Go read the Disclaimer again. I am not a doctor. This is not medical advice. Seriously.
While a lot of health care professionals are perfectly happy to start seeing you after you have been pregnant a month or so, the only things they can really learn about you that you cannot learn on your own are blood tests, urine tests and ultrasound. The diseases they might check for include HIV and hepatitis. They can also check for anemia (if you have it at this point, they will probably really want you to start supplementing immediately). Depending on your race and family history, they might check for some genetic diseases. They will probably also check for rubella antibodies. But it is worth knowing that it is too late to vaccinate you against rubella and it is incredibly rare in the US now anyway. If you do not know your blood type, this is a good time to find out, because depending on your blood type and, more importantly, Rh factor, the Rh of whoever knocked you up and the luck of the draw, some additional precautions may need to be taken throughout the pregnancy and birth. When the pros suggest an ultrasound early on, they are usually looking to confirm dates, and/or to rule out/in multiple pregnancy. Towards the end of the first trimester, they can use a handheld Doppler ultrasound to listen for a heartbeat; you will be able to hear it, also. Your health care practitioner will probably have you pee on a stick to check for sugars, proteins and possibly other things in your urine, that might suggest worrisome developments. Your health care practitioner may measure fundal height (symphysis-fundal height), which is the distance, in centimeters, from your pubic bone to the top of your uterus. Throughout a singleton (one baby) pregnancy, fundal height is expected to increase steadily, and between weeks 20 and 29, equal the number of weeks you are along in centimeters. Growth is slower after 29 weeks, and the height and weight of the mother both strongly influence the largest fundal height reached. Fundal height curves vary by population. In general, however, if fundal height growth stops (or just seems quite low for your dates), they will get worried and suggest other tests, which may or may not be called for if different people have been measuring your fundal height (this is not an exact measurement).
Beyond the check-for-disease, Rh check, sugar-and-protein pee-on-a-stick check and blood pressure, there are a few tests that are done to assess the health of the baby specifically (all the others are health-of-the-mother, and a compatibility problem). Health-of-the-baby checks (other than ultrasound, which appears to be largely innocuous, but also largely useless at least across populations) are just awful because they tend to be truly terrible in terms of specificity and accuracy (high rates of false positives and/or false negatives) or remarkably risky for the baby (amniocentesis and chorionic villus sampling).
This will almost certainly change in the next few years, as tests based on fetal DNA in the maternal bloodstream become available. Currently, a non-medical gender test based on this technology is available.
Until then, basically, the risk of chromosomal defects (which is most of what these tests are intended to find, although they can turn up neural tube problems as well) increases with maternal age. ACOG's latest guidelines, however, are to screen all women for Down Syndrome, using ultrasound (Nuchal Fold Translucency) or a blood test. You can always stop at the blood test or ultrasound, even if your health care practitioner thinks you should proceed to riskier tests. The test in question goes under several names: the alpha-fetoprotein test (AFP), the triple screen and the quad screen. At this point, they should all be doing the quad screen, rather than the triple screen, but the last change was recent (2001, I believe) and a lot of the pros do not realize what happened. But the news is good: the false positives rate was decreased by checking for yet-another-chemical to help deal with the you-might-have-your-dates-wrong problem. The test can still be wrong if you are pregnant with more than one baby and do not know it, and it can just plain be wrong. Do some research (in a current book! Something post-2001 for sure, and ideally something updated within the last year or two. I expect this test to be developed further in the future, since so much rides on it) to understand the details of what the test can and cannot tell you. Health care pros do not necessarily do a good job of conveying all the details and may or may not be entirely up to date on the subject.
In the unlikely event the quad screen comes back indicating your baby may have a neural tube defect and/or chromosomal disorder, the next testing step is either an ultrasound (which may or may not confirm or deny, but at least probably will not hurt you or the baby), or chorionic villus sampling (CVS) or amniocentesis. The latter two amount to sticking a needle through you (several routes are possible; your health care provider can explain the possibilities and the tradeoffs) to collect amniotic fluid (using the ultrasound to avoid the fetus). The needle hauls it back out for further analysis. Assuming they got the right stuff, they can tell for sure whether your baby has one of a set of genetic defects. As you can imagine, this is not a risk-free procedure for anyone; the miscarriage rate runs somewhere between .25 and 2% depending on which procedure is done and when. If you would not terminate the pregnancy for any possible outcome, you probably should not consent to the test, although some people want the information to plan a good support system for when a disabled baby is born. There is no rush. Take your time and discuss it with anyone whose input you want to include in your decision.
Prenatal testing can create a variety of emotional problems for you and your partner, particularly if the results from a screening test are inadequately communicated. Waiting two weeks for the results of amniocentesis or CVS can be emotionally devastating. Seriously consider paying out-of-pocket if necessary for FISH (chromosomal staining) analysis of results; you can get a nearly definitive answer in a couple days instead of weeks.
An excellent summary of amniocentesis can be found here.
Some women who are surprised by a pregnancy in their mid-40s or later decide to skip the blood tests and go straight to CVS or amniocentesis, to get to a decision earlier, particularly if they have older children they'd rather not see the process of deciding to terminate. Other women decide to have CVS or amniocentesis without screening tests to most quickly reach certainty regarding certain birth defects, either because they know how they react to prolonged anxious waiting, or because their family history indicates a higher level of risk. If you are thinking along these lines, you might be surprised how many sympathetic people are out there who've been down a similar path.
Standard of care involves a genetics counseling appointment before amniocentesis or CVS. Their goals seem to include helping you manage the anxiety associated with prenatal testing. If fully navigating all possible outcomes with lots of information helps you (as it does me!), they are a great resource, but they actually won't tell you about the less likely outcomes unless you ask. If you want to focus on the likely outcome and avoid thinking about the horrific possibilities, they are the perfect information source, far less terrifying than reading about everything that can possibly go wrong online or in a book. This is an area where more information has a lot of sharp pointy edges; navigate with as much self-knowledge as you can muster.
This is by no means a complete list of testing that can be done to and for you and your baby, and technology does change over time. When any test is proposed to you, make sure you understand clearly what the test is, what the test involves, what the test can and cannot tell you, how accurate and specific (false positive/false negative) the test is, what population the test is for, and what the next step would be depending on the outcome of the test. While some people believe that additional testing contributes to their peace of mind, there is the chance a test will have a worrisome result, leading to more dangerous testing and other procedures. In general, consider refusing testing which would not cause you to take action, regardless of the result (so if the only thing you could do in the face of a bad outcome is to terminate the pregnancy, and you will not do that, do not accept the test). Your health care provider will probably appreciate understanding that is why you are refusing the test. If they respond by attempting to convince you that you should leave that action as a possibility, consider getting a different health care provider (now is when they should be listening to you, understanding your values and acting in accordance with them). If they respond by clarifying that other actions (that would be acceptable to you) are possible next steps, it costs you little to make sure you fully understand the possibilities. This is complicated thinking. Do not rush yourself. Do not allow others to rush you. It is almost impossible to imagine a testing scenario at this stage that does not let you go home and spend a week doing research before making a decision.
Some health care practitioners will weigh you, and give you some kind of feedback based on that number. You may look around online and in books for information about weight gain during pregnancy and notice that almost everyone is giving exactly the same advice. That is not because this advice is proven to be good advice; it is just there is no good research on how much weight should (or should not) be gained. The current guidelines are higher than previous guidelines, because previous guidelines provably increased low birth weight (LBW) babies. Some people note that gaining too much puts you at risk for various problems. Attempts to correlate (much less prove causation) between weight gain above the typical advice and those various problems have failed miserably and completely. Many now suggest that trying to eat a healthful diet, get enough protein and not eat a lot of junk food. They will tell you not to eliminate salt from your diet completely (because really disastrous things can happen to you and the baby if you do) and to drink enough water and other fluids.
If you've never been bigger than you are when you first get pregnant, the change in your size and shape and the way people react to that change may be distressing. In addition to the possible unsolicited belly-rubbing by strangers, and the predictable array of questions your new shape attracts, if you had a girlish figure and you no longer do, some people are going to say some remarkably tactless or even bigoted things. I find that it helps to distinguish between those who are really quite appalled at how huge I am, and can only with difficulty justify getting large to have a baby, and those who are just amazed at how big I am and unable to stop themselves from saying something about it. The former are people that should be avoided (sizist) and the latter are subject to exactly the same human foibles I am and deserve compassion.
This is going to be a really hard transition and status change for those whose identity has previously been wrapped up in being thin, slim, athletic, small, tiny, anorexic, self-controlled, etc. It can also be a profoundly dangerous transition for those who attempt through exercise or calorie control to minimize weight gain. In non-pregnant women and in men, strict calorie control increases binging. While I have no research to support my belief, I am convinced that calorie control in a pregnant woman leads even more compellingly to binging. I urge you to avoid this by eating as much healthy food as appeals to you, and building into your daily food choices a number of treats. I am completely convinced that a pregnant woman who has a regular amount of baked goodies, chocolate, ice cream, etc. is a lot less likely to down an excessive quantity of those when caught in a particularly weak moment, sabotaged by hunger and hormones.
Gestational diabetes is a myth. Its diagnosis relies on a test that no one trusts to diagnosis Type 2 diabetes any more. The test itself has only a 50-50 chance of returning the same result two days in a row. It is incredibly unlikely (and probably lawsuit-worthy) that anyone would prescribe insulin, so the treatment will be to monitor and control your food and activity levels. The bad outcome they are attempting to avoid does not correlate with the diagnosis, nor does it become less likely with "treatment". The most likely result of this diagnosis is a lot of pressure to have a C-section. The only useful reason to have this test is to discourage people from pressuring you to have a C-section by being able to show a negative result on the test. I just say no to the test and sign the form.
Hypertension is high blood pressure. If you didn't have high blood pressure before you got pregnant and then you developed high blood pressure, that may be diagnosed as pregnancy-induced hypertension, also known as toxemia when it happens in combination with edema (water retention) in the extremities (face, hands, legs) and albuminuria (protein in the urine). Pre-eclampsia is really high blood pressure that developed during pregnancy. Eclampsia is the same thing, plus seizures (convulsions). Obviously, there's some overlap here in terminology, and none of these are to be ignored. The great promise of prenatal care was that with good prenatal care, maternal mortality (death) from causes such as these would be reduced and perhaps eventually eliminated. The pee-on-a-stick thing plus the blood pressure check is there to notice if you are developing PIH, pre-eclampsia etc. Unfortunately, despite numerous theories as to the cause of these problems, and associated proposed methods of preventing the development of these problems (or reversing them when they occur), little progress has been made, other than to discover that the relatively obvious ideas (such as restricting salt) are incredibly dangerous to the pregnant woman and her unborn baby when actually implemented.
That said, there's no reason not to monitor your sodium intake to ensure it is within current healthy guidelines (say, keep it around or under 2000 mg/day), particularly if you know that too much sodium causes you to retain water even when not pregnant. Similarly, if you have reason to suspect you don't get enough of some nutrient (say, calcium if you don't consume any dairy or B12 if you're vegan) from your diet, now is a plausible time to supplement. There's a limited amount of research suggesting that calcium deficient women are at increased risk of pregnanc-induced hypertension.
Great question. As near as I can tell, prenatal care supplies the following, real benefits to pregnant women.
Other than these tangible benefits, prenatal care offers advice and instruction that, ideally, is personalized to the woman but, in general, is biassed and perfunctory; drugs and other medical interventions that may or may not help her and/or her unborn baby at some known or unknown cost; advice of questionable accuracy that could be readily duplicated and probably improved upon in a class, through reading a book, watching a video or talking to her circle of acquaintance.
Do not expect miracles of prenatal care. There is no magic here.Copyright 2005 by Rebecca Allen
Created May 20, 2005 Updated April 16, 2008