are prenatal doctor visits considered preventive

Well-Women Visits and Prenatal Care under the ACA’s Women’s Health Amendment

By: Susan Berke Fogel

Executive Summary

The Affordable Care Act (ACA) recognizes that preventive health services in general, and women’s preventive health services in particular, are critical to individual and community health, and that cost is often a barrier to accessing needed preventive care. In addition to the Essential Health Benefits requirement to cover maternity care and preventive services, the ACA adds § 2713(a)(4) to the Public Health Service Act (the Women’s Health Amendment) to require coverage of women’s health preventive services, including prenatal care, without cost sharing.

The Affordable Care Act (ACA) recognizes that preventive health services in general, and women?s preventive health services in particular, are critical to individual and community health, and that cost is often a barrier to accessing needed preventive care. In addition to the Essential Health Benefits requirement to cover maternity care and preventive services, the ACA adds § 2713(a)(4) to the Public Health Service Act (the Women’s Health Amendment) to require coverage of women’s health preventive services, including prenatal care, without cost sharing.

The ACA Requires Coverage of Preventive Services for Women

• Items or services that have a rating of A or B in the recommendations of the U.S. Preventive Services Task Force,
• The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) recommended vaccinations,
•  Preventive care and screenings for infants, children, and adolescents, as provided for in guidelines supported by the Health Resources and Services Administration (HRSA),
• Additional women’s health preventive care and screenings, to fill in the gaps and supplement the U.S. Preventive Services Task Force recommendations, and as provided for in guidelines supported by HRSA’s the Women’s Health Amendment.[2]

The recommended content of the [well-woman prenatal care] visit includes specific tests and procedures (e.g., blood pressure, weight, urine test, uterine size and fetal heart rate assessment, glucose tolerance testing, and screening for specific sexually transmitted infections and genetic or developmental conditions), as well as topics for counseling and guidance (e.g., tobacco avoidance and nutrition).[6]

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Preventive Care: What's Free and What's Not

Thanks to the Affordable Care Act , health insurers in the U.S. have to cover certain preventive health care without requiring you to pay a deductible , copayment, or coinsurance . That rule applies to all non- grandfathered major medical plans in both the individual/family and employer-sponsored markets.

This article will explain how the preventive care rules work, what services are covered, and what you need to be aware of in terms of potential costs when you go to the doctor for a check-up.

So, what exactly counts as preventive care? Here’s the list of preventive care services for adults that, if recommended for you by your healthcare provider, must be provided free of cost-sharing .

Children have a different list , and there's also an additional list of fully covered preventive services for women .

As long as your health plan isn't grandfathered (or among the types of coverage that aren't regulated by the Affordable Care Act at all, such as short-term health insurance or fixed indemnity plans ), any services on those lists will be fully covered by your plan, regardless of whether you've met your deductible or how long you've been enrolled.

But keep in mind that you'll need to use an in-network medical provider in order to obtain zero-cost preventive care.

Preventive care is one of the ACA's essential health benefits (EHBs). But it's the only one that has to be covered with no cost-sharing . And it's the only one that has to be covered by large group health plans ; the rest of the EHBs only have to be covered on individual/family and small group health plans (although most large employer plans do tend to include all of the EHBs).

Covered preventive care includes:

Cancer prevention measures:

• Colorectal cancer related : for adults age 50 to 75, including screening colonoscopies, removal of polyps discovered during a screening colonoscopy, and anesthesia services required to perform the screening colonoscopy. Note that people do sometimes report being charged for polyp removal during a regular screening colonoscopy, but that is not allowed under federal rules. However, if the colonoscopy is being done in conjunction with any sort of symptoms, or if it's being done more frequently than the normal schedule, it will be considered diagnostic rather than preventive, which means regular cost-sharing rules would apply. For example, if a colonoscopy is being done as a follow-up to a previous colonoscopy in which a polyp was found; doctors sometimes recommend a follow-up after three years, which would generally not be covered by health insurance, since that's outside the regular screening guidelines of once per decade. It's a good idea to thoroughly discuss colonoscopy coverage with your health insurer in order to make sure you fully understand what is and isn't covered under the screening guidelines.
• Breast cancer related : including screening mammograms every 1-2 years for women over 40, BRCA genetic testing and counseling for women at high risk, and breast cancer chemoprevention counseling for women at high risk. As is the case for colonoscopies, mammograms are only covered with zero cost-sharing if they're done purely as a screening measure. If you find a lump in your breast and your healthcare provider wants a mammogram to check it out, your health plan's regular cost-sharing (deductible, copay, and/or coinsurance) will apply, since this will be a diagnostic mammogram rather than a screening mammogram. This will be true even if you've never had a mammogram before, or even if you're due for your regularly-scheduled screening mammogram.
• Cervical cancer related : screening covered once every three years from ages 21 through 65; human papillomavirus DNA testing can instead be done in conjunction with a pap test once every five years.
• Lung cancer related : screening for smokers or those who’ve quit smoking within the last 15 years and are between the ages of 55 and 80

Infectious disease prevention measures:

• Hepatitis C screening one time for anyone born 1945-1965 and for any adult at high risk.
• Hepatitis B screening for pregnant women at their first prenatal visit, and for any adults considered at high risk.
• HIV screening for anyone between ages 15-65, and for others at high risk.
• Syphilis screening for adults at high risk and all pregnant women.
• Chlamydia screening for young women and women at high risk.
• Gonorrhea screening for women at high risk.
• Sexually transmitted infection prevention counseling for adults at increased risk.
• Routine immunizations as recommended by age for
• COVID-19 ( recommendation was added in December 2020 )
• Hepatitis A
• Hepatitis B
• Herpes Zoster(shingles)
• Human Papillomavirus
• Influenza (flu)
• Measles, Mumps, Rubella
• Meningococcal
• Pneumococcal
• Tetanus, Diphtheria, Pertussis (lock-jaw and whooping cough)
• Varicella (chickenpox)
• Obesity screening and counseling.
• Diet counseling for adults at high risk for chronic disease.
• Recommended cardiovascular disease-related preventive measures, including cholesterol screening for high-risk adults and adults of certain ages, blood pressure screening, and aspirin use when prescribed for cardiovascular disease prevention (and/or colorectal cancer prevention) in adults ages 50 to 59.
• Diabetes type 2 screening for overweight adults age 40 to 70
• Abdominal Aortic Aneurysm screening one time for men who have ever smoked

Recommended substance abuse and mental health preventive care:

• Alcohol misuse screening and counseling
• Tobacco use screening and cessation intervention for tobacco users
• Depression screening
• Domestic violence and interpersonal violence screening and counseling for all women

Woman-Specific Preventive Care

• Well-woman visits for women under 65 (note that most Americans transition to Medicare at age 65, and Medicare has its own preventive care coverage).
• Osteoporosis screening for women over 60 based on risk factors.
• Contraception for women with reproductive capacity as prescribed by a healthcare provider. This includes all FDA-approved methods of female contraception, including IUDs, implants, and sterilization. The Supreme Court ruled in 2020 that employers with a "religious or moral objection" to contraception can opt out of providing this coverage as part of their group health plan. But the Biden administration has proposed a rule change that would eliminate the moral objection, and that would ensure access to zero-cost contraception for women whose employers have a religious objection. (Note that although male contraception is not a federally-mandated benefit, some states do require state-regulated health plans to cover vasectomies; state-regulated plans do not include self-insured plans , which account for the majority of employer-sponsored coverage. )
• Preventive services for pregnant or nursing women, including:
• Anemia screening
• Breastfeeding support and counseling including supplies
• Folic acid supplements for pregnant women and those who may become pregnant
• Gestational diabetes screening at 24 and 28 weeks gestation and those at high risk
• Hepatitis B screening at first prenatal visit
• Rh incompatibility screening for all pregnant women and follow up screening if at increased risk
• Expanded tobacco counseling
• Urinary tract or other infection screening
• Syphilis screening

Who Determines Which Preventive Care Benefits Are Covered?

So where did the government come up with the specific list of preventive services that health plans have to cover? The covered preventive care services are things that are:

• Rated “A” or “B” in the current United States Preventive Services Task Force recommendations. (In 2023, a federal judge overturned the requirement that health plans cover preventive services recommended by the USPSTF since 2010. But that ruling has been put on hold while the case is appealed, so health plans must continue to cover these services. )
• Provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA updated its recommendations for women's preventive services in 2019; the updated guidelines are available here ).
• Recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention

All of the services listed above (and on the lists maintained by HealthCare.gov ) meet at least one of those three guidelines for recommended preventive care. But those guidelines change over time, so the list of covered preventive care services can also change over time. For example, COVID vaccines were added to the list of covered preventive care in December 2020.

If there's a specific preventive care treatment that you don't see on the covered list, it's probably not currently recommended by medical experts. That's the case with PSA screening (it's got a "C" or a "D" rating, depending on age, by USPSTF).

Vitamin D screening is another example of a preventive care service that isn't currently recommended (or required to be covered). For now, the USPSTF has determined that there's insufficient evidence to determine whether to recommend Vitamin D screening in asymptomatic adults. But they do note that more research is needed, so it's possible that the recommendation could change in the future.

It's also important to understand that when you go to your healthcare provider for preventive care, they might provide other services that aren't covered under the free preventive care benefit. For example, if your healthcare provider does a cholesterol test and also a complete blood count, the cholesterol test would be covered but the CBC might not be (it would depend on your health plan's rules, as not all of the tests included in the CBC are required to be covered).

And some care can be preventive or diagnostic, depending on the situation. Preventive mammograms are covered, for example, but your insurer can charge you cost-sharing if you have a diagnostic mammogram performed because you or your health provider find a lump or have a specific concern that the mammogram is intended to address.

Or if you need a follow-up screening sooner than the regular recommended screening guidelines (due to an issue that was found on the last screening test, for example), the follow-up may have your plan's regular cost-sharing. If in doubt, talk with your insurer beforehand so that you'll understand how your preventive care benefits work before the bill arrives.

Preventive Care Related to COVID-19

The COVID-19 pandemic gripped the world starting in early 2020. There's normally a lengthy process (which can last nearly two years) involved with adding covered preventive services through the channels described above.

But Congress quickly took action to ensure that most health insurance plans would fully cover the cost of COVID-19 testing, although that only lasted through the end of the COVID public health emergency, which ended in May 2023.

And the legislation that Congress enacted in the spring of 2020—well before COVID-19 vaccines became available—ensured that once the vaccines did become available, non-grandfathered health plans would cover the vaccine nearly immediately , without any cost-sharing.

ACIP voted in December 2020 to add the COVID-19 vaccine to the list of recommended vaccines, and non-grandfathered health plans were required to add the coverage within 15 business days (well before the vaccine actually became available for most Americans).

That continues to be the case, even after the public health emergency has ended. Recommended COVID vaccines continue to be fully covered by non-grandfathered health plans, just like other recommended vaccines.

Obviously, the medical costs related to COVID-19 go well beyond testing. People who need to be hospitalized for the disease can face thousands of dollars in out-of-pocket costs, depending on how their health insurance plan is structured. Many health insurance companies opted to go beyond the basic requirements, temporarily offering to fully cover COVID-19 treatment , as well as testing, for a limited period of time. But those cost-sharing waivers had mostly expired by the end of 2020.

When Your Health Plan Might Not Cover Preventive Care Without Cost-Sharing

If your health insurance is a grandfathered health plan, it’s allowed to charge cost-sharing for preventive care. Since grandfathered health plans lose their grandfathered status if they make substantial changes to the plan, and can no longer be purchased by individuals or businesses, they’re becoming less and less common as time passes.

But there are still a substantial number of people with grandfathered health coverage; among workers who have employer-sponsored health coverage, 14% were enrolled in grandfathered plans as of 2020. Your health plan literature will tell you if your health plan is grandfathered. Alternatively, you can call the customer service number on your health insurance card or check with your employee benefits department.

If you have a managed care health plan that uses a provider network , your health plan is allowed to charge cost-sharing for preventive care you get from an out-of-network provider. If you don’t want to pay for preventive care, use an in-network provider.

Also, if your health plan is considered an "excepted benefit," it's not regulated by the Affordable Care Act and thus not required to cover preventive care without cost-sharing (or at all). This includes coverage such as short-term health plans , fixed indemnity plans , healthcare sharing ministry plans , and Farm Bureau plans in states where they're exempted from insurance rules.

Preventive Care Isn’t Really Free

Although your health plan must pay for preventive health services without charging you a deductible, copay, or coinsurance, this doesn’t really mean those services are free to you. Your insurer takes the cost of preventive care services into account when it sets premium rates each year.

Although you don’t pay cost-sharing charges when you receive preventive care, the cost of those services is wrapped into the cost of your health insurance. This means, whether or not you choose to get the recommended preventive care, you’re paying for it through the cost of your health insurance premiums anyway.

Under the Affordable Care Act, certain preventive care has to be covered in full (ie, without a deductible, copay, or coinsurance) on all non-grandfathered major medical plans. Covered preventive care includes a long list of services that are recommended by medical experts, although it does not include all medical care that's considered preventive. And some services, such as mammograms, pap test, or colonoscopies—can be fully paid for by the health plan or not. Coverage will depend on whether they're done at regular screening intervals without any symptoms, or to diagnose a problem or follow-up after a previous test returned abnormal results.

A Word From Verywell

Your health plan likely covers a wide range of preventive services at no cost to you, and it's in your best interest to take advantage of these benefits. But to avoid being surprised by an unexpected medical bill, you'll want to be sure you understand the details prior to receiving preventive care. Make sure you use a provider who is in your health plan's network, and make sure you understand exactly what tests or services will be provided during the visit. If you decide to go beyond what your health plan will cover, that's perfectly fine and is a decision you'll make with your medical provider.

U.S. Centers for Medicare & Medicaid Services.  Preventive care benefits for adults .

Centers for Medicare and Medicaid Services. Affordable Care Act Implementation FAQs - Set 12 (See Q5) .

Rovner, Julie. Kaiser Health News. High Court Allows Employers To Opt Out of ACA's Mandate On Birth Control Coverage .

U.S. Center for Medicare and Medicaid Services. Coverage of Certain Preventive Services Under the Affordable Care Act: Proposed Rules . January 30, 2023.

Rakoczy, Christy. lendedu. Does Health Insurance Cover the Cost of a Vasectomy?

Kaiser Family Foundation. 2021 Employer Health Benefits Survey .

American Cancer Society. Patient Groups Applaud Circuit Court Ruling That Largely Stays Remedy in Braidwood Management v. Becerra . June 13, 2023.

Health Resources and Services Administration. Women's Preventive Services Guidelines .

Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) .

U.S. Preventive Services Task Force. Final Recommendation Statement: Prostate Cancer: Screening .

U.S. Preventive Services Task Force. Vitamin D Deficiency in Adults: Screening .

Pollitz, Karen. Kaiser Family Foundation. Private Health Coverage of COVID-19: Key Facts and Issues .

America's Health Insurance Plans. Health Insurance Providers Respond to Coronavirus (COVID-19) .

Kaiser Family Foundation. 2020 Employer Health Benefits Survey .

By Elizabeth Davis, RN Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.

Call or Text the Maternal Mental Health Hotline

Parents: don’t struggle alone

The National Maternal Mental Health Hotline provides free, confidential mental health support. Pregnant people, moms, and new parents can call or text any time, every day.

Start a call: 1-833-TLC-MAMA (1-833-852-6262)

Text now: 1-833-TLC-MAMA (1-833-852-6262)

Use TTY: Use your preferred relay service or dial 711 , then 1-833-852-6262 .

Learn more about the Hotline

Women’s Preventive Services Guidelines

Affordable care act expands prevention coverage for women's health and well-being.

The Affordable Care Act (ACA) – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention services affordable and accessible for all Americans by requiring most health insurance plans to provide coverage without cost sharing for certain recommended preventive services. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.

Under the ACA, most private health insurers must provide coverage of women's preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services –with no cost sharing. Under section 2713 of the Public Health Service Act, as modified by the ACA, non-grandfathered group health plans and non-grandfathered group and individual health insurance coverage are required to cover specified preventive services without a copayment, coinsurance, deductible, or other cost sharing, including preventive care and screenings for women as provided for in comprehensive guidelines supported by HRSA for this purpose.

The law recognizes and HHS understands the unique health needs of women across their lifespan. The purpose of WPSI is to improve women’s health across the lifespan by identifying preventive services and screenings to be used in clinical practice and, when supported by HRSA, incorporated in the Guidelines.

HRSA-Supported Women's Preventive Services Guidelines: Background

The HRSA-supported Women’s Preventive Services Guidelines (Guidelines) were originally established in 2011 based on recommendations from a Department of Health and Human Services' commissioned study by the Institute of Medicine (IOM), now known as the National Academy of Medicine (NAM).

Since the establishment of the Guidelines, there have been advancements in science and gaps identified in clinical practice. To address these, in 2016, the Health Resources and Services Administration (HRSA) awarded a five-year cooperative agreement, the Women’s Preventive Services Initiative (WPSI), to the American College of Obstetricians and Gynecologists (ACOG) to convene a coalition of clinician, academic, and consumer-focused health professional organizations to conduct a scientifically rigorous review to develop recommendations for updated Guidelines in accordance with the model created by the NAM Clinical Practice Guidelines We Can Trust. The American College of Obstetricians and Gynecologists (ACOG) formed an expert panel, also called the WPSI, for this purpose.

In March 2021, ACOG was awarded a subsequent cooperative agreement to review and recommend updates to the Guidelines. Under ACOG, WPSI reviews existing Women’s Preventive Services Guidelines biennially, or upon the availability of new evidence, as well as new preventive services topics. New topics for future consideration can be submitted on a rolling basis at the Women’s Preventive Services Initiative website .

HRSA-Supported Women's Preventive Services Guidelines

HRSA supports the Women’s Preventive Services Guidelines (Guidelines) listed below that address health needs specific to women. 

In December 2022, HRSA approved updates to the Guidelines for two listed preventive services:  Screening for Gestational Diabetes Mellitus (to be retitled as “Screening for Diabetes in Pregnancy”) and Screening for Diabetes Mellitus after Pregnancy (to be retitled as “Screening for Diabetes after Pregnancy”). The Guidelines are provided in the table below. 

Updated Guidelines

Current guidelines, implementation considerations.

While not included as part of the HRSA-supported guidelines, the Women's Preventive Services Initiative, through ACOG, also developed implementation considerations, available at the Women's Preventive Services Initiative website , which provide additional clarity on implementation of the guidelines into clinical practice. The implementation considerations are separate from the clinical recommendations, are informational, and are not part of the formal action by the Administrator under Section 2713.

* Non-grandfathered plans and coverage (generally, plans or policies created or sold after March 23, 2010, or older plans or policies that have been changed in certain ways since that date) are required to provide coverage without cost sharing consistent with these guidelines beginning with the first plan year (in the individual market policy year) that begins on or after December 30, 2022. Before that time, non-grandfathered plans are generally required to provide coverage without cost sharing consistent with the guidelines as previously updated in 2019.

** (I)(a) Objecting entities—religious beliefs.

(1) These Guidelines do not provide for or support the requirement of coverage or payments for contraceptive services with respect to a group health plan established or maintained by an objecting organization, or health insurance coverage offered or arranged by an objecting organization, and thus the Health Resources and Service Administration exempts from any Guidelines requirements issued under 45 CFR 147.130(a)(1)(iv) that relate to the provision of contraceptive services: (i) A group health plan and health insurance coverage provided in connection with a group health plan to the extent the non-governmental plan sponsor objects as specified in paragraph (I)(a)(2) of this note. Such non-governmental plan sponsors include, but are not limited to, the following entities: (A) A church, an integrated auxiliary of a church, a convention or association of churches, or a religious order; (B) A nonprofit organization; (C) A closely held for-profit entity; (D) A for-profit entity that is not closely held; or (E) Any other non-governmental employer; (ii) An institution of higher education as defined in 20 U.S.C. 1002 in its arrangement of student health insurance coverage, to the extent that institution objects as specified in paragraph (I)(a)(2) of this note. In the case of student health insurance coverage, section (I) of this note is applicable in a manner comparable to its applicability to group health insurance coverage provided in connection with a group health plan established or maintained by a plan sponsor that is an employer, and references to “plan participants and beneficiaries” will be interpreted as references to student enrollees and their covered dependents; and (iii) A health insurance issuer offering group or individual insurance coverage to the extent the issuer objects as specified in paragraph (I)(a)(2) of this note. Where a health insurance issuer providing group health insurance coverage is exempt under this paragraph (I)(a)(1)(iii), the plan remains subject to any requirement to provide coverage for contraceptive services under these Guidelines unless it is also exempt from that requirement.

(2) The exemption of this paragraph (I)(a) will apply to the extent that an entity described in paragraph (I)(a)(1) of this note objects to its establishing, maintaining, providing, offering, or arranging (as applicable) coverage, payments, or a plan that provides coverage or payments for some or all contraceptive services, based on its sincerely held religious beliefs. (b) Objecting individuals—religious beliefs. These Guidelines do not provide for or support the requirement of coverage or payments for contraceptive services with respect to individuals who object as specified in this paragraph (I)(b), and nothing in 45 CFR 147.130(a)(1)(iv), 26 CFR 54.9815–2713(a) (1)(iv), or 29 CFR 2590.715-2713(a)(1)(iv) may be construed to prevent a willing health insurance issuer offering group or individual health insurance coverage, and as applicable, a willing plan sponsor of a group health plan, from offering a separate benefit package option, or a separate policy, certificate or contract of insurance, to any individual who objects to coverage or payments for some or all contraceptive services based on sincerely held religious beliefs.

(II)(a) Objecting entities—moral convictions.

(1) These Guidelines do not provide for or support the requirement of coverage or payments for contraceptive services with respect to a group health plan established or maintained by an objecting organization, or health insurance coverage offered or arranged by an objecting organization, and thus the Health Resources and Service Administration exempts from any Guidelines requirements issued under 45 CFR 147.130(a)(1)(iv) that relate to the provision of contraceptive services: (i) A group health plan and health insurance coverage provided in connection with a group health plan to the extent one of the following non-governmental plan sponsors object as specified in paragraph (II)(a)(2) of this note: (A) A nonprofit organization; or (B) A for-profit entity that has no publicly traded ownership interests (for this purpose, a publicly traded ownership interest is any class of common equity securities required to be registered under section 12 of the Securities Exchange Act of 1934); (ii) An institution of higher education as defined in 20 U.S.C. 1002 in its arrangement of student health insurance coverage, to the extent that institution objects as specified in paragraph (II)(a)(2) of this note. In the case of student health insurance coverage, section (I) of this note is applicable in a manner comparable to its applicability to group health insurance coverage provided in connection with a group health plan established or maintained by a plan sponsor that is an employer, and references to “plan participants and beneficiaries” will be interpreted as references to student enrollees and their covered dependents; and (iii) A health insurance issuer offering group or individual insurance coverage to the extent the issuer objects as specified in paragraph (II)(a)(2) of this note. Where a health insurance issuer providing group health insurance coverage is exempt under this paragraph (II)(a)(1)(iii), the group health plan established or maintained by the plan sponsor with which the health insurance issuer contracts remains subject to any requirement to provide coverage for contraceptive services under these Guidelines unless it is also exempt from that requirement.

(2) The exemption of this paragraph (II)(a) will apply to the extent that an entity described in paragraph (II)(a)(1) of this note objects to its establishing, maintaining, providing, offering, or arranging (as applicable) coverage or payments for some or all contraceptive services, or for a plan, issuer, or third party administrator that provides or arranges such coverage or payments, based on its sincerely held moral convictions. (b) Objecting individuals—moral convictions. These Guidelines do not provide for or support the requirement of coverage or payments for contraceptive services with respect to individuals who object as specified in this paragraph (II)(b), and nothing in § 147.130(a)(1)(iv), 26 CFR 54.9815–2713(a) (1)(iv), or 29 CFR 2590.715-2713(a)(1)(iv) may be construed to prevent a willing health insurance issuer offering group or individual health insurance coverage, and as applicable, a willing plan sponsor of a group health plan, from offering a separate policy, certificate or contract of insurance or a separate group health plan or benefit package option, to any individual who objects to coverage or payments for some or all contraceptive services based on sincerely held moral convictions.

(III) Definition. For the purposes of this note, reference to “contraceptive” services, benefits, or coverage includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling, to the extent specified for purposes of these Guidelines.

See Federal Register Notice: Religious Exemptions and Accommodations for Coverage of Certain Preventive Services under the Affordable Care Act (PDF - 474 KB)

*** General Notice On July 29, 2019, the District Court for the Northern District of Texas issued an injunction preventing the enforcement of “the Contraceptive Mandate, codified at 42 U.S.C. § 300gg–13(a)(4), 45 C.F.R. § 147.130(a)(1)(iv), 29 C.F.R. § 2590.715–2713(a)(1)(iv), and 26 C.F.R. § 54.9815–2713(a)(1)(iv), against any group health plan, and any health insurance coverage provided in connection with a group health plan, that is sponsored by an Employer Class member[,]” to the extent that such coverage conflicts with the Employer Class member’s sincerely held religious objections to such coverage, in connection with DeOtte v. Azar, No. 4:18-CV-00825-O, 2019 WL 3786545 (N.D. Tex. July 29, 2019). The injunction also prevents the enforcement of “the Contraceptive Mandate” to the extent it requires an "Individual Class member[] to provide coverage or payments for contraceptive services" to which the individual objects based on sincerely held religious beliefs, if a health insurance issuer and, if applicable, a sponsor of a group health plan, is willing to offer the Individual Class member a separate policy or plan that omits such contraceptive coverage. On December 17, 2021, the Fifth Circuit vacated the injunction in DeOtte v. Nevada, No. 19-10754 (5th Cir. Dec. 17, 2021). However, as of the date of this publication, the Fifth Circuit has yet to issue a mandate in connection with its order, and the injunction remains in place.

**** Education and counseling includes all methods of contraception, including but not limited to, hormonal, devices, surgical, barrier, and fertility-based awareness methods, including lactation amenorrhea.

***** FDA's Birth Control Guide This refers to  FDA’s Birth Control Guide  (PDF - 450 KB) as posted on December 22, 2021 with the exception of sterilization surgery for men, which is beyond the scope of the WPSI.

****** Notice This sentence, included at the end of the "Contraception" section of the previous Guidelines, remains at the conclusion of the "Contraception" section of the 2021 Guidelines per a Final Order issued on December 6, 2022, in Tice-Harouff v. Johnson, Eastern District of Texas (Tyler Division), Case No. 6:22-cv-201-JDK. This is consistent with footnote **** above, which indicates that education and counseling within the "Contraception" section of the 2021 Guidelines includes fertility awareness-based methods, including lactation amenorrhea.

[email protected] .

• HRSA/MCHB Preventive Guidelines and Screening for Women, Children, and Youth
• Historical Files
• 2019 Guidelines
• 2016 Guidelines
• Institute of Medicine:  Clinical Preventive Services for Women  (2011)
• Bright Futures
• Advisory Committee on Heritable Disorders in Newborns and Children

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Prenatal care

Prenatal care is the health care you get while you are pregnant. 

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. Take care of yourself and your baby by:

• Getting  early  prenatal care. If you know you're pregnant, or think you might be, call your doctor to schedule a visit.
• Getting  regular  prenatal care. Your doctor will schedule you for many checkups over the course of your pregnancy. Don't miss any — they are all important.
• Following your doctor's advice.

Why do I need prenatal care?

Prenatal care can help keep you and your baby healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.

I am thinking about getting pregnant. How can I take care of myself?

You should start taking care of yourself  before  you start trying to get pregnant. This is called preconception health. It means knowing how health conditions and risk factors could affect you or your unborn baby if you become pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems also can affect pregnancy.

Talk to your doctor before pregnancy to learn what you can do to prepare your body. Women should prepare for pregnancy before becoming sexually active. Ideally, women should give themselves at least 3 months to prepare before getting pregnant.

The five most important things you can do before becoming pregnant are:

• Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of  folic acid  every day for at least 3 months before getting pregnant to lower your risk of some birth defects of the brain and spine. You can get folic acid from some foods. But it's hard to get all the folic acid you need from foods alone. Taking a vitamin with folic acid is the best and easiest way to be sure you're getting enough.
• Stop smoking and drinking alcohol. Ask your doctor for help.
• If you have a medical condition, be sure it is under control. Some conditions include  asthma ,  diabetes ,  depression ,  high blood pressure ,  obesity , thyroid disease, or  epilepsy . Be sure your vaccinations are up to date.
• Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Some  medicines  are not safe during pregnancy. At the same time, stopping medicines you need also can be harmful.
• Avoid contact with toxic substances or materials at work and at home that could be harmful. Stay away from chemicals and cat or rodent feces.

I'm pregnant. What should I do — or not do — to take care of myself and my unborn baby?

Follow these do's and don'ts to take care of yourself and the precious life growing inside you:

Health care do's and don'ts

• Get early and regular prenatal care. Whether this is your first pregnancy or third, health care is extremely important. Your doctor will check to make sure you and the baby are healthy at each visit. If there are any problems, early action will help you and the baby.
• Take a multivitamin or prenatal vitamin with 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day. Folic acid is most important in the early stages of pregnancy, but you should continue taking folic acid throughout pregnancy.
• Ask your doctor before stopping any medicines or starting any new medicines. Some medicines are not safe during pregnancy. Keep in mind that even over-the-counter medicines and herbal products may cause side effects or other problems. But not using medicines you need could also be harmful.
• Avoid x-rays. If you must have dental work or diagnostic tests, tell your dentist or doctor that you are pregnant so that extra care can be taken.
• Get a flu shot. Pregnant women can get very sick from the flu and may need hospital care.

Food do's and don'ts

• Eat a variety of healthy foods.  Choose fruits, vegetables, whole grains, calcium-rich foods, and foods low in saturated fat. Also, make sure to drink plenty of fluids, especially water.
• Get all the nutrients you need each day, including iron. Getting enough iron prevents you from getting anemia, which is linked to  preterm birth  and  low birth weight . Eating a variety of healthy foods will help you get the nutrients your baby needs. But ask your doctor if you need to take a daily prenatal vitamin or iron supplement to be sure you are getting enough.
• Protect yourself and your baby from food-borne illnesses, including  toxoplasmosis  (TOK-soh-plaz-MOH-suhss) and  listeria  (lih-STEER-ee-uh). Wash fruits and vegetables before eating. Don't eat uncooked or undercooked meats or fish. Always handle, clean, cook, eat, and store foods properly.
• Don't eat fish with lots of mercury, including swordfish, king mackerel, shark, and tilefish.

Lifestyle do's and don'ts

• Gain a healthy amount of weight. Your doctor can tell you how much weight gain you should aim for during pregnancy.
• Don't smoke, drink alcohol, or use drugs. These can cause long-term harm or death to your baby. Ask your doctor for help quitting.
• Unless your doctor tells you not to, try to get at least 2 hours and 30 minutes of moderate-intensity aerobic activity a week. It's best to spread out your workouts throughout the week. If you worked out regularly before pregnancy, you can keep up your activity level as long as your health doesn't change and you talk to your doctor about your activity level throughout your pregnancy. Learn more about  how to have a fit pregnancy .
• Don't take very hot baths or use hot tubs or saunas.
• Get plenty of sleep and find ways to control stress.
• Get informed. Read books, watch videos, go to a childbirth class, and talk with moms you know.
• Ask your doctor about childbirth education classes for you and your partner. Classes can help you prepare for the birth of your baby.

Environmental do's and don'ts

• Stay away from chemicals like  insecticides , solvents (like some cleaners or paint thinners), lead, mercury, and paint (including paint fumes). Not all products have pregnancy warnings on their labels. If you're unsure if a product is safe, ask your doctor before using it. Talk to your doctor if you are worried that chemicals used in your workplace might be harmful.
• If you have a cat, ask your doctor about  toxoplasmosis . This infection is caused by a parasite sometimes found in cat feces. If not treated toxoplasmosis can cause birth defects. You can lower your risk of by avoiding cat litter and wearing gloves when gardening. 
• Avoid contact with rodents, including pet rodents, and with their urine, droppings, or nesting material. Rodents can carry a virus that can be harmful or even deadly to your unborn baby.
• Take steps to avoid illness, such as washing hands frequently.
• Stay away from secondhand smoke.

I don't want to get pregnant right now. Should I still take folic acid every day?

Yes! Birth defects of the brain and spine happen in the very early stages of pregnancy, often before a woman knows she is pregnant. By the time she finds out she is pregnant, it might be too late to prevent those birth defects. Also, half of all pregnancies in the United States are not planned. For these reasons, all women who are able to get pregnant need 400 to 800 mcg of folic acid every day.

How often should I see my doctor during pregnancy?

Your doctor will give you a schedule of all the doctor's visits you should have while pregnant. Most experts suggest you see your doctor:

• About once each month for weeks 4 through 28
• Twice a month for weeks 28 through 36
• Weekly for weeks 36 to birth

If you are older than 35 or your pregnancy is high risk, you'll probably see your doctor more often.

What happens during prenatal visits?

During the first prenatal visit, you can expect your doctor to:

• Ask about your health history including diseases, operations, or prior pregnancies
• Ask about your family's health history
• Do a complete physical exam, including a pelvic exam and  Pap test
• Take your blood and urine for lab work
• Check your blood pressure, height, and weight
• Calculate your due date
• Answer your questions

At the first visit, you should ask questions and discuss any issues related to your pregnancy. Find out all you can about how to stay healthy.

Later prenatal visits will probably be shorter. Your doctor will check on your health and make sure the baby is growing as expected.  Most prenatal visits will include:

• Checking your blood pressure
• Measuring your weight gain
• Measuring your abdomen to check your baby's growth (once you begin to show)
• Checking the baby's heart rate

While you're pregnant, you also will have some routine tests. Some tests are suggested for all women, such as blood work to check for anemia, your blood type, HIV, and other factors. Other tests might be offered based on your age, personal or family health history, your ethnic background, or the results of routine tests you have had. Visit the pregnancy section of our website for more details on  prenatal care and tests .

I am in my late 30s and I want to get pregnant. Should I do anything special?

As you age, you have an increasing chance of having a baby born with a birth defect. Yet most women in their late 30s and early 40s have healthy babies. See your doctor regularly before you even start trying to get pregnant. She will be able to help you prepare your body for pregnancy. She will also be able to tell you about how age can affect pregnancy.

During your pregnancy, seeing your doctor regularly is very important. Because of your age, your doctor will probably suggest some extra tests to check on your baby's health.

More and more women are waiting until they are in their 30s and 40s to have children. While many women of this age have no problems getting pregnant, fertility does decline with age. Women over 40 who don't get pregnant after six months of trying should see their doctors for a fertility evaluation. 

Experts define infertility as the inability to become pregnant after trying for one year. If a woman keeps having miscarriages, it's also called infertility. If you think you or your partner may be infertile, talk to your doctor. Doctors are able to help many infertile couples go on to have healthy babies.

Where can I go to get free or reduced-cost prenatal care?

Women in every state can get help to pay for medical care during their pregnancies. This prenatal care can help you have a healthy baby. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy.

To find out about the program in your state:

• Call 800-311-BABY (800-311-2229). This toll-free telephone number will connect you to the Health Department in your area code.
• For information in Spanish, call 800-504-7081.
• Contact your local Health Department.

Did we answer your question about prenatal care?

For more information about prenatal care, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• American College of Obstetricians and Gynecologists Phone:  202-638-5577
• American Pregnancy Association Phone:  972-550-0140
• Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, HHS Phone:  800-370-2943 (TDD: 888-320-6942)
• March of Dimes Phone:  914-997-4488
• National Center on Birth Defects and Developmental Disabilities, CDC, HHS Phone:  800-232-4636 (TDD: 888-232-6348)
• John W. Schmitt, M.D., Associate Professor of Clinical Obstetrics and Gynecology, University of Virginia Medical School
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Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

• Your menstrual cycle, gynecological history and any past pregnancies
• Your personal and family medical history
• Exposure to anything that could be toxic
• Medications you take, including prescription and over-the-counter medications, vitamins or supplements
• Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
• Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

• Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
• Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
• Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
• Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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• Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
• Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
• WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
• Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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Prenatal Care

(medical care during pregnancy).

• Should I see a doctor before I try to get pregnant? |
• What happens at my first doctor visit? |
• What medical care will I need during my pregnancy? |

Prenatal care is medical care you get before you give birth. Prenatal care includes routine doctor visits and routine tests. The doctor checks your health and the health of your developing baby.

Routine visits and tests let your doctor find problems before they cause symptoms

Problems you had before, like high blood pressure or asthma, may need to be treated differently when you're pregnant

Your doctor will tell you how to take care of yourself, including your diet and what vitamins you need

You'll see your doctor once a month in the beginning of pregnancy and more often as you get closer to delivery

Doctors check your weight, your urine, and your blood pressure at each visit

Doctors usually do an ultrasound at least once during pregnancy—more often depending on your health history and symptoms

Should I see a doctor before I try to get pregnant?

It's a good idea to see a doctor before you get pregnant. The doctor can make sure your pregnancy will be as safe as possible and help you prepare to get pregnant. Your doctor will:

Talk to you about how pregnancy might affect any diseases you have

Give you any immunizations you need

Ask you about risk factors for diseases that could be passed to your baby (inherited)

If you have risk factors for inherited diseases, the doctor may recommend doing blood tests as part of genetic screening . The tests look to see if you or your partner carry genes for diseases you could pass on to your child. Some doctors do these tests on everyone because people don't always have risk factors.

If you decide to try to get pregnant, do the following to give your baby the best chance of being healthy:

Take a multivitamin with at least 400 micrograms of

Don’t use tobacco or be around someone who is smoking

Don’t drink alcohol

Avoid scooping used kitty litter or touching cat poop—this can transmit a disease, toxoplasmosis , that damages your baby

Avoid being around people who are sick, especially if they have certain infections such as rubella , chickenpox , or shingles

What happens at my first doctor visit?

You’ll see your doctor once you're about 6 to 8 weeks pregnant. The weeks of pregnancy are counted from the first day of your last menstrual period.

At this visit, your doctor will:

Estimate your due date (the day your doctor expects your baby to be born, usually 40 weeks after the first day of your last period)

Measure your height, weight, and blood pressure

Ask about your health, your medicines, and details about any earlier pregnancies

Check your ankles for swelling

Do a pelvic (internal) exam to check for diseases or other problems

Do a Pap test (a test to check for cancer in your cervix), if you haven't had one in the recommended time period

Take samples of blood and urine for testing

Test for sexually transmitted infections

What medical care will I need during my pregnancy?

You'll see the doctor more often as your pregnancy goes along. After the first visit, you’ll see your doctor:

Every 4 weeks until 28 weeks of pregnancy

Every 2 weeks until 36 weeks

Then once a week until delivery

At each visit, your doctor will:

Take your blood pressure

Look at your ankles for swelling

Measure your uterus

Check your baby’s heartbeat

Check a urine sample for sugar

At about 16 to 20 weeks, your doctor will do an ultrasound to check your fetus's:

Size and growth

The ultrasound can also tell:

Whether you're pregnant with twins or multiples

Whether your fetus has any possible issues, including birth defects or problems with the placenta (the organ that feeds your fetus)

Depending on the ultrasound results, your doctor may do more ultrasounds later in your pregnancy.

At about 24 to 28 weeks, your doctor will do a blood test to check for high blood sugar ( gestational diabetes ).

X-rays aren't a regular part of pregnancy care. If you need an x-ray, you can get one safely by using a lead apron to shield your belly.

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Supporting a healthy pregnancy

If you just took a pregnancy test and got a positive result, there may be a lot going through your mind. After you process the fact that you might be pregnant, the next step for many expecting moms is to schedule a doctor’s appointment. The earlier you start your prenatal care — also known as care you receive while pregnant — the better. Prenatal care is one of the best ways to reduce the risk of complications for both you and your little one, helping to reduce low birthweight 1 and iron-deficiency anemia, which can lead to premature birth. 2

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What happens during a prenatal care visit?

Depending on where you are in your pregnancy, prenatal appointments may include:

An estimated due date

• A review of your medical history
• A physical exam
• Blood tests
• Measuring your baby’s growth
• Checking your baby’s heartbeat
• Checking your blood pressure
• Recording your weight
• A urine sample, or urinalysis, to look for glucose (or sugar) which can indicate pre-existing type 2 diabetes, protein, which can be a sign of preeclampsia (pregnancy induced high blood pressure) and the presence of bacteria, which can indicate a urinary tract infection
• At least one ultrasound, possibly more

Additional tests may be required, depending on your needs. Your provider will decide how often they want to see you throughout your pregnancy.

How often do I need prenatal visits?

If you’re over 35 or have a pre-existing health condition, your doctor may want to see you more frequently. Otherwise, prenatal appointments will likely be scheduled:

• Once a month from weeks 4 to 28
• Every two weeks from weeks 28 to 36
• Every week from weeks 36 to 40

When should I be worried?

Pregnancy can include a range of emotions, from excitement to anxiety. When your body is changing in different ways, it may be hard to know which symptoms are part of the pregnancy process, and which ones could be worrisome. While relatively rare, there are times you shouldn’t wait for your next appointment to address concerns.

Situations that may warrant immediate medical care might include:

Your baby moving less than usual

Vaginal bleeding 3

Strong cramps, a lasting backache or bellyache

A sudden onset of pain or abdominal pain

Blinding headache or blurred vision

Extreme vomiting that may lead to dehydration

Severe headaches that may signal preeclampsia

Contractions that continue for 30 minutes after exercising

Dizziness or chest pain following exercise

Severe itching

A gush of fluids before 37 weeks

When in doubt, get checked out. If you have questions or concerns about your pregnancy do not hesitate to contact your doctor or to seek medical attention.

Other than doctor’s appointments, what does prenatal care include?

Going to the doctor is a great first step in getting the prenatal care you need. Other important aspects of prenatal care include:

• Following a healthy diet.
• Taking your prenatal vitamins every day. Folic acid, a B vitamin, can help prevent major birth defects and help nourish your developing baby. 4
• Maintaining a healthy weight. Talk to your doctor about how much weight you should gain during your pregnancy.
• Not drinking alcohol, using street drugs or smoking. Even small amounts of nicotine during pregnancy can increase the risk for Sudden Infant Death Syndrome. 5 Drinking alcohol increases the risk of having a baby with fetal alcohol spectrum disorder (FASD).
• Staying out of hot tubs and saunas, where the heat can raise your body temperature.
• Asking your doctor before stopping any medications or starting any new ones. Some medicines, including over-the-counter and herbal remedies, aren’t safe during pregnancy.
• Exercising during pregnancy to lower stress, strengthen muscles and reduce fatigue.
• Staying hydrated. Try to drink at least 8-12 glasses of water a day. 6
• Getting plenty of rest. If you feel tired, take a break. Don't push yourself. to maintain your usual pace. Try to get 7-9 hours of sleep at night.

Related content

More like this:

• Pregnancy and prenatal care
• Video series: What to expect at your prenatal appointments

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Presbyterian Preventive Healthcare Guidelines

Preventive care services include screenings, immunizations and physical exams that help you to stay healthy. Regular preventive care can also help to identify a health condition before you begin to experience symptoms--and early detection can mean the difference between continuing good health and illness. Keep in mind that your healthcare provider is the best source to answer questions about your health and that these guidelines are for healthy children and adults.

WHAT PREVENTIVE CARE DO YOU NEED?

From infancy through age 20, learn about the recommended exams, screenings and immunizations.

From ages 21 to 65 and older, learn about when screenings, tests and immunizations (yes, it’s true: you’re never too old for immunizations!) are recommended.

From your first visit with your healthcare provider through to your baby’s birth, learn about the recommended screenings and what to discuss with your doctor during your pregnancy.

Children and Adolescent Guidelines

*Subject to benefit plan and its limitations.

Adult Preventive Healthcare Guidelines

*Subject to Medicare coverage guidelines. **Subject to benefit plan and its limitations.

Pregnancy Preventive Healthcare Guidelines

Visit a practitioner as soon as you think you might be pregnant.

Your practitioner will tell you how often you need to visit after your first visit, usually every four weeks until your last trimester, then every two weeks, and then every week during the last month.

You will need to visit your practitioner again 4-6 weeks after you deliver your baby.

Follow these guidelines in addition to those listed for your age.

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What is Preventive Care?

Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care. This may also be called routine care.

What’s the difference between preventive care and diagnostic care?

Diagnostic care is related to services in which your provider is looking for something specific, often based on the results of a preventive test or screening. For example, a radiologist may ask for a follow-up mammogram for a patient. This follow-up is to check for something that may have been detected during the preventive or routine mammogram. The follow-up mammogram is diagnostic, and not covered as preventive care.

What are preventive care services?

Examples of preventive health services and their frequency:

• Annual check-up (1 per calendar year): This is when your Primary Care Provider (PCP) checks all areas of your health—physical, as well as emotional. This can help detect any health concerns early, before they become major medical problems.
• Flu shot (1 per year): This is typically covered 100% under most health plans and helps protect you from certain strains of the flu virus.
• Mammogram (1 per calendar year, usually after the age of 40): Routine X-rays of breast tissue to check for any signs of cancer or other abnormalities. Some health plans may also cover costs for 3D imaging.
• Colonoscopy (typically 1 per every 10 years, usually after the age of 45): Screening for colon cancer.
• Vaccinations (usually administered during childhood, includes boosters as needed): Vaccinations like measles, mumps, rubella, polio, etc. are covered 100%.

Examples of non-preventive care include:

• Diagnostic tests and screenings: These are not routine tests and screenings. For example, if your radiologist finds something on your mammogram and wants another, it’s considered a diagnostic mammogram and will typically not be covered as preventive care.
• Additional primary care visits: Most health plans will cover you for 1 annual check-up with your doctor. Other visits during the same calendar year will likely not be covered as preventive. For example, let’s say you have flu symptoms and need to see your doctor—that’s not a covered preventive care visit.
• Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular problem are not covered as preventive care.
• Alternative therapies: Services such as chiropractic, massage, acupuncture, and other alternative health services are not considered preventive care.
• PSA blood test: This is a test to check for prostate cancer. Some health plans may cover this as preventive care, but many do not.

Is preventive care free?

Most health plans are required by law to cover eligible preventive care services at 100%. This includes health insurance plans you get through your employer as well as those you may buy on your own through the Health Insurance Marketplace. Your doctor must also be in-network in order to be fully covered.

What are the benefits of preventive care?

Preventive care is intended to help you stay as healthy as possible. Regularly scheduled visits and tests allow your doctor to identify any medical problems before they can become major.

Benefits of preventive care include:

• Most preventive care at no cost to you as part of your health coverage
• Early detection of medical problems, illnesses, and diseases helps your doctor provide proactive care and treatment
• Routine care can help you stay focused on your own health goals

How do you know what preventive care you need and when?

Your PCP can help you coordinate what tests and shots are right for you. They may consider things like family history, age, sex, current health status, and more.

See a complete list of preventive care services

Preventive care is often covered 100% by your health plan and offers many benefits, both in cost and health. If you have questions about what’s covered and not covered, or when you should have certain tests done, make sure to ask your doctor.

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The Full Prenatal Care Guide

Getting good healthcare during your pregnancy is important for both you and your baby.

Prenatal care helps boost your chances of having a full-term pregnancy and delivering a healthy baby. Plus, having regular visits to your healthcare provider offers a great opportunity to get answers to any questions you have about your pregnancy and the birth of your baby.

You have lots of choices when it comes to your prenatal care. This guide can help you understand what types of prenatal care may be offered to you, and describes some of the options you may have.

Read on to find out why prenatal care is important, how to choose a good prenatal healthcare provider, what happens during your prenatal care visits, what tests might be recommended to you as part of your prenatal care schedule, and more.

What Prenatal Care Is and Why It’s Important

Prenatal care, as the name suggests, is the healthcare you get during your pregnancy. It consists of regular medical checkups that may include various types of tests and exams, along with a chance to discuss what might happen when it comes to your pregnancy, labor, and the delivery of your baby.

If you're wondering why prenatal care is important, it’s because it helps keep you and your baby healthy and safe. With prenatal care, your doctor, nurse, or midwife can spot any health problems early and treat them. Another benefit of prenatal care is that you have the opportunity to get guidance from your healthcare provider on how to have a healthy pregnancy.

It’s ideal if you visit your healthcare provider when you first decide you want to get pregnant. Taking care of your health and preparing for a successful conception helps put you on the path to a healthy pregnancy.

If you’ve just discovered that you’re pregnant and you didn’t get a chance to visit your provider beforehand, don’t worry. You’ll certainly still benefit from great prenatal care to help ensure you have a healthy pregnancy.

Once you’ve chosen a prenatal care provider, she will plan your prenatal care schedule, including the timing of your first prenatal checkup.

How to Choose Your Prenatal Care Doctor

Finding a healthcare provider is one of the most important decisions you’ll make in the early stages of your pregnancy.

You’ll want to choose a prenatal healthcare provider with a good reputation, of course, but it’s also crucial that she listens to you, cares about your preferences, and respects you. The key is to choose someone you feel comfortable with.

Another thing to consider as you begin your search for a prenatal healthcare provider is where you want to have your baby. If you’d prefer to have your baby at a specific hospital or birthing center, or if you’re considering a home birth, make sure your provider supports your choice and can deliver your baby in the place you want.

Your current healthcare provider can give you recommendations for a prenatal care provider, and you may also want to ask moms in your circle for their opinions about their prenatal healthcare providers.

Your health insurance provider will also have a list you can check to help you find a prenatal care provider.

As you do your research, you’ll find there are different types of healthcare providers who can give you care during pregnancy, labor, and childbirth. Depending on your pregnancy and preferences, you may end up with one or a combination of the following:

Obstetrician-gynecologists (ob-gyns). These medical doctors specialize in women’s healthcare.

Maternal-fetal medicine specialists. These doctors, also called perinatologists, have the same specialized training as ob-gyns do, plus additional training in high-risk obstetrics. This kind of doctor may be what you need if yours is a high-risk pregnancy.

Family physicians. Family care doctors also have some training in obstetrics. A family physician can care for you if yours is a low-risk, straightforward pregnancy.

Certified nurse-midwives (CNMs) and certified-midwives (CMs). These specially trained practitioners can provide care if you have a low-risk pregnancy. CNMs are registered nurses with a graduate degree in midwifery. CMs have graduated from an accredited midwifery educational program. CMs have completed the same midwifery requirements as CNMs but don’t have the additional training that nurses have. Both usually work with a qualified medical doctor, like an ob-gyn or a family physician, who provides additional support.

Family nurse practitioners (FNPs) or women's health nurse practitioners (WNPs). These nurses receive advanced training in caring for all family members or in caring for women of all ages, including pregnant women.

Doulas. Doulas aren’t medically trained and don’t stand in for a doctor or nurse, but they are trained to help coach you through your labor. Doulas can be supportive for you and your partner during childbirth and postpartum.

Timing of Your Prenatal Checkups

As soon as you find out that you're pregnant, call your healthcare provider's office to set up an appointment. This first prenatal visit might take place as early as 6 to 8 weeks of pregnancy.

If you don’t have any risk factors that complicate your pregnancy, your prenatal care provider may recommend the standard schedule for checkups, which is:

Every 4 weeks until you’re 28 weeks pregnant

Every 2 weeks between 28 and 36 weeks

Once a week from 36 weeks until the birth of your baby.

If yours is a high-risk pregnancy or if a special circumstance arises, your healthcare provider may recommend scheduling additional tests or more frequent prenatal checkups.

Your provider will determine whether your pregnancy is considered high risk by taking into account certain factors, such as if you

are 35 or older, or are 17 or younger

were underweight or overweight before you become pregnant

have high blood pressure, diabetes, depression, or another health issue

are pregnant with twins, triplets, or other multiples

had a previous pregnancy that included problems such as premature labor, or had a child with a birth defect.

What Might Happen at Your Prenatal Care Visits

Most of your prenatal checkups will include:

Checking your weight and blood pressure

Measuring your abdomen to monitor your baby’s growth

Checking your baby’s heart rate.

During each of your visits, your healthcare provider will ask several questions and sometimes offer you various prenatal tests.

Between visits, keep a list of any questions or concerns you have, and be sure to raise them during your next prenatal visit.

Of course, if something is urgent or distressing, or if you experience a pregnancy symptom you think shouldn’t be ignored, you can reach out to your healthcare provider anytime at all.

Types of Prenatal Tests

Prenatal tests are various medical tests you’ll be offered throughout your pregnancy. Some prenatal tests will be done several times during your pregnancy, and some you’ll get only at certain times or under specific conditions.

Two primary types of prenatal tests are screening tests and diagnostic tests:

Screening tests. These standard prenatal tests help determine if there’s a chance of a possible health risk for you or your baby. If screening tests show that you or your baby might be at risk for some kind of health condition, then a diagnostic test may be recommended. Screening tests typically pose no risk to you or your baby. Standard screening tests check things like:

Your blood type

Your blood pressure, which can help determine if you have a blood pressure disorder called preeclampsia

Whether or not you have a health condition such as anemia or gestational diabetes

Whether or not you have an STD or cervical cancer

Your protein levels, signs of infection, or blood sugar levels

Your baby’s size, age, and position in your uterus.

Diagnostic tests. These tests help your healthcare provider confirm whether your baby has a certain health condition. Diagnostic tests are conducted when results from a screening test indicate there might be a risk for you or your baby. Some diagnostic tests carry a slight risk for miscarriage, for example. Your healthcare provider will explain the risks and benefits so that you can make an informed choice about whether you would like such a test.

First Trimester Prenatal Care: Visits and Tests

During your first prenatal care visit, you’ll get a complete physical exam, have blood tests done, and get an estimate of your due date, which will let you know approximately how far along you are.

Your healthcare provider may prescribe you prenatal vitamins, such as a prenatal multivitamin that contains folic acid.

Folic acid is an important vitamin that can help protect your baby from neural tube defects and also from cleft lip and palate.

You might also be offered vaccinations, like a flu shot.

Your first prenatal care visit will include your healthcare provider taking a full health history, and you’ll be asked about your lifestyle and relationships, among other things. Be open and honest, because your answers help your provider determine how to provide you with the best prenatal care possible.

If you don’t feel comfortable sharing openly with your provider, consider finding one you trust.

During your first or second prenatal care visit, you may also have a pelvic exam, a breast exam, and a cervical exam, which includes a Pap test.

Your provider will also check your uterus. Some healthcare providers may do this via an ultrasound exam.

Near the end of your first trimester , your healthcare provider might use what’s called a Doppler to listen to your baby’s heartbeat. This is a thrilling moment as you finally get to hear that wonderful sign of life.

Here are descriptions of some tests and exams your prenatal care provider might recommend during the first trimester:

Early ultrasound. This helps determine how far along you are and also measures the clear space in the tissue at the back of your baby’s neck, called nuchal translucency. This screening test can give your healthcare provider important information about your baby’s health and development.

A blood test. This helps determine, among other things, your blood type and your hemoglobin levels. Low hemoglobin levels can be a sign that you have anemia, which can make you feel extremely fatigued. This test will also be used to check your Rh (Rhesus) factor, a protein on the surface of red blood cells. Most people have this protein, and are what's known as Rh positive. However, if you’re Rh negative and your baby is Rh positive, this Rh incompatibility may sometimes lead to health problems. Your healthcare provider will know how to manage this condition to keep you and your baby healthy.

Carrier screening test. This is a test of your blood or saliva to determine if you’re a carrier of certain genetic conditions that could have an effect on your baby.

Cell-free fetal DNA testing. Sometimes called a noninvasive prenatal screening, this test checks your blood for your baby’s DNA to see if certain genetic conditions may be present. Depending on the result, your healthcare provider may recommend further diagnostic testing, like amniocentesis.

Chorionic villus sampling. Also called CVS, this is a diagnostic test that checks the placental tissue to determine if your baby has a genetic condition like Down syndrome. Your healthcare provider will only recommend this diagnostic test if you have a screening test, such as the cell-free fetal DNA test, for example, that indicates there might be an issue.

Second Trimester Prenatal Care: Visits and Tests

During your second trimester prenatal care visits, your healthcare provider will

check your baby’s movement

monitor your baby’s heartbeat

track your baby’s growth.

Your healthcare provider will also continue to check your weight and blood pressure at every visit.

These prenatal tests, should you choose to have them, might be done during the second trimester:

Quad test. Also called maternal blood screening, this blood test measures four different substances in your blood to screen for things like Down syndrome or Edwards syndrome (trisomy 18). The substances measured in the QUAD test include the protein called alpha-fetoprotein and the pregnancy hormone hCG.

Ultrasound. An ultrasound exam can help your healthcare provider check for birth defects, see the position of the placenta , and track your baby’s growth. It’s also possible in a second trimester ultrasound to determine your baby’s gender.

Glucose screening. This tests to see if you might have gestational diabetes.

Third Trimester Prenatal Care: Visits and Tests

At one of your prenatal visits, your healthcare provider may recommend you start doing kick counts (also called fetal movement counts) to track how often your baby moves. Your provider will explain how to do these, but you may find this Fetal Movement Tracker helpful.

You might be offered a Tdap vaccination, which is a vaccination that protects you and your baby against pertussis (also called whooping cough ), an infection that's very dangerous for newborns, as well as tetanus and diphtheria.

Near the end of your third trimester , at around 36 weeks, , you’ll start having weekly prenatal checkups. Your healthcare provider will continue to check your baby’s heartbeat and movement, as well as your blood pressure and weight gain.

Your healthcare provider will also check the position of your baby. If your baby is not facing head down — for example, if he’s in a breech position — your provider will discuss your options with you.

This prenatal test, should you choose to have it, is done during the third trimester:

Group B strep test. Also called GBS, this tests fluid from your cervix to make sure you don’t have a strep infection that you could pass to your baby during delivery.

Prenatal Care Cost

The extra expense of prenatal care can be overwhelming even if you have health insurance.

Fortunately, every state has a program to help with prenatal care. If you’d like to see what no-cost or low-cost care you’re eligible for, start by contacting the U.S. Department of Health and Human Services or your local Health Department.

You might also find help through

local hospitals or social service agencies

the federal Women, Infants, and Children (WIC) Program

community clinics

places of worship.

Staying healthy during pregnancy, and helping your baby grow and develop, starts with good prenatal care. We hope our prenatal care guidelines have helped you better understand the benefits of prenatal care and given you a rough idea of your prenatal care schedule for the coming weeks, months, and trimesters of your pregnancy.

See all sources

• Mayo Clinic: Prenatal care
• March of Dimes: Prenatal Care
• Healthy Children: Prenatal Care
• CDC Gov: Prenatal care
• Womens Health: Prenatal Care
• Mayo Clinic: Fetal Ultrasound

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