The first antenatal care contact should come early in pregnancy, ideally before week 12. For most women, 8 contacts with a health care provider during pregnancy are appropriate. Women with certain health conditions or complications of pregnancy may need more contacts.

Health Promotion and Disease Prevention

• Counsel women about good nutrition. Pregnant women should eat foods that contain iron, folate, vitamin A, calcium, and iodine. They should avoid using tobacco and breathing second-hand smoke, drinking alcohol, and taking drugs (except medications recommended by a health care provider). Pregnant women should take daily oral iron and folic acid supplements if available.
• Encourage women to stay active. Physical activity is healthy for a pregnant woman and helps her avoid gaining too much weight.
• If a woman has had hyperglycemia (high blood sugar) first diagnosed during a pregnancy, it should be classified as either gestational diabetes mellitus, which will resolve for most women after pregnancy, or diabetes mellitus in pregnancy, which will require continuing treatment after pregnancy. High blood sugar increases the chances of adverse outcomes of pregnancy.
• Assess gestational age with an ultrasound scan, if available, before 24 weeks’ gestation.
• Help pregnant women protect themselves from infections and to get treatment if infected.
  • If she is at risk for STIs, discuss condom use or abstinence during pregnancy (see Chapter 22 – Sexually Transmitted Infections, Including HIV).
  • Ensure that pregnant women are immunized against tetanus.
  • To prevent or treat anemia where hookworm infection is common, provide treatment (antihelminthic therapy) after the first trimester.
  • Screen pregnant women for bacteriuria (bacteria in the urine) according to program guidelines. Cases with symptoms and cases without symptoms should be treated with antibiotics. Bacteriuria without symptoms increases the chances of preterm birth and low birth weight.
• Help pregnant women protect their babies from infections.
  • Test for syphilis as early in pregnancy as possible, and treat as needed.
  • Offer HIV testing and counseling.
  • Pregnant women are particularly likely to get malaria. Provide insecticide-treated bed nets for malaria prevention and effective malaria treatment to every pregnant woman in areas where malaria is widespread, whether or not malaria is diagnosed (presumptive treatment). Monitor pregnant women for malaria and provide immediate treatment if diagnosed.
• For common symptoms during pregnancy, these treatments may help:
  • Nausea in early pregnancy: ginger, chamomile, vitamin B6, acupuncture
  • Heartburn: avoid large, fatty meals and alcohol; stop smoking; take antacids (at least 2 hours before or after taking iron and folic acid supplements)
  • Leg cramps: magnesium, calcium
  • Low back pain and pelvic pain: regular exercise, physiotherapy, support belts, acupuncture
  • Constipation: wheat bran or other fiber supplements
  • Varicose veins and edema: compression stockings, leg elevation, soaking in water
• To improve continuity and quality of care, each pregnant woman should be given her clinic case notes or records about her pregnancy and asked to take them to any health facility that she visits.