Guidelines for preconception and pregnancy health care Preconception and pregnancy health care is an important measure for reducing maternal mortality and birth defects. Traditional pregnancy health care, especially the number of prenatal checkups, their contents, gestational weeks and intervals, lacks the support of evidence-based medicine, and can no longer meet the requirements of modern prenatal health care; there are large differences in prenatal checkups in various regions and hospitals in China, and even the prenatal checkups provided by different obstetricians in the same hospital are inconsistent, which is an important reason for the high rates of maternal deaths and birth defects among newborns. This is also an important reason for the high maternal mortality and neonatal birth defects in China. In recent years, with the deepening of the understanding of perinatal complications and the advancement of prenatal screening technology, the guidelines for preconception and maternal health care formulated by the United States, the United Kingdom, Canada, and the WHO have been continuously updated. Therefore, it is necessary to develop preconception and pregnancy healthcare guidelines that are suitable for our national conditions. This guideline was developed with reference to the latest preconception and pregnancy healthcare guidelines issued by the United States, the United Kingdom, Canada, and WHO, as well as evidence-based medicine, and in accordance with the Maternal and Infant Healthcare Law of the People’s Republic of China, the Technical Service Specifications for the Pilot Work of the National Free Preconception Eugenic Health Screening Program (Trial) of the National Population and Family Planning Commission (2010), and the Work Specifications for Preconception Healthcare Services (Trial) of the National Department of Health (2010), and the Work Specifications for Preconception Healthcare Services (Trial) of the Ministry of Health. norms (for trial implementation) (2007), the Ministry of Health’s Measures for the Administration of Prenatal Diagnostic Techniques and related supporting documents (2002); and the Ministry of Health’s Measures for the Administration of Perinatal Health Care in China’s Cities (1987) and Measures for the Administration of Systematic Health Care for Rural Mothers (1989), which also take full account of the requirements of health economics. The contents of this guideline include: health education and guidance, routine health care contents, and auxiliary examination items (divided into mandatory and preparatory items), of which the mandatory items of health education and guidance, routine health care contents, and auxiliary examination are applicable to all pregnant women, and the preparatory items of auxiliary examination can be carried out by hospitals that have the conditions or when there are indications to do so. Pre-pregnancy health care (3 months before pregnancy) Pre-pregnancy health care is to prevent birth defects from occurring and improve the quality of the birth population by evaluating and improving the health of couples who plan to have a pregnancy, reducing or eliminating the risk factors that lead to birth defects and other undesirable outcomes of pregnancy, and it is a forward movement of health care during pregnancy. I. Health education and guidance Following the principle of combining universal guidance and individualized guidance, couples who plan to have a pregnancy are given pre-pregnancy health education and guidance, the main contents of which include: (1) Prepared and planned pregnancies, and avoiding pregnancies at advanced ages. (2) Reasonable nutrition and control of body mass (weight) gain. (3) Supplementation with folic acid 0.4 to 0.8 mg/d, or a multivitamin containing folic acid validated by evidence-based medicine. Pregnant women with previous neural tube defects (NTDs) require folic acid supplementation of 4mg/day. (4) Women with genetic, chronic and infectious diseases who are preparing for pregnancy should be evaluated and instructed. (5) Reasonable use of medication and avoidance of drugs that may affect the normal development of the fetus. (6) Avoid contact with toxic and harmful substances in the living and occupational environments (e.g. radiation, high temperature, lead, mercury, benzene, arsenic, pesticides, etc.) and avoid close contact with pets. (7) Change bad habits (e.g. smoking, alcoholism, drug abuse, etc.) and lifestyles; avoid high-intensity work, high-noise environments and domestic violence. (8) Maintaining mental health, relieving mental stress, and preventing the occurrence of psychological problems during pregnancy and after childbirth. (9) Reasonable choice of exercise. II. Routine health care 1. Evaluate pre-pregnancy high-risk factors: inquire about the health status of the couple preparing for pregnancy. Evaluate the history of previous chronic diseases, family and genetic history, those who are not suitable for pregnancy should be informed in time. Detailed understanding of the history of adverse pregnancy and childbirth. Lifestyle, diet and nutrition, occupational status and work environment, exercise (labor), domestic violence, interpersonal relationships. 2. Physical examination: including measurement of blood pressure, body mass, calculation of body mass index (BMI), BMI = body mass (kg)/height (m)2. routine gynecological examination. Auxiliary examination 1, mandatory items: including the following items: blood routine; urine routine; blood type (ABO and Rh); liver function; renal function; fasting blood glucose; HBsAg; syphilis spirochetes; HIV screening; (10) cervical cytology (1 year without examination). 2.Preparation items: including the following items: (1) Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus (TORCH) screening. (2) Cervico-vaginal secretion examination (routine vaginal secretion, gonococcus, chlamydia trachomatis). (3) Thyroid function test. (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan and Chongqing). (5) 75g oral glucose tolerance test (OGTT; for high-risk women). (6) Lipid test. (7) Gynecological ultrasonography. (8) Electrocardiogram. (9) Chest X-ray. Pregnancy care The main feature of pregnancy care is the requirement for a systematic provision of evidence-based prenatal screening programs at specific times. The schedule of prenatal examinations is determined by the purpose of the prenatal examination. I. Frequency of antenatal checkups and gestational weeks Reasonable frequency of antenatal checkups and gestational weeks not only ensure the quality of pregnancy care, but also save health care resources. For uncomplicated pregnant women in developing countries, WHO (2006) suggests at least 4 antenatal checkups at <16 weeks, 24-28 weeks, 30-32 weeks and 36-38 weeks of gestation. According to the current situation of pregnancy health care and the need for prenatal checkup programs in China, the recommended gestational weeks for prenatal checkups in this guideline are: 6-13 weeks + 6, 14-19 weeks + 6, 20-24 weeks, 24-28 weeks, 30-32 weeks, 33-36 weeks, and 37-41 weeks of gestation, respectively. For those with high risk factors, increase the number of times as appropriate. II. Contents of prenatal examination (I) First prenatal examination (6-13 weeks of pregnancy+6) 1. Health education and guidance: (1) Awareness and prevention of miscarriage. (2) Nutrition and lifestyle guidance (hygiene, sex life, sports exercise, travel, work). (3) Continue to supplement folic acid 0.4-0.8mg/d until the 3rd month of pregnancy, and continue to take multivitamins containing folic acid if available. (4) Avoid contact with toxic and harmful substances (such as radiation, high temperature, lead, mercury, benzene, arsenic, pesticides, etc.), and avoid close contact with pets. (5) Use drugs with caution and avoid drugs that may affect the normal development of the fetus. (6) If necessary, vaccinate against tetanus or influenza during pregnancy. (7) Change bad habits (e.g. smoking, alcoholism, drug abuse, etc.) and lifestyles; avoid high-intensity work, high-noise environments and domestic violence. (8) Maintaining mental health, relieving mental stress, and preventing the occurrence of psychological problems during pregnancy and after delivery. 2. Routine health care: (1) Establish a pregnancy health care manual. (2) Carefully inquire about menstruation, determine the week of pregnancy, and project the expected date of delivery. Assess high-risk factors during pregnancy. Maternal history, especially adverse maternal history such as miscarriage, preterm labor, stillbirth, history of stillbirth, history of reproductive tract surgery, any malformation of the fetus or mental retardation of the young child, pre-pregnancy preparations, family history of the person and his/her spouse and history of hereditary diseases. Pay attention to the presence of pregnancy comorbidities, such as: chronic hypertension, heart disease, diabetes, liver and kidney disease, systemic lupus erythematosus, blood diseases, neurological and psychiatric disorders, etc., and promptly ask for consultation with relevant disciplines, those who are not suitable to continue the pregnancy should be informed and terminate the pregnancy in a timely manner; those who continue the pregnancy in high-risk pregnancies are evaluated to see if they should be referred to the hospital. There is no vaginal bleeding in this pregnancy, and there are no possible teratogenic factors. Physical examination. Including the measurement of blood pressure, body mass, calculation of BMI; routine gynecological examination (not done in the first 3 months of pregnancy); fetal heart rate measurement (using Doppler auscultation, about 12 weeks of pregnancy). 3, mandatory items: (1) routine blood; (2) urine routine; (3) blood type (ABO and Rh); (4) liver function; (5) kidney function; (6) fasting blood glucose; (7) HBsAg; (8 syphilis spirochetes; (9) HIV screening. (Note: Items that have been checked in the first 6 months of pregnancy can be checked without repeating) 4. Preparatory items: (1) Hepatitis C virus (HCV) screening. (2) Anti-D titer test (Rh negative). (3) 75g OGTT (high-risk pregnant women or those with symptoms). (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan and Chongqing). (5) Thyroid function test. (6) Serum ferritin (those with hemoglobin <105g/L). (7) Tuberculin (PPD) test (high-risk pregnant women). (8) Cervical cytology (those who have not been examined in the first 12 months of pregnancy). (9) Cervical secretion test for gonococcus and chlamydia trachomatis (high-risk pregnant women or those with symptoms). (10) Testing for bacterial vaginosis (BV) (for those with a history of preterm labor). (11) Maternal serologic screening in early pregnancy for fetal chromosomal aneuploidy abnormalities [pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG, 10-13 weeks of gestation]. Precautions: fasting; ultrasound to determine gestational week; determine body mass on day of blood draw. In high-risk individuals, consider chorionic villus biopsy or combined midgestation serologic screening results before deciding on amniocentesis. (12) Ultrasonography. Ultrasonography is performed during early pregnancy: to determine intrauterine pregnancy and gestational week, fetal viability, number of fetuses or nature of twin chorionic villi, and uterine adnexa. Ultrasound of fetal nuchal translucency thickness (NT) at 11-13 weeks of gestation; approved gestational week.NT measurements are performed according to the British Fetal Medicine Foundation standards. (13) Chorionic villus biopsy (10-12 weeks of gestation, mainly for high-risk pregnancies). (14) Electrocardiogram. (I) 14-19 weeks of gestation + 6 prenatal checkups 1. Health education and guidance: (1) Awareness and prevention of miscarriage. (2) Knowledge of pregnancy physiology. (3) Guidance on nutrition and lifestyle. (4) Meaning of screening for fetal chromosomal aneuploidy anomalies in the middle trimester. (5) Hemoglobin <105g/L, serum ferritin <12ug/L, supplementation of elemental iron 60-100mg/d. (6) Beginning of calcium supplementation, 600mg/d. 2. Routine health care: (1) Analyze the results of the first prenatal examination. (2) Ask about vaginal bleeding, diet and exercise. (3) Physical examination, including blood pressure and body mass, to assess whether the growth of pregnant women's body mass is reasonable; uterine fundal height and abdominal circumference, to assess whether the growth of fetal body mass is reasonable; fetal heart rate measurement. 3.Required items: None. 4.Preparatory items: (1) Maternal serologic screening for fetal chromosome aneuploidy anomalies in the middle trimester (15-20 weeks of gestation, with the optimal gestational week of detection being 16-18 weeks). Precautions: Same as early pregnancy serologic screening. (2) Amniocentesis screening for fetal karyotyping (16-21 weeks of gestation; for pregnant women aged 35 years and above at the time of expected delivery or for high-risk groups). (II) Prenatal examination at 20-24 weeks of pregnancy 1. Health education and guidance: (1) Awareness and prevention of preterm labor. (2) Nutrition and lifestyle guidance. (3) The significance of fetal systematic ultrasound screening. 2.Routine health care: (1) Inquiries about fetal movement, vaginal bleeding, diet and exercise. (2) Physical examination, same as 14-19 weeks gestation + 6 prenatal examination. 3.Required items: (1) Fetal systematic ultrasound screening (18-24 weeks of gestation), screening for serious malformations of the fetus. (2) Blood routine, urine routine. (4) Preparatory items: cervical assessment (ultrasound measurement of cervical length). (C) Prenatal examination at 24-28 weeks of pregnancy 1. Health education and guidance: awareness and prevention of preterm labor. Significance of screening for gestational diabetes mellitus (GDM). 2. Routine health care: inquire about fetal movement, vaginal bleeding, contractions, diet and exercise. Physical examination, same as 14-19 weeks gestation +6 prenatal examination. 3.Required items: GDM screening. First, 50g glucose screening test (GCT), if blood glucose ≥7.2mmol/L, ≤11.1mmol/L, then 75g OGTT; if ≥11.1mmol/L, then fasting blood glucose will be measured. The recent international recommendation is that 50gGCT is not necessary, and if possible, 75gOGTT can be performed directly, and the upper limit of normal is 5.1 mmol/L for fasting glucose, 10.0 mmol/L for 1h glucose, and 8.5 mmol/L for 2h glucose, or through the testing of fasting glucose seating screening criteria. Urine routine. 4. Preparatory items: anti-D titer test (Rh-negative). Cervicovaginal secretion test for fetal fibronectin (fFN) level (for those at high risk of preterm labor). (D) Prenatal examination at 33-36 weeks of pregnancy 1. Health education and guidance: (1) Lifestyle guidance before delivery. (2) Knowledge related to labor and delivery (symptoms of approaching labor, guidance on delivery methods, labor analgesia). (3) Newborn disease screening. (4) Prevention of depression.