Pre-conception and pregnancy care are important measures to reduce maternal mortality and birth defects. Traditional pregnancy care, especially the number, content, gestational week, and interval of prenatal checkups, lacks the support of evidence-based medical evidence and can no longer meet the requirements of modern prenatal care, and the protocols of prenatal checkups vary greatly among regions and different hospitals in China, and even different obstetricians in the same hospital provide inconsistent prenatal checkup protocols, which is also the cause of the current maternal mortality and neonatal birth This is an important reason for the high rate of maternal mortality and neonatal birth defects in China. In recent years, with the in-depth understanding of perinatal complications and the advancement of prenatal screening technology, the preconception and pregnancy care guidelines developed by the United States, the United Kingdom, Canada, and WHO have been updated. Therefore, it is necessary to develop preconception and pregnancy care guidelines that are appropriate for our national situation. This guideline was developed with reference to the latest preconception and pregnancy health care guidelines issued by the United States, the United Kingdom, Canada, and WHO, as well as evidence-based medical evidence, and follows the Law of the People’s Republic of China on Maternal and Child Health Care, the Technical Service Specifications for the Pilot Project of National Free Preconception Eugenics Health Screening Program (for Trial Implementation) of the National Population and Family Planning Commission (2010), and the Work Specifications for Preconception Health Care Services of the National Ministry of Health (2010). Norms (for Trial Implementation)” (2007), “Measures for the Administration of Prenatal Diagnostic Technology” and related supporting documents (2002), “Measures for the Administration of Perinatal Health Care in China’s Cities” (1987) and “Measures for the Administration of Rural Maternal System Health Care” (1989) of the State Ministry of Health, 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 compulsory items and preparatory items), among which the compulsory 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 items can be carried out in hospitals with conditions or when there are indications. Preconception health care (3 months before pregnancy) Preconception health care is to prevent birth defects and improve the quality of the birth population by assessing and improving the health status of the couple planning to have a pregnancy, reducing or eliminating risk factors that lead to birth defects and other adverse pregnancy outcomes, and is the forward movement of health care during pregnancy. I. Health education and guidance Following the principle of combining universal guidance and personalized guidance, preconception health education and guidance for couples planning pregnancy, the main contents include: (1) Prepared and planned pregnancy, avoiding high-age pregnancy. (2) Rational nutrition and control of body mass (weight) gain. (3) Supplementation with folic acid 0.4-0.8 mg/d, or evidence-based medically proven multivitamin containing folic acid. Pregnant women with previous neural tube defects (NTD) require folic acid supplementation of 4mg/d. (4) Women with genetic, chronic and infectious diseases who are preparing for pregnancy should be evaluated and guided. (5) Rational use of medication and avoidance of drugs that may affect normal fetal development. (6) Avoid exposure to toxic and harmful substances in the living and occupational environment (such as radiation, high temperature, lead, mercury, benzene, arsenic, pesticides, etc.) and avoid close contact with pets. (7) Change bad habits (such as smoking, alcoholism, drug abuse, etc.) and lifestyles; avoid high-intensity work, high-noise environments and domestic violence. (8) Maintain mental health, relieve mental stress, and prevent the occurrence of psychological problems during pregnancy and after delivery. (9) Reasonable choice of exercise. (2) Routine health care 1. Assessment of pre-pregnancy high-risk factors: (1) Ask about the health status of the couple preparing for pregnancy. (2) Evaluate the history of previous chronic diseases, family and genetic history, and inform those who are not suitable for pregnancy. (3) Detailed history of adverse pregnancy and childbirth. (4) lifestyle, diet and nutrition, occupational status and work environment, exercise (labor), domestic violence, interpersonal relationships, etc. 2. Physical examination: (1) Including measurement of blood pressure and body mass, calculation of body mass index (BMI), BMI = body mass (kg)/height (m)2. (2) Routine gynecological examination. Auxiliary examination 1. Compulsory items: including the following: (1) routine blood test; (2) routine urine test; (3) blood group (ABO and Rh); (4) liver function; (5) kidney function; (6) fasting blood sugar; (7) HBsAg; (8) syphilis spirochete; (9) HIV screening; (10) cervical cytology test (for those who have not been examined within 1 year). 2. Preparation items: including the following items: (1) Toxoplasma gondii, rubella virus, cytomegalovirus and herpes simplex virus (TORCH) screening. (2) Cervicovaginal discharge examination (routine vaginal discharge, gonococcus, Chlamydia trachomatis). (3) Thyroid function test. (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan, Chongqing, etc.). (5) 75g oral glucose tolerance test (OGTT; for high-risk women). (6) Blood lipid examination. (7) Gynecologic ultrasound examination. (8) Electrocardiogram. (9) Chest x-ray. Pregnancy care The main feature of pregnancy care is the requirement to systematically provide evidence-based prenatal screening programs at specific times. The schedule of prenatal checkups should be decided according to the purpose of prenatal checkups. I. Number of antenatal checkups and gestational week A reasonable number of antenatal checkups and gestational week can not only ensure the quality of pregnancy care, but also save health care resources. For pregnant women without comorbidities in developing countries, WHO (2006) recommends at least 4 antenatal checkups at <16weeks, 24-28 weeks, 30-32 weeks and 36-38 weeks of gestation respectively. Based on the current status of pregnancy 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. For those with high-risk factors, increase the number of times as appropriate. II. Contents of prenatal checkups (a) First prenatal checkup (6-13 weeks +6) 1. Health education and guidance: (1) Awareness and prevention of miscarriage. (2) Guidance on nutrition and lifestyle (hygiene, sexual life, sports and exercise, travel, work). (3) Continue supplementation of folic acid 0.4-0.8mg/d until the third trimester, and continue taking 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 carefully and avoid using drugs that may affect the normal development of the fetus. (6) If necessary, get vaccinated against tetanus or influenza during pregnancy. (7) Change bad habits (such as smoking, alcoholism, drug abuse, etc.) and lifestyles; avoid high-intensity work, high-noise environments and domestic violence. (8) Maintain mental health, relieve mental stress, and prevent 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. (3) Assess risk factors during pregnancy. Pregnancy and childbirth history, especially the history of bad pregnancy and childbirth such as miscarriage, premature birth, stillbirth, stillbirth, history of reproductive tract surgery, any fetal malformation or mental retardation in young children, preconception preparation, family history and genetic history of myself and my spouse. Pay attention to the presence of pregnancy comorbidities, such as: chronic hypertension, heart disease, diabetes, liver and kidney disease, systemic lupus erythematosus, hematological disease, neurological and psychiatric diseases, etc., and promptly request consultation from relevant disciplines; those who are not suitable to continue the pregnancy should be informed and promptly terminate the pregnancy; those who continue the pregnancy in high-risk pregnancy should be evaluated for referral. Any vaginal bleeding in this pregnancy and any possible teratogenic factors. (4) Physical examination. Including measurement of blood pressure and body mass, calculation of BMI; routine gynecological examination (for those who have not done so in the first 3 months of pregnancy); fetal heart rate determination (by Doppler auscultation, around 12 weeks of pregnancy). 3. Mandatory tests: (1) routine blood test; (2) routine urine test; (3) blood type (ABO and Rh); (4) liver function; (5) kidney function; (6) fasting blood sugar; (7) HBsAg; (8) syphilis spirochete; (9) HIV screening. (Note: Items already checked in the first 6 months of pregnancy can be checked without repetition) 4. Preparation items: (1) Hepatitis C virus (HCV) screening. (2) Anti-D titer test (Rh-negative). (3) 75g OGTT (for high-risk pregnant women or those with symptoms). (4) Thalassemia screening (Guangdong, Guangxi, Hainan, Hunan, Hubei, Sichuan, Chongqing, etc.). (5) Thyroid function test. (6) Serum ferritin (for those with hemoglobin <105g/L). (7) Tuberculin (PPD) test (for high-risk pregnant women). (8) Cervical cytology (for those who have not been examined in the first 12 months of pregnancy). (9) Cervical discharge test for gonococcus and Chlamydia trachomatis (for high-risk pregnant women or those with symptoms). (10) Testing for bacterial vaginosis (BV) (for those with a history of preterm delivery). (11) Early maternal serologic screening for fetal chromosomal aneuploidy abnormalities [pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG, 10-13 weeks gestation]. Precautions: fasting; ultrasound to determine gestational week; determine body mass on the day of the blood draw. In high-risk individuals, consider chorionic villus biopsy or combine the results of mid-pregnancy serologic screening before deciding on amniocentesis. (12) Ultrasonography. Ultrasound is performed in early pregnancy to determine intrauterine pregnancy and gestational week, fetal viability, number of fetuses or nature of the twin chorionic villi, and uterine adnexal conditions. Ultrasound at 11-13 weeks of gestation to check the thickness of the posterior nuchal translucency (NT); approved gestational weeks; NT measurement is 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. (II) 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 abnormalities in midtrimester. (5) Hemoglobin <105g/L, serum ferritin <12ug/L, elemental iron supplementation 60-100mg/d. (6) Start 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 maternal body mass growth is reasonable; fundal height and abdominal circumference, to assess whether the fetal body mass growth is reasonable; fetal heart rate measurement. 3. Compulsory items: None. 4.Preparation items: (1) Midtrimester maternal serological screening for fetal chromosomal aneuploidy (15-20 weeks of gestation, the best week of gestation for testing is 16-18 weeks). Caution: Same as early pregnancy serologic screening. (2) Amniocentesis to check fetal karyotype (16-21 weeks of gestation; for pregnant women aged 35 years and above at the due date or for those at high risk). (3) Prenatal checkups at 20-24 weeks of gestation 1. Health education and guidance: (1) Awareness and prevention of preterm labor. (2) Guidance on nutrition and lifestyle. (3) The significance of fetal system ultrasound screening. 2. Routine health care : 1) Ask about fetal movement, vaginal bleeding, diet and exercise. (2) Physical examination, same as 14-19 weeks of gestation +6 prenatal examination. 3. Compulsory checkups: (1) Fetal system ultrasound screening (18-24 weeks of gestation) to screen for serious fetal malformations. (2) Routine blood and urine tests. 4. Preparation items: cervical assessment (ultrasound measurement of cervical length). (D) Antenatal checkups at 24-28 weeks of gestation 1. Health education and guidance: (1) Awareness and prevention of preterm delivery. (2) The significance of gestational diabetes mellitus (GDM) screening. 2. Routine health care: (1) Ask about fetal movement, vaginal bleeding, contractions, diet and exercise. (2) Physical examination, same as 14-19 weeks of gestation +6 prenatal examination. 3.Compulsory checkups: (1) GDM screening. First perform 50g glucose screening (GCT), if blood sugar ≥7.2mmol/L, ≤11.1mmol/L, then perform 75g OGTT; if ≥11.1mmol/L, then measure fasting blood sugar. The recent international recommendation is that it is not necessary to perform 50gGCT first, and those who have the condition can directly perform 75gOGTT, whose normal upper limit is 5.1 mmol/L for fasting blood glucose, 10.0 mmol/L for 1h blood glucose and 8.5 mmol/L for 2h blood glucose. or by testing fasting blood glucose seat screening standard. (2) urine routine. 4. Preparation items: (1) Anti-D titer test (Rh-negative person). (2) Cervicovaginal discharge to detect fetal fibronectin (fFN) level (for those at high risk of preterm delivery). (E) Antenatal checkups at 33-36 weeks of gestation 1. Health education and guidance: (1) Guidance on lifestyle before delivery. (2) Knowledge related to childbirth (symptoms of labor, guidance on delivery methods, labor analgesia). (3) Newborn disease screening. (4) Prevention of depression. 2. Routine health care: (1) Ask about fetal movement, vaginal bleeding, contractions, skin itching, diet, exercise, and preparation for delivery. (2) Physical examination, same as prenatal examination of pregnancy 30-32. 3. Compulsory check-ups: urinary routine. 4.Ready items: (1) Streptococcus B (GBS) screening at 35-37 weeks of gestation: pregnant women with high-risk factors (such as combined diabetes, GBS infection in newborns born in previous pregnancies), culture of perianal and lower 1/3 of vaginal secretions. (2) Liver function and serum bile acid test at 32-34 weeks of gestation (for pregnant women in areas with high prevalence of ICP). (3) Electronic fetal heart monitoring (no-load test, NST) examination was started at 34 weeks of gestation (for high-risk pregnant women). (4) Electrocardiogram review (high-risk pregnant women). (6) Antenatal checkups at 37-41 weeks of gestation 1. Health education and guidance: (1) Knowledge related to childbirth (symptoms of labor, guidance on delivery methods, labor analgesia). (2) Guidance on immunization of newborns. (3) Instruction on the puerperium. (4) Monitoring of intrauterine condition of the fetus. (5) Hospitalization and induction of labor if the pregnancy is ≥ 41 weeks. 2. Routine health care: (1) Ask about fetal movement, contractions, redness, etc. (2) Physical examination, same as prenatal examination of 30-32 weeks of pregnancy; cervical examination and Bishop score. (3) Compulsory checkups: (1) Ultrasonography: assess fetal size, amniotic fluid volume, placental maturity, fetal position and the ratio of peak systolic to end-diastolic flow rate of umbilical artery (S/D value), etc. (2) NST examination (once a week). 4.Readiness checkup items: None. The contents of routine examination during pregnancy are not recommended 1. External pelvic measurements: There is sufficient evidence that external pelvic measurements do not predict cephalopelvic disproportion at delivery. Therefore, it is not necessary to routinely check external pelvic measurements during pregnancy. For pregnant women with vaginal delivery, the pelvic outlet diameter can be measured in the late pregnancy. Serologic screening for Toxoplasma gondii, cytomegalovirus and herpes simplex virus: There are no established screening methods for these three pathogens, and maternal serologic specific antibody testing cannot confirm when a pregnant woman is infected, whether the fetus is involved, or whether there are long-term sequelae, nor can the results of maternal serologic screening be used to determine whether a pregnancy should be terminated. It is recommended that pre-pregnancy screening or targeted screening during pregnancy should not be performed on all pregnant women to avoid psychological fear and unnecessary interventions. 3.BV screening: the incidence of BV during pregnancy is 10-20%, which is associated with the occurrence of preterm delivery. Pregnant women at high risk of preterm delivery can be screened for BV, but routine BV screening should not be performed for all pregnant women. 4. cervicovaginal discharge test for fFN and ultrasonographic assessment of the cervix: in pregnant women at high risk of preterm delivery, the value of these two screening tests is that a negative result indicates that there is no possibility of preterm delivery in the near future, thus reducing unnecessary interventions. However, there is insufficient evidence to support cervicovaginal secretion fFN testing and ultrasound cervical assessment in all pregnant women. 5.Checking urine protein and blood routine at each antenatal visit: urine protein and blood routine tests are not required at each antenatal visit, but repeated urine protein and blood routine tests may be performed in pregnant women with hypertensive disorders in pregnancy and anemia in pregnancy. 6. Thyroid function screening: Hypothyroidism in pregnant women affects the development of neurointelligence in children. Some experts recommend screening thyroid function (FT3, FT4, TSH) in all pregnant women, but there is not enough evidence to support screening of thyroid function in all pregnant women, and adequate iodine intake should be ensured during pregnancy. 7. Tuberculosis screening: At present, there is insufficient evidence to support screening for tuberculosis (including PPD tests and chest x-ray) in all pregnant women. High-risk pregnant women (those in areas with high TB prevalence, poor housing conditions, HIV infection, and drug addiction) can be screened for TB at any time during pregnancy.