Prenatal care - WikiHQ

Prenatal care, also known as antenatal care, is a type of preventive healthcare for pregnant women. It is provided in the form of medical checkups and healthy lifestyle recommendations for the pregnant person. Antenatal care also consists of educating the pregnant woman or girl about maternal physiological and biological changes in pregnancy, along with prenatal nutrition, all of which prevent potential health problems throughout the pregnancy and promote good health for the parent and the fetus. The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections, and other preventable health problems.

Visits

Traditional prenatal care in high-income countries generally consists of:

monthly visits during the first two trimesters (from the 1st week to the 28th week)
fortnightly visits from the 28th week to the 36th week of pregnancy
weekly visits after 36th week to the delivery, from the 38th week to the 42nd week
Assessment of parental needs and family dynamics

The WHO recommends that pregnant women receive at least eight antenatal visits to spot and treat problems and give immunizations. Although antenatal care is important to improve the health of both mother and baby, many women do not receive the recommended eight visits.

There is little evidence behind the number of antenatal visits pregnant women receive and what care and information is given at each visit. It has been suggested that women who have low-risk pregnancies should have fewer antenatal visits. Antenatal risk assessment began in the United Kingdom before becoming a widespread practice. (The SFH is measured from the woman's pubic bone to the top of the uterus. A review into this practice found only one piece of research, so there is not enough evidence to say whether measuring the SFH helps to detect small or large babies. As measuring the SFH is not costly and is used in many places, the review recommends carrying on this practice. There are two types of growth chart:

Population-based chart, which shows a standard growth and size for each baby
Customized growth chart, which is calculated by looking at the mother's height and weight, along with the weights of their previous babies.

Early scans mean that multiple pregnancies can be detected at an early stage of pregnancy and also gives more accurate due dates so that fewer women are induced who do not need to be. Low feedback is when the findings are discussed at the end, and the parents are given a picture of the ultrasound. This is performed to detect signs that the baby is not getting a normal blood flow and therefore is 'at risk'. A review looked at performing Doppler ultrasounds on all women, even if they were at 'low risk' of having complications. Of these causes, unintentional drug overdose was the leading cause at 5.2 deaths per 100,000 live births, and homicide and suicide accounted for 3.9 deaths per 100,000 live births. Preventing these unnecessary deaths starts in the prenatal period. Some screenings ask pregnant women about suicidal ideation and other common mental health conditions through the Patient Health Questionnaire (PHQ 2 or 9), the Generalized Anxiety Screener (GAD 3 or 7), and the Pregnancy/Postnatal Depression Scale (EPDS). However, these screenings lack thoroughness in their ability to create a full picture of a person's mental well-being due to the standardized nature of the screener. Earlier intervention in the pregnancy through asking about coping mechanisms, home life, financial stability, employment, and past trauma can create a clearer perspective of a pregnant person's emotional and mental well-being.

Prevention of homicide and interpersonal violence for pregnant women and birthing persons can lead to better mental health and maternal mortality outcomes for pregnant individuals. Homicides were committed 77% of the time with a firearm. Screening for firearms in the household or firearm use could prevent some of these deaths. Additionally, another mode of prevention can occur through state Red Flag laws. These laws help keep firearms out of the way of people who could harm someone.

Currently, most maternal deaths, 62%, occur after the 42 days up until 1 year post-partum. The standard of care is one follow-up visit 6-weeks post-partum. The American College of Obstetricians and Gynecologists (ACOG) has recommended that this standard include more visits within 12 weeks, but this recommendation has not yet become the standard practice of care. Due to the limited amount of check-ups post-partum, many women and birthing people may feel isolated at the beginning of motherhood. 21.8% of American Indian/Alaska Native people report symptoms of post-partum depression compared to 16.3% of Black, non-Hispanic, 15.4% Multiple Race, Non-Hispanic, 13.8% Hispanic, 11.7% White, and 8% Asian. Systemic racism can exacerbate symptoms of post-partum depression through making it harder to access medical care, implicit bias in providers, and race-based traumatic stress (RBTS). Creating more avenues for women and birthing people to have interactions with a doctor or trusted medical professional could create better mental health outcomes. Asking about existing support networks in place for these women and birthing people can also aid medical professionals in learning about gaps in their patients' network of care.

Diet

Main article: Prenatal nutrition

Prenatal care not only applies to the parent carrying the baby, but it also applies to the sperm donor. Sperm affects the fetus's ability to grow properly, and proper nutrition is one of the main factors. For example, a zinc deficiency can lead to sperm deformations and reduced sperm motility which can cause infertility or improper fertilization of the egg, which has the potential to cause miscarriages or fetal deformities. Foods are typically fortified with folic acid to reduce this, but some flours like masa flour are not within those federal outlines, which is theorized to be why Hispanic women are most likely to have children with spina bifida.

Exercise

Research suggests that physical activity levels during pregnancy can impact delivery outcomes. A study examining the effects of exercise intensity on delivery type and risk of preterm birth found that varying levels of physical activity were linked to different pregnancy outcomes and associated risks.

Very low levels of physical activity are associated with an increased risk of both preterm and instrumental deliveries. Pregnant individuals with minimal activity may experience lower overall fitness and muscle tone, which can impact the body's ability to manage the physical demands of labor. Another study showed that individuals with higher handgrip strength are more likely to have a vaginal delivery, as greater muscle strength and endurance can support the labor process. In contrast, those who gained more weight during pregnancy or had larger arm and calf circumferences were more likely to undergo cesarean delivery, particularly in cases of nonprogressive labor. Low levels of physical activity during pregnancy have been linked to a slightly elevated risk of cesarean delivery. This type of care offers a group of multiple pregnant women (typically around 8-12 of them that are in a similar stage of pregnancy) to see one or more providers simultaneously, along with following up every few weeks to these group appointments for continual care. Midwife-led care is typically used by women with low-risk pregnancies. Women with midwife-led pregnancies are more likely to give birth without being induced; instead, they partake in natural labor. However, they are less likely to have their waters broken, an instrumental delivery, episiotomy, or preterm birth. However, around the same number of women in each group underwent a caesarean section. If the mother goes to a different hospital for care or to give birth, the summary of her case notes can be used by the midwives and doctors until her hospital notes arrive. Transportation is one of the biggest threats to prenatal care access, making it hard for pregnant women in rural communities to have access to proper prenatal care. Specifically, over half of the people in rural areas who are seeking prenatal care have to travel at least 30 minutes to receive care, and there are higher rates of clinic closures in rural areas. Because of Telemedicine, the gap in care due to transportation issues has been reduced.

Telemedicine

A new alternative for some of the routine prenatal care visits is Telemedicine, which is an online route of performing these prenatal appointments, and became more of a standardized practice due to the COVID pandemic. Specifically, over half of pregnant women were afraid of stepping foot inside a hospital because of the risk of contracting the virus, so Telemedicine offered a way of communication that was not face to face, but would still get people the care they required. Racial minorities are also more likely to have high-risk pregnancies and conditions such as preeclampsia, gestational diabetes, and gestational hypertension. However, pregnant Black women who encounter racism end up having physiological changes in their amniotic fluid and alterations in immune and endocrine mechanisms.

Class-based Health Disparities

The World Health Organization (WHO) reported that in 2015, around 830 women died every day from problems in pregnancy and childbirth. Only 5 lived in high-income countries, and the rest lived in low-income countries. The study, between 1997 and 2008, looked at 21,708 women giving birth in a region of Spain. The results indicated that very preterm birth (VPTB) and very low birth weight (VLBW) were much more common for immigrants than locals. Community interventions to help people change their behavior can also play a part. Examples of interventions are media campaigns reaching many people, enabling communities to take control of their health, informative-education-communication interventions, and financial incentives.

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