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. Liu Zongyin, Department of Obstetrics and Gynecology, Baoji Maternal and Child Health Hospital In recent years, as the understanding of perinatal complications and prenatal screening techniques have advanced, 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) Assess the history of previous chronic diseases, family and genetic history, those who are not suitable for pregnancy should be informed in time. (3) Detailed information about the history of adverse pregnancy and delivery. (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 that at least four antenatal checkups are needed at gestational weeks <16 weeks, 24-28 weeks, 30-32 weeks, and 36-38 weeks, respectively. According to 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 as appropriate. 2. The contents of routine examination are not recommended during pregnancy 1. extra-pelvic measurement: there is sufficient evidence that extra-pelvic measurement does 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.