessation during pregnancy: committee opinion, no. 721. Obstet Gynecol. 2017;130(4):1.

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins–Obstetrics. Opioid use and opioid use disorder in pregnancy: committee opinion, no. 711. Obstet Gynecol. 2017;130(2):e81-e94.

American College of Obstetricians and Gynecologists' Committee on Obstetric Practice; Society for Maternal-Fetal Medicine. Indications for outpatient antenatal fetal surveillance: committee opinion, no. 828. Obstet Gynecol. 2021;137(6):e177-e197.

American College of Obstetricians and Gynecologists' Committee on Obstetric Practice; Society for Maternal-Fetal Medicine. Medically indicated late-preterm and early-term deliveries: committee opinion, no. 831. Obstet Gynecol. 2021;138(1):e35-e39.

Grobman WA, Rice MM, Reddy UM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction vs. expectant management in low-risk nulliparous women. N Engl J Med. 2018;379(6):513-523.

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Shah-Kulkarni S, Lee S, Jeong KS, et al. Prenatal exposure to mixtures of heavy metals and neurodevelopment in infants at 6 months. Environ Res. 2020;182:109122.

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Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020;70(5):321-346.

Perkins RB, Guido RS, Castle PE; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors [published correction appears in J Low Genit Tract Dis . 2020; 24(4): 427]. J Low Genit Tract Dis. 2020;24(2):102-131.

Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2019(11):CD000490.

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• Pregnancy Weeks
• Nursery Design
• Toddler Sleep
• White Noise

Prenatal Appointment Schedule

On This Page

• First-Trimester Prenatal Care
• 7 to 10 Weeks
• 10 to 13 Weeks
• Second-Trimester Prenatal Care
• 16 to 20 Weeks
• 18 to 22 Weeks
• Third-Trimester Prenatal Care
• 27 to 36 Weeks
• 32 to 36 Weeks
• 36 to 37 Weeks
• 39 to 40 Weeks

Your home pregnancy test let you know loud and clear: You’re expecting a baby! Congrats! And while you may be itching to shout your big news from the rooftops, for many parents-to-be, the first call they make is not to their parents or their best friends…but to their doctor. And that’s a smart move. After all, The American College of Obstetricians and Gynecologists (ACOG) recommends you reach out to your healthcare provider to set up a prenatal appointment as soon as you think you may be pregnant. But that doesn’t mean your OB/GYN or midwife will want to see you right away. To find out when you need to start your prenatal visits—how often you should go and what to expect at each prenatal visit—keep reading .

Since 1930, 12 to 14 in-person prenatal visits have been the go-to recommendation for healthy pregnancies in America, which shakes out to : 

Weeks 4 to 28 of pregnancy: One prenatal visit every 4 weeks (once a month)

Weeks 28 to 36 of pregnancy: One prenatal visit every 2 weeks (twice a month)

  Weeks 36 to 41 of pregnancy: One prenatal visit every week (once a week)

Your physician or midwife may ask you to come in for prenatal check-ups more often if you have a high-risk pregnancy or if you are at a so-called “ advanced maternal age .”

Or your doctor might schedule fewer prenatal visits. That’s because ACOG and the University of Michigan convened an independent panel  of maternal care experts in 2021 to review the current prenatal visit schedule—and that panel recommended eight to 10 prenatal visits for pregnancies without chronic medical conditions. Since formal guidance from ACOG is forthcoming, the revised schedule is not yet the norm. But if you and your care provider decide on a reduced schedule, you can rest assured that this newfangled approach is more on par with peer countries that have better maternity outcomes than here in America. Based on the panels’ recommendations, a prenatal care schedule for a healthy pregnant person between 18 and 35 years old can look like this:

Weeks 7 to 10 of pregnancy: First ultrasound and risk assessment

Weeks 6 to 28 of pregnancy: One prenatal visit every 4 to 6 weeks

Weeks 28 to 36 of pregnancy: One prenatal visit every 2 to 4 weeks

Weeks 36 to 41 of pregnancy: One prenatal visit every week or every 2 weeks

Some prenatal genetic testing and other lab work can either be completed within the limited  appointment timeframe—or separately. For example, if you have an in-person visit at 9 weeks, but that’s too early to complete prenatal genetic testing, you can return for a separate lab draw one week later.

Can I do virtual prenatal appointments?

If you’re healthy and free of any pregnancy complications, ACOG/University of Michigan panel (called MiPATH) notes that about half of your prenatal appointments can be virtual… if you and your care provider decide that this is the best option.

These four prenatal visits must be in person:

First prenatal visit

28-week prenatal visit

36-week prenatal visit

39-week prenatal visit

These visits can be either in person or conducted with telemedicine.

16-week prenatal visit

22-week prenatal visit

32-week prenatal visit

38-week prenatal visit

If you and your care provider agree to divide up your prenatal visits between in-person prenatal checkups and virtual, you’ll likely need instructions and supplies , such as:

Blood pressure cuff

Fetal Doppler (aka electronic fetal heart rate monitor) to check Baby’s heartbeat

Doppler gel, to be used with the heartbeat monitor

 Tape measure that includes centimeters to measure fundal height, which is the distance from the pubic bone to the top of the uterus

You’ll be instructed how to use all of the above and how to upload this data into a secure network roughly 48 hours before your appointment , so your provider has time to review these measurements before your virtual appointment.

First-Trimester Prenatal Care Visits

Because not everyone has their first prenatal care visit during the same week of pregnancy, the timing of subsequent visits may differ from others. For instance, if your first prenatal visit was at week 8, your next appointment would likely be four weeks later, at 12 weeks pregnant . But if, your initial appointment was earlier, your second appointment may be earlier, too!

As long as your appointments are spaced out properly—and you are getting prenatal tests and vaccines during the proper window—it’s all good! In your first trimester, you’ll likely have a prenatal visit every month. (The first trimester spans from zero to 13 weeks of pregnancy.) Here’s what to expect :

Appointments will be brief. (But they’re important!)

You’ll be weighed. During your first trimester, you’ll likely gain between 2 and 4 pounds .

Your blood pressure will be checked. Because blood pressure fluctuates, if your numbers come up high, your doc or midwife will likely redo your reading. (An ideal blood pressure result is less than 120/80 mm Hg.)

You’ll hear Baby’s “heartbeat.” What you’re truly hearing is fetal cardiac activity. It’ll take until 17 to 20 weeks until the chambers of the heart develop and can be detected on an ultrasound.

You’ll pee in a cup. Your care provider will collect a urine sample to test for sugar or protein to screen for gestational diabetes and high blood pressure.

Questions to Ask During First Trimester Prenatal Visits

Your prenatal appointments are the ideal time to discuss any questions, including:

What type of prenatal vitamins should I take?

Are other medications or supplements safe?

Is sex safe during pregnancy?

What foods are off limits? Can I have coffee and fish ?

Can I continue my exercise routine? Should I tamp down (or ramp up) my workouts?

How can I tame my morning sickness? And when will it end?

What other symptoms can I expect? When should I call you?

Is spotting normal?

What’s my due date?

What’s your advice regarding prenatal genetic testing ?

What hospital or birth center do you deliver at?

 Will you be the one to deliver my baby?

First Prenatal Appointment

It’s best to see your healthcare provider before you get pregnant , so you can go over your health history, get up to date on vaccinations, discuss medications or pre-existing medical conditions—and start on prenatal vitamins—ahead of conception. But if that ship has sailed, no worries! It’s recommended that you begin regular prenatal care visits sometime between 7 weeks and 10 weeks of pregnancy , often starting at 8 weeks of pregnancy . (At times, your care provider will have you come in between 4 weeks and 6 weeks pregnant .)

Regardless of the timing, your first prenatal appointment is usually the longest one and it must be conducted in person. You’ll be asked about your family and medical history (this family health history tool  from the Surgeon General will help you get organized), your pregnancy history, medications and supplements you may be on, any unhealthy habits you may be engaged in, and the date of your last period. You can expect a complete physical exam, likely including:

Pregnancy test

Weight and height check

Blood pressure check

Breast exam

Pelvic exam

Urine test to looks for signs of a bladder or urinary tract infection

Check blood type

Screen for anemia

Screen for diabetes

Check Rh status, which is a specific protein on red blood cells that requires special care

Check immunity for rubella and chickenpox, unless proof of vaccination is documented in your medical history

Test for infections, such as hepatitis B, chlamydia, gonorrhea, syphilis, and HIV

Screen for depression

Listen for embryonic cardiac activity if your visit is before 8 weeks; listen for fetal cardiac activity after 8 weeks

If you haven't yet gotten your annual flu shot , you should talk to your healthcare provider about receiving it at this appointment . (Influenza can be much more dangerous during pregnancy.)  

First Prenatal Visit Ultrasound

ACOG recommends that you have at least one standard ultrasound exam during your pregnancy, usually between 18 and 22 weeks of pregnancy . That means the first-trimester ultrasound is not standard .

If you do get a first-trimester ultrasound, you may be expecting the jelly-and-wand-on-the-belly ultrasound. But for early pregnancy a transvaginal ultrasound is often the go-to ultrasound because it can reliably identify normal and abnormal pregnancies—and various developmental markers—earlier than an abdominal ultrasound. With a vaginal ultrasound (aka transvaginal or fetal ultrasound), a wandlike device  is placed in your vagina to send sound waves and  create an image . The info gathered from this first trimester ultrasound—coupled with the date of your last menstrual period—will help your care provider determine your due date. PS: Your due date is not a prediction of when you’ll deliver your baby! It’s the date that you’ll be 40 weeks pregnant . Very few people give birth on their due dates. In fact, many first-timers go up to two weeks after their due date before their bundle arrives.

10 to 13 Week Prenatal Appointment: Genetic Screening

In addition to your standard check-up, at this appointment you’ll likely be offered one of two screening tests…

First-Trimester Screening

The first-trimester screening is a blood test that measures two pregnancy-specific substances, plus an ultrasound. The ultrasound is called a nuchal translucency screening (NT ultrasound exam) and it measures the thickness at the back of Baby’s neck. Unusual results can mean that your baby-to-be is at an increased risk for Down syndrome (trisomy 21), another type of chromosomal abnormality (trisomy 18), and/or a physical defect of the heart, abdomen, and/or skeleton. With this test, the detection rate for Down syndrome and trisomy 18 is roughly 80% . This screening is also part one of something called sequential integrated screening (or integrated screening test.) Part two occurs during your second trimester and helps to more accurately highlight your baby-to-be’s possible risks.

Cell-Free DNA Screening (cfDNA)

This blood test (aka non-invasive prenatal testing) can be done as early as 10 weeks to detect more than 99% of Down syndrome cases , 97% of trisomy 18 pregnancies, and about 87% of trisomy 13 pregnancies. It can also tell you your baby’s sex. ACOG recommends cell-free DNA screening be discussed and offered to all pregnant patients, but it’s most often suggested to those over 35, parents who’ve had another baby with a chromosome disorder, or to folks whose first-trimester ultrasound looked abnormal. This test is not recommended for those carrying more than one baby.

If your results for either screening are abnormal, your doctor may recommend a diagnostic test called Chorionic Villus Sampling (CVS). (Learn more about prenatal diagnostic tests .)

Second-Trimester Prenatal Care Visits

You’re one-third of the way through your pregnancy. The second trimester—from week 14 of pregnancy to week 26 —is here! Now, prenatal visits are still spaced on a once-a-month basis for most. For each visit, your practitioner will continue to cover the basics. Here’s what’s in store :

Weight. Most gain 1 pound a week from this point forward.

Blood pressure. During the second trimester, blood pressure decreases in healthy pregnancies, but not for those who develop gestational hypertension, which can lead to preeclampsia .

Fundal height. That’s a fancy way of saying “belly size.” Your provider will measure the distance from your pubic bone to the top of your uterus to gauge your baby's growth.

Heartbeat. Just a few weeks into the second trimester ( week 17 ) Baby’s heart chambers develop, which means you’ll hear an honest-to-goodness heartbeat thanks to a fetal Doppler ultrasound, which uses sound waves to detect the movement of blood in vessels.

Urinalysis.  This’ll look for signs of infection, protein in the urine (sign of preeclampsia), and glucose (sugar). Too much sugar in your urine may signify gestational diabetes, which can develop in the second trimester , sometimes as early as week 20 of pregnancy .

Fetal movement. Between 16 and 20 weeks of pregnancy you’ll likely start noticing some baby flutters. Expect your OB/GYN or midwife to start asking about them at that time. (PS: If this is your first , it’s common not to feel a thing till 20 weeks.)  

Questions to Ask During Second-Trimester Prenatal Visits

Some questions you might want to ask during your second trimester include:

When will I feel my baby move and kick?

Is spotting normal in the second trimester?

Is sex still safe?

Should my exercise routine change in the second trimester?

What symptoms are normal? What symptoms are abnormal?

What complications can arise this trimester?

What kind of exercise can I do?

When should I start sleeping side-sleeping?

When should I tour the hospital or birth center?

What birthing class, infant CPR, breastfeeding, and baby care classes do you recommend?

16 to 20 Week Prenatal Appointments: Second Trimester Screening

In addition to the standard tests and screeners that occur during each of your second trimester prenatal visits, any appointment between week 16 of pregnancy and week 18 is the ideal time to get your second-trimester triple or quad screening. (You can get these as early as week 15 and as late as 22 weeks pregnant.) And, if you got your first-trimester screening (blood test and NT ultrasound), you may be getting the second half of the sequential integrated screening test. If any of these—or prior—tests come back indicating an elevated risk of birth defects, an amniocentesis may be performed during this timeframe.

Triple Screening

The second-trimester triple screening is a blood test that measures for three specific proteins and hormones: alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and  estriol (uE3) . The amount of these substances can help determine the likelihood that your baby-to-be may have a birth defect, such as Down syndrome, spina bifida, or anencephaly.

Quad Screening

The second trimester quad screening also involves checking how much AFP, hCG, and uE3 are circulating in your blood—plus one more test for the hormone inhibin A (inhA).

Sequential Integrated Screening

This is also called combined first- and second-trimester screening. Part one of this two-part test (blood test and nuchal translucency ultrasound) occurred between 10 and 13 weeks of pregnancy. And between 15 weeks and 20 weeks pregnant , the second part of the sequential integrated screening takes place. Here, a new blood sample will be taken to measure the same four proteins and hormones as the quad screening: AFP, hCG, uE3, and inhA. The first-trimester portion of this test yields a roughly 80% detection rate for Down syndrome and trisomy 18. But when the results of those tests are then reviewed alongside this new blood test, the detection rate bumps to 90% for Down syndrome and trisomy 18—and 80% detection rate for open neural tube defects.

18 to 22 Week Prenatal Appointment: The Anatomy Scan

By now, you know the deal with the weight checks, the blood pressure screening, and the like. And during one of your second-trimester appointments between 18 and 22 weeks, you’ll get an ultrasound. That means, this prenatal appointment will be longer than others. It may take up to 45 minutes to do the ultrasound alone!

The Anatomy Scan

While often dubbed the 20-week ultrasound, the anatomy scan (or anomaly scan) can be performed any time between 18 and 22 weeks of pregnancy. Here, the ultrasound technician will jelly your belly and use a 2D, 3D, or a 4D ultrasound wand over your abdomen to look at your baby-to-be’s physical development, the placenta, and your organs. Here’s some of what your healthcare team will be looking for:

Listen for any abnormal heart rhythms

Detect congenital disorders

Detect anatomical abnormalities

Check umbilical cord for blood flow

Ensure the placenta isn’t covering the cervix

Measure amniotic fluid

Measure baby to ensure they’re growing appropriately for their age

Learn sex of your growing baby, if you chose

24 Week Prenatal Appointment: The Glucose Test

Weight? Check. Blood pressure? Check. Urine screening? Check. And now for a little something different…the glucose tolerance test! If you’re not at an elevated risk for gestational diabetes , you’ll get the glucose screening test anytime between 24 and 28 weeks pregnant. (High-risk moms-to-be get tested earlier.) For this test, you drink down a special (super-sweet) sugar mixture…then cool your heels for an hour. Once time’s up, your blood will be drawn to check your blood sugar level. If high, that may be a sign that you have gestational diabetes. Your care provider will have you do another type of glucose test to confirm the results.  

Third-Trimester Prenatal Care Visits

The final stretch! During your third trimester (starting at week 27 ), you’ll most likely see your doctor or midwife every two weeks until week 36 for your prenatal visits. After that, visit them weekly until week 40—or until Baby arrives! During your visits, you provider will check your:

Weight. You’re likely still gaining 1 pound a week by your third trimester. If you’re having twins, then you’ll be gaining more, landing somewhere between 37 to 54 pounds gained total.

Blood pressure. Expecting parents with chronic hypertension can get preeclampsia in their second or third trimester and super-high BP that begins during this timeframe is called gestational hypertension.

Fundal height. Fun fact: After week 24 of pregnancy , fundal height often matches the number of weeks pregnant you are, plus or minus 2 centimeters.

Urinalysis . Your urine will be screened for signs of preeclampsia, toxemia, and sugar.

Fetal movement. It’s perfectly normal to feel Baby kicking and moving a lot early in your third trimester…but feeling fewer movements as the weeks stretch on. That’s because there’s less room for your baby to move!

Baby position.  Your midwife or OB/GYN will check the position of your baby-to-be during most of your third trimester prenatal appointments by simply  touching your abdomen

Questions to Ask During Third-Trimester Prenatal Visits

Here are some questions you may be thinking about in the home-stretch of pregnancy:

Can we talk about my birth plan ?

Can you recommend any postpartum doulas ?

In what ways will my baby’s movements change this trimester?

How much swelling of hands and feet is normal?

What happens if my water breaks at home?

How can I tell the difference between labor and Braxton Hicks ?

When should I go to the hospital or birthing center for delivery?

What are my pain management options?

Who will be with me throughout my labor?

How likely is it that I’ll need a C-section?

What support is available if I choose to breastfeed?

What’s the difference between baby blues and postpartum depression ?

How can I prepare for my own postpartum care at home?

How soon can I see you for my postpartum checkup ?

27 to 36 Week Prenatal Appointments

Between 27 and 36 weeks, you’re likely seeing your provider every other week. You can expect many familiar pokes and prods…plus, at one of your appointments, a new poke: your Tdap vaccine .

This must-get shot offers protective antibodies that you then pass on to your baby before birth to help shield them from whooping cough, a potentially deadly disease that babies are most vulnerable to during their first few months of life. Because the number of antibodies in your body decreases over time, it’s important to get the Tdap vaccine during each pregnancy, even if you’ve been previously vaccinated. Doing so lowers your young baby’s risk of whooping cough by 78% , according to the Centers for Disease Control and Prevention (CDC). Try to get the shot as close to 27 weeks pregnant as possible, since the protective antibodies peak roughly two weeks post-vaccine— and it takes some time to pass them on to your baby.

You’ll also be screened for depression in this window. The U.S. Preventive Services Task Force recommends routine depression screening in all pregnant and postpartum women. While the group doesn’t specify when exactly , a 2020 review in The Cleveland Clinic Journal of Medicine notes that depression screening should occur at the initial prenatal visit and again in the last trimester.

32 to 36 Week Prenatal Appointments

Your care provider will continue to check the position of your baby-to-be during your prenatal appointments, but by 32 to 36 weeks they’re going to really want your little one locked and loaded in the head-down position. If your doctor or midwife is unsure of your little one's exact positioning, they may perform an ultrasound to check. The reason?  Babies who remain in the breech position after 36 weeks of pregnancy may need to be delivered via a planned C-section . That said, some healthcare providers may be comfortable with a vaginal breech birth . And others may offer to try and turn your baby to the head-down position while they’re still in the uterus. ( Learn more about breech babies .)

36 to 37 Week Prenatal Appointments

You’re now likely seeing your care provider every week! Either during your 36 week or 37 week visit, expect all of the standard prenatal checkup to-dos— and the Group B strep test. Group B strep (GBS) is a bacteria that lives in about a quarter of all moms-to-be . It usually causes no serious concern… unless it’s passed to a newborn during labor. A newborn infected with GBS may contract meningitis, pneumonia, sepsis, or other issues. That’s why it’s important to get tested before labor begins.

Your provider will swab your vagina and your rectum and then send the sample to be examined. If it comes back positive, don’t panic! You’ll receive an IV antibiotic once labor begins to help shield your baby from being infected. The antibiotics work best when given at least four hours before delivery, preventing roughly 90% of infections .

38 Week Prenatal Appointment

Your due date is almost here! At this appointment, your care provider will continue to give a quick-check of Baby’s movements, they’ll ask some questions, and review the signs of labor with you. Your provider may also perform a pelvic exam . It’s most appropriate to do a pelvic exam if…

You think you might be in labor. Pain, bleeding, bloody show? Then your doctor or midwife will want to check to see how dilated (open) and effaced (thinned out) your cervix is.

There are other complications. If you’re dealing with an infection, premature rupture of membranes, heavy bleeding, or another potential issue, an internal exam can help your doc help you.

Induction is on the horizon. If high blood pressure, Baby growth issues, or another health issue has you on the path to induction , your care provider will want to know the state of your cervix before proceeding. The same holds true if you’re choosing to be induced.

You want to know.  A pelvic exam will let you know if (and how much) your cervix is dilated and effaced. But the kicker: These signs alone won’t necessarily clue you into when labor will start!

If none of the above applies to you, you can feel free to tell your provider that you’d rather take a pass on that third trimester pelvic exam! It’s 100% okay to say no!

39 to 40 Week Prenatal Appointments

Good news: At 39 weeks , your baby is now considered full term ! Expect more of the same at these quick prenatal check-ins. However, at week 39 your doctor or midwife might offer something called a membrane sweep . This is a common procedure that’s billed as a way to help induce labor. Here, your provider inserts a gloved finger into your cervix to loosen your amniotic sac from your uterus. You’ll likely experience some light bleeding, cramping, and/or mild discomfort post-sweep. Getting your membranes swept is entirely up to you and there’s no guarantee that it’ll work. In fact, a 2020 report concluded that membrane sweeping may be effective in achieving a spontaneous onset of labor…but the evidence is “low certainty.”  PS:  57% of babies are born in weeks 39 to 40 . 

41 Week Prenatal Appointment

It’s true that there are supposed to be 40 weeks in a pregnancy…but the CDC notes that almost 5% of babies are born during week 41 and less than 1% arrive at 42 weeks or beyond. (A pregnancy that lasts 41 weeks up to 42 weeks is called late term . A pregnancy that drags on longer than 42 weeks is called post-term.) When you’re more than one week past your due date , your doctor or midwife may recommend:  

Nonstress test (NST): This test utilizes an electronic fetal monitor (a belt with a sensor on your abdomen) to measure Baby’s heart rate. It generally takes about 20 minutes to perform and can be done in your provider’s office or in a hospital setting.

Biophysical profile (BPP) Here, your baby’s heart rate is monitored in conjunction with an ultrasound exam to check on your baby-to-be’s amniotic fluid, their heart rate, breathing, muscle tone, and movement.

Contraction stress test (CST): This test assesses how your baby’s heart rate changes when your uterus contracts. To create a mild contraction, you may be given IV oxytocin.)

Depending on the results of the above tests, your healthcare provider may suggest an induction.

Questions to Ask If Past Your Due Date

Is there anything I can do to safely start labor on my own?

If we decide to induce, what’s the plan?

What can I expect during labor induction?

Does induction increase my chances of a C-section?

Are there any risks to inducing labor?

How long after induction can I expect contractions to start?

More on Prenatal Care

• The Pregnancy Deficiency You Need to Know About
• Depression During Pregnancy Need-to-Know
• The 6 Nutrients You Need When Pregnant
• How to Help Round Ligament Pain
• The American College of Obstetricians and Gynecologists (ACOG): Having a Baby
• March of Dimes: Prenatal Care Checkups
• Trends and state variations in out-of-hospital births in the United States, 2004-2017. June 2019
• The impact of family physicians in rural maternity care. Birth Issues in Perinatal Care. September 2021
• Centers for Disease Control and Prevention (CDC): Planning for Pregnancy
• ACOG: Redesigning Prenatal Care Initiative
• ACOG: MiPATH Prenatal Care Recommendations: A How To Guide for Maternity Care Professionals
• A comparison of international prenatal care guidelines for low-risk women to inform high-value care. American Journal of Obstetrics & Gynecology. January 2020
• Kaiser Family Foundation: Telemedicine and Pregnancy Care
• Health University of Utah: Virtual Prenatal Care
• Planned Parenthood: What happens at prenatal care appointments?
• Perinatal depression: A review. The Cleveland Clinic Journal of Medicine. May 2020
• ACOG: ACOG Guide to Language and Abortion
• CDC: Frequently Asked Influenza (Flu) Questions: 2022-2023 Season
• Kaiser Permanente: First trimester prenatal care
• ACOG: Ultrasound Exams
• Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Journal of Pharmacy and Bioallied Sciences. July - September 2011
• Nemours Children’s Health, KidsHealth: What if My Baby Isn't Born by My Due Date?
• ACOG: Prenatal Genetic Screening Tests
• Penn Medicine: Sequential Screening (Combined First and Second Trimester Screening)
• UCSF Health: Prenatal Screening Tests
• UCSF Health: FAQ: Cell-Free DNA Screening
• ACOG: Current ACOG Guidance
• MedlinePlus: Prenatal Cell-Free DNA Screening
• Cleveland Clinic: Chorionic Villus Sampling for Prenatal Diagnosis
• Mount Sinai: Prenatal care in your first trimester
• MedlinePlus: Managing your weight gain during pregnancy
• ACOG: Preeclampsia and High Blood Pressure During Pregnancy
• Mayo Clinic: Pregnancy week by week: Healthy pregnancy
• Blood Pressure Patterns in Normal Pregnancy, Gestational Hypertension, and Preeclampsia. August 2000
• American Academy of Family Physicians: Gestational Diabetes
• Cleveland Clinic: Quickening in Pregnancy
• Stanford Medicine Children’s Health: Second Trimester Prenatal Screening Tests
• Kaiser Permanente: Triple or Quad Screening for Birth Defects
• ACOG: Amniocentesis
• Cleveland Clinic: 20-Week Ultrasound (Anatomy Scan)
• Mount Sinai: Glucose screening tests during pregnancy
• CDC: High Blood Pressure During Pregnancy
• Cleveland Clinic: Fetal Positions for Birth
• CDC: Get the Whooping Cough Vaccine During Each Pregnancy
• Screening for Depression in Adults US Preventive Services Task Force Recommendation Statement. January 2016
• Cleveland Clinic: Breech Baby
• CDC: Group B Strep (GBS)
• Cleveland Clinic: Group B Strep Pregnancy
• Northwell Health, The Well: When You Do (And Don’t) Need A Cervical Check
• National Child & Maternal Health Education Program: Know ​Your Terms
• Cleveland Clinic: Membrane Sweep
• Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews. February 2020
• Births: Final Data for 2020. National Vital Statistics Reports. February 2022
• ACOG: When Pregnancy Goes Past Your Due Date
• Mayo Clinic: Pregnancy week by week: Overdue pregnancy: What to do when baby's overdue

View more posts tagged, pregnancy health

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.

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