China’s preconception and antenatal care guide (1st edition) I: preconception care
Prenatal care and antenatal care are important measures to reduce maternal mortality and birth defects. Traditional prenatal care, especially the number, content, gestational week and interval of antenatal checkups, lacks the support of evidence-based medical evidence and can no longer meet the requirements of modern prenatal care. 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 in accordance with the Maternal and Child Health Law of the People’s Republic of China, 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 Preconception Health Care Service Specifications of the National Ministry of Health ( for Trial Implementation) (2007), the Measures for the Administration of Prenatal Diagnostic Technology and Related Supporting Documents (2002), the Measures for the Administration of Perinatal Health Care in China’s Cities (1987) and the Measures for the Administration of Systematic Maternal Health Care in Rural Areas (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 preparation 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 preparation 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)
Pre-conception health care is to prevent the occurrence of birth defects and improve the quality of the birth population by assessing and improving the health status of the planned couple, 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
Follow the principle of combining universal guidance and personalized guidance, pre-conception health education and guidance for couples planning pregnancy, the main content includes.
(1) Prepare and plan for pregnancy, and avoid pregnancy at an advanced age.
(2) Reasonable nutrition and control of body mass gain.
(3) Folic acid supplementation of 0,4 to 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 per day.
(4) Women with genetic, chronic and infectious diseases who are preparing for pregnancy should be evaluated and guided.
(5) Use medication rationally and avoid using 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) Choose exercise reasonably.
II. Routine health care
1. Assessment of pre-pregnancy high-risk factors.
(1) Ask about the health status of the couple preparing for pregnancy.
(2) Assess previous history of chronic diseases, family and genetic history, and inform those who are not suitable for pregnancy.
(3) Detailed history of adverse pregnancy and delivery.
(4) To understand the 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, body mass, and calculation of body mass index (BMI), BMI = body mass (kg)/height (m)2.
(2) Routine gynecological examination.
C. Auxiliary examination
1.Compulsory examination items: including the following items.
(1) blood routine.
(2) urine routine.
(3) blood type (ABO and Rh).
(4) liver function
(5) kidney function
(6) fasting blood sugar; (7) HBsAg
(7) HBsAg.
(8) syphilis spirochetes.
(9) HIV screening.
(10) Cervical cytology examination (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 screening.
(7) Gynecologic ultrasound examination.
(8) Electrocardiogram.
(9) Chest x-ray.