Preconception and pregnancy care is an important measure for reducing maternal mortality and birth defects. Traditional pregnancy health care, especially the number of prenatal checkups, content, gestational weeks and intervals, lacks the support of evidence-based medicine, and can no longer adapt to the requirements of modern prenatal health care, and there are large differences in the prenatal checkup programs of different regions and hospitals in China, and even the prenatal checkup programs 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 in China. This is also an important reason for the high maternal mortality and neonatal birth defect rates 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 of the National Population and Family Planning Commission (Trial) (2010), and the National Ministry of Health’s Work Specifications for Preconception Healthcare Services (Trial) (2007). Norms (for Trial Implementation) (2007), the State Ministry of Health’s Measures for the Administration of Prenatal Diagnostic Techniques and Related Supporting Documents (2002), and the State 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 have 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 status of couples who plan to have a pregnancy, reducing or eliminating the risk factors that lead to birth defects and other undesirable pregnancy outcomes, 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 of folic acid 0.4-0.8 mg/d, or multivitamins containing folic acid verified by evidence-based medicine. Pregnant women with previous neural tube defects (NTDs) require folic acid supplementation of 4 mg/d. (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. Assessment of pre-pregnancy high-risk factors: (1) Inquire about the health status of the couple preparing for pregnancy. (2) Evaluate the history of previous chronic diseases, family and genetic history, those who are not suitable for pregnancy should be informed in time. (3) Detailed understanding of adverse pregnancy and childbirth history. (4) Lifestyle, diet and nutrition, occupational status and work environment, exercise (labor), domestic violence, interpersonal relationships. 2, physical examination: (1) including measurement of blood pressure, body mass, calculation of body mass index (BMI), BMI = body mass (kg) / height (m) 2. (2) routine gynecological examination. Third, auxiliary examination 1, mandatory items: including the following items: (1) routine blood; (2) urine routine; (3) blood type (ABO and Rh); (4) liver function; (5) renal function; (6) fasting glucose; (7) HBsAg; (8) syphilis spirochetes; (9) HIV screening; (10) cervical cytology (1 year without examination). 2.Preparation items: including the following items: (1) Screening for toxoplasmosis, rubella virus, cytomegalovirus and herpes simplex virus (TORCH). (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 screening. (7) Gynecological ultrasonography. (8) Electrocardiography. (9) Chest X-ray examination. 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 that at least 4 antenatal checkups are needed, and the gestational weeks are <16 weeks, 24-28 weeks, 30-32 weeks, and 36-38 weeks, respectively. 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, the number of times should be increased 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. (3) Evaluate high-risk factors during pregnancy. Maternal history, especially adverse maternal history such as miscarriage, preterm labor, stillbirth, stillbirth history, reproductive tract surgery history, the presence of fetal malformations or mental retardation in young children, pre-pregnancy preparations, the family history of the person and his or her spouse and the history of hereditary diseases. Pay attention to the presence of pregnancy comorbidities, such as: chronic hypertension, heart disease, diabetes, liver and kidney diseases, systemic lupus erythematosus, hematological diseases, neurological and psychiatric disorders, etc., and promptly consult the relevant disciplines, those who are not suitable to continue the pregnancy should be informed and terminate the pregnancy in a timely manner; for those who continue the pregnancy in high-risk pregnancies, assess whether or not to be referred to the clinic. There is no vaginal bleeding in this pregnancy, and there are no possible teratogenic factors. (4) Physical examination. Including measurement of blood pressure, body mass, calculation of BMI; routine gynecological examination (those who have not done it in the first 3 months of pregnancy); fetal heart rate measurement (using Doppler auscultation, around 12 weeks of pregnancy). 3, mandatory items: (1) blood routine; (2) urine routine; (3) blood type (ABO and Rh); (4) liver function; (5) renal function; (6) fasting 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) 75gOGTT (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 were 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) Nutrition and lifestyle guidance. (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 fetus's body mass is reasonable; and determination of fetal heart rate. 3. Required items: None. 4.Preparatory items: (1) Maternal serologic screening for fetal chromosome aneuploidies in the middle trimester (15-20 weeks of gestation, with the optimal detection gestational week 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). (III) 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) Inquire 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 evaluation (ultrasound measurement of cervical length). (D) Antenatal examination at 24-28 weeks of pregnancy 1. Health education and guidance: (1) Awareness and prevention of preterm labor. (2) The significance of screening for gestational diabetes mellitus (GDM). 2. Routine health care: (1) Inquire about fetal movement, vaginal bleeding, contractions, diet and exercise. (2) Physical examination, same as 14-19 weeks gestation +6 prenatal examination. 3.Required items: (1) 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 may not be necessary first, and those who have the conditions can directly perform 75gOGTT, whose upper limit of normal is 5.1mmol/L for fasting blood glucose, 10.0mmol/L for 1h blood glucose, and 8.5mmol/L for 2h blood glucose, or through the detection of fasting blood glucose seat screening criteria. (2) Urine routine. 4, Preparatory items: (1) anti-D titer test (Rh negative). (2) Cervicovaginal secretion test for fetal fibronectin (fFN) level (for those at high risk of preterm labor). (E) Prenatal examination at 30-32 weeks of pregnancy 1. Health education and guidance: (1) Guidance on mode of delivery. (2) Begin to pay attention to fetal movement. (3) Breastfeeding instruction. (4) Newborn care guidance. 2.Routine health care: (1) Ask about fetal movement, vaginal bleeding, contractions, diet and exercise. (2) Physical examination, same as 14-19 weeks of pregnancy +6 prenatal examination; fetal position examination. 3.Required examination: (1) blood routine, urine routine. (2) Ultrasonography: fetal growth and development, amniotic fluid volume, fetal position, placenta position. (4) Preparatory items: for those at high risk of preterm labor, ultrasound measurement of cervical length or cervicovaginal secretion to detect fFN level. (F) 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. 2. Routine health care: (1) Inquire about fetal movement, vaginal bleeding, contractions, skin itching, diet, exercise, and preparation for delivery. (2) Physical examination, same as pregnancy 30-32 prenatal examination. 3.Required items: urine routine. 4.Preparatory items: (1) 35-37 weeks of pregnancy Group B Streptococcus (GBS) screening: pregnant women with high-risk factors (such as diabetes mellitus, newborns born in the previous pregnancy with GBS infection, etc.), take the perianal and the lower third of the vagina for culture of the secretion. (2) Liver function and serum bile acid test at 32-34 weeks of gestation (pregnant women in areas with high incidence of ICP). (3) Electronic fetal cardiac monitoring (no load test, NST) test starting at 34 weeks of gestation (high-risk pregnant women). (4) Electrocardiogram review (high-risk pregnant women). (VII) Prenatal examination at 37-41 weeks of pregnancy 1. Health education and guidance: (1) Knowledge related to labor (symptoms of labor, guidance on delivery methods, labor analgesia). (2) Guidance on immunization for newborns. (3) Guidance on the puerperium. (4) Fetal intrauterine monitoring. (5) Hospitalization and induction of labor if pregnancy is ≥41 weeks. 2. Routine health care: (1) Inquire about fetal movement, contractions, and redness. (2) Physical examination, same as pregnancy 30-32 prenatal examination; cervical examination and Bishop score. 3. Required items: (1) ultrasonography: assess fetal size, amniotic fluid volume, placental maturity, fetal position and the ratio of peak systolic to end-diastolic flow rate of the umbilical artery (S/D value). (2) NST examination (once a week). 4.Remarked items: None. C. What is not recommended for routine examination during pregnancy 1. Extrapelvic measurements: There is sufficient evidence to show that extrapelvic measurements do not predict cephalopelvic disproportion at the time of delivery. Therefore, there is no need to routinely check extra-pelvic measurements during pregnancy. For vaginal delivery, the pelvic outlet diameter can be measured in late pregnancy. Toxoplasma gondii, cytomegalovirus and herpes simplex virus serologic screening: there is no mature screening method for these three pathogens, and serologic specific antibody testing of pregnant women cannot confirm when a pregnant woman is infected, whether the fetus is involved, and whether there are any long-term sequelae, and it cannot be based on the results of the serologic screening of pregnant women to decide whether or not termination of pregnancy is necessary. 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 intervention. 3, BV screening: the incidence of BV in pregnancy is 10-20%, which is related to the occurrence of preterm labor, high-risk pregnant women with preterm labor can be screened for BV, but it is not suitable for all pregnant women to carry out routine BV screening. 4, cervicovaginal secretion test fFN and ultrasonography to assess the cervix: pregnant women at high risk of preterm labor, the value of these two screening is that a negative result suggests that there is no likelihood of preterm labor in the near future, thus minimizing unnecessary interventions. However, there is insufficient evidence to support cervicovaginal secretion fFN testing and ultrasound cervical evaluation in all pregnant women. 5. Urine protein and blood tests at each prenatal visit: Urine protein and blood tests are not required at each prenatal visit, but may be repeated in pregnant women with hypertensive disorders of pregnancy and anemia of pregnancy. 6. Thyroid function screening: hypothyroidism in pregnant women affects the development of children's neurointelligence. Some experts suggest screening thyroid function (FT3, FT4, TSH) in all pregnant women, but there is not enough evidence to support screening thyroid function in all pregnant women, and adequate iodine intake should be ensured during pregnancy. 7. Tuberculosis screening: At present, there is not enough evidence to support screening for tuberculosis (including PPD test and chest X-ray) for all pregnant women. High-risk pregnant women (high TB prevalence areas, poor living conditions, HIV infection, drug addicts) can be screened for TB at any point in their pregnancy.