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Mental Health; Your Pregnancy Matters

Studying the connection between anxiety and preterm birth

February 9, 2024

During pregnancy, you will likely feel a range of emotions: joy, anticipation, exhaustion, vulnerability. For many pregnant individuals, anxiety is part of the mix. While it is a normal human emotion, anxiety can become pervasive and begin to affect your daily life.

Generalized anxiety disorder (GAD) affects 2% to 3% of the population, but the risk heightens in pregnancy. Up to 35% of pregnant patients develop clinical anxiety, with GAD affecting 1 in 12 pregnant and postpartum individuals (likely a lower estimate due to a lack of routine screening).

Anxiety during pregnancy is known to cause physical and emotional symptoms for expectant birthing people, such as social isolation and disrupted sleep. Less recognized are the significant impacts on the pregnancy – particularly the risk of preterm birth, before 37 weeks’ gestation.

Screening for maternal anxiety can help providers identify at-risk patients and intervene to reduce its health impacts for pregnant people and their infants.

The Department of Obstetrics and Gynecology at UT Southwestern recently completed a study in which we screened for anxiety in patients with and without a history of early delivery. The findings showed that previous preterm birth and anxiety are strongly linked, providing new insights into the importance of screening and strategies to help manage anxiety during and after pregnancy.

Screening for anxiety

Anxiety-related preterm birth is thought to be caused by a combination of factors that cause inflammation. Pregnancy can triple a pregnant person’s levels of cortisol, an inflammatory stress hormone. Anxiety can also be caused by early activation of the maternal hypothalamic pituitary system, which acts like an internal “timer” for regularly scheduled or preterm delivery.

4 key findings of the UTSW study

* Patients with a history of preterm birth had significantly higher General Anxiety Disorder (GAD-7) scores.

* 20% of patients with a history of preterm birth had a GAD-7 positive screen compared to those without a history (13%).

* 78% of patients who had a positive screen and accepted a referral had successful contact with a mental health provider.

* 17% of patients with a positive GAD-7 screen were ultimately diagnosed with a perinatal mood disorder.

The study highlights the need for universal maternal anxiety screening, which could help us better identify patients at risk for anxiety and offer personalized treatment options.

Infants born before 37 weeks face a higher risk of lifelong health problems such as underdeveloped lungs, high blood pressure, heart and kidney disease, and death – two-thirds of infant deaths occur in infants born preterm. About 10% of U.S. births are preterm, and a third of patients who have a preterm birth will deliver early in a later pregnancy.

In our study, we screened 1,349 pregnant individuals with the Generalized Anxiety Disorder 7 (GAD-7) questionnaire, which includes seven questions each assigned a score of 0 to 3 for a maximum possible 21 points. Higher scores mean the patient is more likely to have an anxiety disorder. In our study, patients with a score of 10 or higher were offered a referral to a mental health counselor.

Symptoms of anxiety in pregnancy

While mood changes are common during and after pregnancy, problems can develop when these symptoms start to negatively impact daily life:

• Difficulty concentrating
• Restlessness or irritability
• Trouble controlling feelings of worry
• Sense of impending danger, panic, or doom
• Problems falling or staying asleep
• Rapid breathing

Some of these overlap with normal pregnancy symptoms, making it difficult to differentiate. That’s where screenings with your health care provider come in. Screenings help identify thresholds at which regular stress starts to affect daily life and cause health problems.

The American College of Obstetrics and Gynecology recommends pregnant individuals be screened for depression and anxiety at the first prenatal visit, later in pregnancy, and at postpartum visits. Be honest when answering your provider’s questions during these screenings – we will never judge you for your responses. Screening questionnaires help us spot anxiety symptoms early so we can help you feel better.

Anxiety treatment options

Every person’s treatment journey is different, and the first steps typically involve self-care strategies such as practicing good sleep hygiene , getting regular exercise, and eating balanced meals. Patients may need help reducing stressors such as getting to and from appointments or having access to reliable childcare. Your doctor can connect you with community resources to lighten the load.

Counseling and medication are safe, effective options if your anxiety continues. We know that you may be reluctant to take medication during pregnancy. However, almost all mental health medications carry a very low risk of harm for your baby, and not taking medication when it’s needed may have risks, too. In 2023, ACOG released a strong recommendation against withholding or discontinuing medications for mental health conditions due to pregnancy or lactation status alone.

My colleagues and I at UT Southwestern and Parkland Health are passionate about making pregnancy safer – physically and mentally. By performing studies like these, we are better able to identify expecting patients who may need support and develop strategies to help improve the health of both the pregnant individual and their infant.

To find out whether you or a loved one might benefit from a prenatal or postpartum mental health screening, call 214-645-8300 or request an appointment online .

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How to Deal With First Trimester Fears During Pregnancy

It's completely normal to feel nervous from time to time when you're pregnant — particularly if you're pregnant for the first time and finding yourself in unfamiliar territory. Those fears can strike especially hard in your first trimester when there are a lot of unknowns and few people even know you're expecting.

But it's important to remember that above all else, pregnancy is exciting and truly worth enjoying. That's why we suggest taking a few simple steps that'll help you curb the first-trimester fear and focus instead on how amazing this stage of life truly is. While speaking with a mental health counselor is definitely the best step if your anxiety is interfering with your day-to-day life, these simple, at-home steps may work wonders in reducing some of the fear you feel in the early days of your pregnancy.

Talk about your pregnancy

One of the toughest things about the first trimester is the fact that it can feel really isolating. If you and your partner are the only people who know you're expecting, it's natural to feel like you have to no one to rely on when your nerves take over. Talking about it with a family member or even an anonymous online community can help you feel more at ease — because chances are, you'll realize most women who have ever been pregnant have felt some degree of what you're experiencing...and that so many of them went on to have perfectly healthy babies!

Stop over-analyzing your symptoms

Say it with us: Every pregnancy is different . If you're six weeks in and still not experiencing any morning sickness, don't worry that this means your pregnancy isn't healthy — the notorious first trimester symptom may strike later, or you just may be one of the lucky ones who avoids it entirely (in which case, you should thank your lucky stars!). If you feel miserable one day and fantastic the next, don't read too far into it and start thinking it means your pregnancy is slipping away — just enjoy feeling well. Remind yourself that there's a whole spectrum of normal. Tell yourself that obsessing over every little symptom is counterproductive...because it is!

Stay away from Google

Trust us: Falling into a Google black hole is not a good idea. Instead of searching every pregnancy question you have, create a list of clear, credible resources that can help you figure out the answers to your most pressing questions. When you just need some outside information (hey, it happens to the best of us), consult those instead — but take your findings with a grain of salt. There's always a chance you'll find something alarming, but that doesn't necessarily mean things won't be just fine for you and your baby.

Ask your doctor about early monitoring

While most pregnant women wait until they're about eight weeks along to see their doctors, sometimes exceptions can be made. If you've had a history of miscarriage, for example, your OB-GYN may agree to bring you in for an early ultrasound just to ease your mind. Again, this isn't always standard protocol, so don't expect to be accommodated — but this may be an option for women who have specific concerns during early pregnancy.

Get your zen on

Now might be the perfect time to give meditation a try — lots of people rave about the practice's stress-relieving powers. If your doctor is fine with it, you could even try acupuncture to help manage your anxiety, and if you've already been practicing yoga for some time, you should give prenatal classes a try (with your doctor's blessing, of course!). These activities could go a long way toward helping you feel more grounded and settled.

Know the rules

Pregnancy comes with a laundry list of rules (goodbye raw sushi and unpasteurized cheese!). Your doctor will likely go over them at your first prenatal appointment, but familiarizing yourself with the basics will give you a greater sense of control over your pregnancy in those first few weeks.

You know how you always worry about the small stuff more when you....have to time to worry about the small stuff? That principle applies here, and that's why it's important to stay busy through your first trimester. Book an impromptu weekend trip, take lots of walks, cook healthy meals, start a new Netflix series, read some good books — do whatever you have to do to avoid getting bored. But at the same time...

Listen to your body

If you need a nap, take it. If you can't find the energy to make it to your weekly workout class, skip it. If you're too queasy to make it out to a dinner with friends, cancel. There's a lot going on in your body when you're pregnant (especially in those early days) and if you feel like you need a break, take one. This is great for you both mentally and physically — because ultimately, all we can do to keep our babies safe is take care of ourselves.

If you're feeling overwhelmed or nervous through the early days of your pregnancy, know you're not alone. And while we hope you'll try these simple at-home methods for dealing with common fears, we also know sometimes you just need to talk to a professional —like your OB-GYN or a therapist — to address some of your bigger worries. But if you're feeling like you just need to calm down, these simple do-it-yourself tricks may be all you need.

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There’s a Name For the Anxiety You Feel in Pregnancy: Perinatal Anxiety

TLDR : Perinatal anxiety can affect you during pregnancy and sometimes into your baby’s first year. It’s very common, and also highly treatable with therapy, medication, mindfulness, or other approaches. 

Anxiety after the birth of a baby—aka postpartum anxiety 1   —is a topic that’s becoming more normalized, but did you know that many women also experience anxiety during pregnancy?

Termed perinatal anxiety 2   , it’s the feelings of sadness, anger, worry, or fear during pregnancy or the first year after the birth of your baby—and if you’re having those feelings, you shouldn’t overlook or dismiss them.

What is Perinatal Anxiety?

Perinatal mood and anxiety disorders—also known as PMADs—are one of the top complications of pregnancy and childbirth. They’re very common—around  15% to 21% of pregnant and postpartum women experience PMADs 3   .

So, what exactly is perinatal anxiety—and how does it differ from other anxiety disorders that can happen during and after pregnancy ? Here’s a quick breakdown:

Prenatal or antenatal anxiety is anxiety that occurs during pregnancy.

Perinatal anxiety is anxiety that happens during pregnancy and up to one year postpartum.

“Baby blues” is the short-term (two weeks or less) feelings of anxiety before or after birth. (Note that people are using this term less, as it can sometimes be seen as diminishing to more serious anxiety and depression.)

Postnatal anxiety is anxiety that happens in the first year after birth.

The Research on Anxiety and Pregnancy

While perinatal anxiety is less researched than PMADs like postpartum depression, it’s no less important and can be treated to combat its negative effects.

According to a 2015 study, high levels of stress and anxiety during pregnancy increased the risk for preterm birth 4   , low birth weight, earlier gestational age, and a smaller head circumference, as well as potential issues into childhood, like prolonged crying 5   in infants or higher risk of illness 6   .

Research also tells us that women with mental health disorders are less likely to seek treatment 7   due to the stigma associated with their diagnosis. Of the women who experience symptoms of perinatal anxiety,   fewer than 50% will seek help 8   —and even fewer will go on to receive effective treatment.

It’s time to change that.

Symptoms of Perinatal Anxiety

Some level of anxiety and fear during pregnancy is normal. This is a huge moment in your life, and everything around you is changing in a short amount of time. Being scared of the uncertain is both expected and very common—and not just in pregnancy, but in life in general. But when anxiety becomes overwhelming and interferes with your day-to-day life, that’s when you should seek help.

These symptoms of perinatal anxiety 9   , as well as others, could be a sign that you have a form of perinatal mood or anxiety disorder and should talk to your healthcare provider.

Physical Symptoms of Perinatal Anxiety

Rapid breathing (hyperventilating)

Difficulty sleeping or restlessness

Increased heart rate

Nausea or upset stomach 

Trembling or shaking

Tension or muscle aches

Mental Symptoms of Perinatal Anxiety

Difficulty focusing

Feeling on edge

Frequent anger or irritability

Frequent worry or fear

Frequent sense of panic

Intrusive thoughts

Ruminating (dwelling on thoughts)

Risk Factors and Causes of Perinatal Anxiety

Many risk factors have been identified for why we experience anxiety in pregnancy , 10   from the increase of hormones circulating in our body to traumatic experiences or external stressors.

These risk factors don’t guarantee you’ll have prenatal anxiety, nor do the absence of these risk factors indicate you won’t get prenatal anxiety—but some people may be more prone to experiencing an anxiety disorder. If you have experienced or are experiencing any of these, it could be helpful to discuss it with your doctor or someone you feel safe with:

Excess stress

Exposure to racism

Family or personal history of anxiety

Lack of support

Previous pregnancy loss

Personal history of drug or alcohol misuse

Thyroid or other medical conditions

Trauma (previous or current)

How Long Does Perinatal Anxiety Last?

Everyone is different, so how long a person might experience PMADs will vary. While some women experience anxiety for several weeks, others may feel its effects for months or even years. The positive news is that perinatal anxiety is very treatable after a diagnosis.

How is Perinatal Anxiety Different from Depression?

The primary difference between anxiety and depression (whether in pregnancy or in general) is the symptoms. A person who is experiencing depression 11   may have some of the same symptoms as above, but they will also experience a prolonged feeling of sadness, worthlessness, or loss of interest in things they used to enjoy.

Even though there’s a difference between them, anxiety and depression often go hand-in-hand. About 60% of people with anxiety also show symptoms of depression 12   , and vice versa. Also, each condition can make symptoms of the other get worse or last longer.

How Do I Get a Proper Diagnosis of Perinatal Anxiety?

Perinatal anxiety is still a relatively new concept and may be less understood than postpartum anxiety or depression. In addition to this, many women may avoid treatment for perinatal anxiety if they feel guilt or shame about the experience.  

Dr. Lauren Demosthenes, the senior medical director with Babyscripts , encourages you to speak up during your prenatal appointments. She says, “Most healthcare providers will ask you about your feelings, as mental health is just as important as physical health. You can expect to be screened with a questionnaire at least once during pregnancy and then again postpartum.” 

But outside of these questionnaires, speaking up can help get the treatment you need. “If you are experiencing any signs of anxiety or depression, you may find help with talk therapy or even medication,” she says.

While there is still a lot to learn about the condition, only a trained healthcare or mental health professional will be able to assess whether you have a perinatal mood and anxiety disorder. Here are a few tips to help get you the treatment you deserve:

Advocate for what you need. The first step happens with you—it can be difficult or scary to talk about how we feel, but it’s the way to start healing.

Talk to someone you trust about how you’re feeling. It can be your partner, ob-gyn, primary care provider, therapist, or friend. While a friend can’t give you a medical diagnosis, they can join you during an appointment or provide moral support.

Ask your doctor or provider if they’ve treated perinatal anxiety before and what treatment methods they prefer. 

Some questions to bring up are: 

Is medication right for you?

Is a medication and therapy combination better? 

Do you want to avoid certain medications during pregnancy? 

How do they assess perinatal anxiety and how does it differ from depression? 

Do you need a blood panel to rule out underlying conditions? 

Ask any questions you have and don’t leave anything out.

Be sure that any screenings or assessments you take are specific to the perinatal period and not just for generalized depression or anxiety. The most commonly used scale is the Edinburgh Postnatal Depression Scale .

How to Cope With Perinatal Anxiety

Perinatal anxiety can affect any pregnant woman or new parent. It doesn’t matter how old you are, your income, race, ethnicity, or education. If you think you may be suffering from PMADs, or perinatal anxiety specifically, there are ways to overcome it.

Practice mindfulness and meditation

There is mounting evidence that shows meditation has benefits when it comes to helping deal with stress. Meditation reduces stress and anxiety, increases mindfulness and awareness, and can help you fall asleep and stay asleep longer.

Studies support the use of meditation as a stress-reducer , with one 2021 randomized controlled trial finding that a mindfulness program reduced stress in women who have had multiple miscarriages .

Dr. Marieme Mbaye, ob-gyn and senior medical director for Noula , agrees, saying, “Meditation not only helps pregnant people lower their stress levels, but it can also help to boost positive feelings and promote the healthy development of their baby. A few studies have even shown that meditation may help decrease the risk of premature birth.

Mindfulness techniques were also found to be effective in improving both the mental health and relationships of women who experienced infertility or were going through reproductive treatment.

So no matter what’s causing your anxiety, meditation may help.

Cognitive behavioral therapy (CBT) or talk therapy

Cognitive behavioral therapy works by asking a patient to change their thinking patterns. By recognizing problems, reevaluating them, and reframing them or finding coping skills, you and your therapist develop a treatment strategy unique to your needs. CBT has been proven to be effective in improving anxiety and related symptoms among women with anxiety disorders in the perinatal period.

If you haven’t worked with a therapist before, now is a great time to start. Nobody is judging you—definitely not your therapist.

If you can’t find affordable therapists in your area, consider a virtual or app-based appointment. Resources like BetterHelp and TalkSpace can be a place to start.

Prescription medication

If other methods of treatment don’t seem to be working, your doctor may suggest medication or a combination of treatment with medication.

Many women are concerned about whether medication will affect them, their baby, or breastfeeding. Many SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are considered safe and effective while breastfeeding and during pregnancy . 

As always, talk with your doctor if you have questions about medication types, length of use, side effects for you or your baby, or if you just want more information.

Self-care and lifestyle changes

You can’t just self-care your way out of depression and anxiety. However, increasing some self-care practices like getting enough sleep, eating whole, nutrient-dense foods, and staying hydrated are effective ways to support your mind and body. Here are a few self-care practices you can start today:

Journal when you feel anxious

Limit processed and fast foods 

Make time for hobbies

Schedule time to do something you find relaxing

Spend time with friends and family you enjoy

Spend time outdoors

If you’re experiencing perinatal anxiety, you’re not alone.

If you notice any mental or physical symptoms of anxiety, such as panic attacks, feeling on edge, difficulty focusing, or any others, call your doctor as soon as possible. Keep in mind that symptoms may appear all of a sudden, or come on more gradually.

Perinatal mood and anxiety disorders—PMADs—are common but highly treatable. Therapy, medication, mindfulness, and other approaches can help.

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Expectful uses only high-quality sources, including academic research institutions, medical associations, and subject matter experts.

The New York Times .  " This Is What Postpartum Anxiety Feels Like " ,  https://www.nytimes.com/2020/04/15/parenting/postpartum-anxiety.html .

Sarah Araji, Ashley Griffin, Laura Dixon, Shauna-Kay Spencer, Charlotte Peavie, Kedra Wallace .  " An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period " ,  Nov 29, 2020 ,  https://www.mentalhealthjournal.org/articles/an-overview-of-maternal-anxiety-during-pregnancy-and-the-post-partum-period.html .

Lorraine Byrnes .  " Perinatal Mood and Anxiety Disorders " , vol.  14 , no.  7 ,  Jun 30, 2018 ,  https://www.npjournal.org/article/S1555-4155(18)30134-X/fulltext .

Zohreh Shahhosseini, Mehdi Pourasghar, Alireza Khalilian, and Fariba Salehi .  " A Review of the Effects of Anxiety During Pregnancy on Children’s Health " , vol.  27 ,  Jun 26, 2015 ,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499279/ .

Marcel F van der Wal, Manon van Eijsden, Gouke J Bonsel .  " Stress and emotional problems during pregnancy and excessive infant crying " ,  Dec 27, 2007 ,  https://pubmed.ncbi.nlm.nih.gov/18091087/ .

Marion Tegethoff,Naomi Greene,Jørn Olsen Emmanuel Schaffner and Gunther Meinlschmidt .  " Stress during Pregnancy and Offspring Pediatric Disease: A National Cohort Study " , vol.  119 , no.  11 ,  Jul 20, 2011 ,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226491/ .

Regis College .  " Women’s Mental Health 101: Statistics, Symptoms & Resources " ,  Jun 29, 2023 ,  https://online.regiscollege.edu/blog/womens-mental-health/ .

Erin Henshaw, Bethany Sabourin, Melanie Warning .  " Treatment-seeking behaviors and attitudes survey among women at risk for perinatal depression or anxiety " ,  Jan 31, 2013 ,  https://pubmed.ncbi.nlm.nih.gov/23374137/ .

National Institute of Mental Health .  " Perinatal Depression " ,  https://www.nimh.nih.gov/health/publications/perinatal-depression .

Hamideh Bayrampour, Angela Vinturache, Erin Hetherington, Diane L Lorenzetti , Suzanne Tough .  " Risk factors for antenatal anxiety: A systematic review of the literature " ,  Oct 7, 2018 ,  https://pubmed.ncbi.nlm.nih.gov/30293441/ .

Mayo Clinic .  " Depression (major depressive disorder) " ,  https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007 .

Beth Salcedo, MD .  " The Comorbidity of Anxiety and Depression " ,  Jan 18, 2018 ,  https://www.nami.org/Blogs/NAMI-Blog/January-2018/The-Comorbidity-of-Anxiety-and-Depression#:~:text=In%20mental%20health%2C%20one%20of,with%20depression%20also%20experiencing%20anxiety. .

Haley Tardy

Newsletter Editor, Expectful

Haley Tardy is a newsletter editor at Expectful, where she brings her passion for mental health and experience as a mom of one (with another on the way) to her articles and emails.

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Pregnancy · July 8, 2023

First Prenatal Visit: What to Expect and How to Prepare

This post may contain affiliate links, which means I'll earn a commission, at no extra cost to you, if you make a purchase through those links. For more info, please read my affiliate disclosure. As an Amazon Associate, I earn from qualifying purchases. For the latest deals, visit my exclusive discount codes page.

Congrats on your pregnancy, mama! Did you already schedule your first prenatal visit?!

I know the wait between a positive pregnancy test and your first prenatal visit can feel like foreveeer …

And a bit surreal too.

Then you FINALLY get to go to your first prenatal appointment and BAM— the reality of your pregnancy really hits you!

After all, that’s when your pregnancy will be confirmed!

But in the meantime, while you’re waiting, you may be thinking a lot about your first pregnancy appointment.

What should I expect? How do I prepare? What should I wear? What questions should I ask?

So to shed some light on what may be the longest prenatal appointment you’ll ever have, let’s get into your first prenatal visit: what to expect and how to prepare !

In this post

When to make your first prenatal appointment

Before you call to make a prenatal appointment, make sure you have this info ready:, an example of what to say when scheduling your first prenatal appointment:, urine sample, confirmation of your pregnancy, calculation of your estimated due date, blood pressure check, weight check, review of you and your family’s medical history, surgical history, reproductive history, gynecological history, medication history, review of previous or current substance use, review of lifestyle habits, review of social and mental health history, assessment for domestic violence, full physical exam including pelvic exam and pap smear, fetal heart check, schedule next prenatal appointment, what is the normal schedule of routine prenatal care, how to prepare for your first prenatal visit, what questions to ask at your first prenatal visit, 7 tips and hacks to help you make the most of your prenatal appointments, now you’re totally ready for your first prenatal visit.

So when should you make your first prenatal appointment?

My BEST answer is to call to schedule a prenatal appointment as soon as you get a big fat positive (BFP) on your pregnancy test .

Even though you won’t get seen until you’re about about 8-10 weeks pregnant.

Why? Because prenatal appointments are booked pretty quickly. And the longer you wait, the further into the future your first prenatal appointment will be scheduled.

It’s bad enough that waiting for your first prenatal visit can feel like an eternity. So spare yourself those extra days (or weeks) of anxious waiting…

And call, like right now, if you haven’t already.

What to say when scheduling your first prenatal visit

I totally get it. This may be your first pregnancy, you might be nervous, shy or have social anxiety. It’s possible you never made a call to schedule an appointment before.

So I’m going to give you a script of what to say when scheduling your first prenatal appointment!

But before doing that, I want to give you some tips on how to prepare for the call. This is REALLY important!

• Name and date of birth (DOB): Yep, have your name and DOB ready LOL. Trust me, nervousness can make you forget your name, age, DOB, the reason why you’re calling in the first place, etc.
• First day of your LMP: They might ask, so they can get an idea of how far along you are in your pregnancy.
• Insurance cards: You’ll most likely be asked to provide your insurance name (e.g., Aetna) and your policy number (i.e., member ID number). Remember to ask about any co-payments!
• Your (& maybe your partner’s) schedule: Know when you’ll be free to make it to your appointment. You might be asked if you prefer an AM/PM time slot. If your partner is going, make sure you know his schedule and when he might be available to go with you.
• Calendar: Have a calendar in front of you. You can check your phone’s calendar, but you’ll have to put the call on speaker. So it might be better to have a physical calendar. This will help you see the day (e.g., Monday) a prospective appointment falls on and make it easier for you to schedule your appointment.
• Pen and paper/notebook: Have this in hand to write down any info you might be given (e.g., date, time, what you’re required to bring to your first appointment, any other specific instructions, etc.). I absolutely LOVE using pocket planners/calendars (like this ) to keep my scheduled appointments and other info all in one place. They usually have a notes section for you to write down any questions you may have .

Seriously, all of this preparation is 100% WORTHWHILE!

Okay, so now that you know how to prep for the call, here is…

“Hi, good [morning, afternoon]. My name is [your name]. I just found out I’m pregnant, so I’m calling to schedule my first prenatal appointment. Are you accepting new patients and do you take [name of your health insurance] insurance?”

Filled out version of the example above:

“Hi good morning. My name is Olivia Williams. I just found out I’m pregnant, so I’m calling to schedule my first prenatal appointment. Are you accepting new patients and do you take Aetna insurance?”

Note: If new patients are being accepted, the receptionist will ask for your name, DOB and health insurance information to register you into their system and set up your appointment.

What to expect at your first prenatal visit

Here is a quick glance at what to expect at your first pregnancy appointment:

• Review of previous and current substance use

Here’s a deeper look at what to expect at your first prenatal appointment:

One of the first things you’ll be asked to do is go to the bathroom to collect a urine sample.

You’ll be given a specimen bag with a specimen cup and a few packs of pre-moistened wipes to clean yourself beforehand.

Make sure to clean front to back and it’s better to collect a midstream catch (i.e., pee a little bit into the toilet then fill the cup with the rest of your urine).

If the outside of the cup gets soaked with pee, don’t panic. Just use some tissue to wipe the OUTSIDE of the cup dry and make sure you secure the top before placing into the specimen bag.

Give it to the nurse, or drop it off at the place you were directed to leave it.

Your urine will be checked for excess protein, sugar and other substances that may indicate an infection or pregnancy complication such as gestational diabetes.

Even though you got a positive home pregnancy test, your pregnancy still has to be confirmed at your first prenatal appointment.

They have to do their own pregnancy test so they can enter it into their system.

The urine sample you provided can be used to confirm your pregnancy, but it can also be confirmed with a blood test and/or ultrasound.

They will ask you for the first day of your last menstrual period. This helps them to give you an estimated due date by calculating 40 weeks from that date.

Don’t worry if you can’t remember the date of your LMP because an ultrasound can be done to predict your baby’s estimated due date (EDD).

Your EDD can also be calculated based on the date of your conception, if you happen to know it.

Your blood pressure will most likely be checked after you give them your urine sample.

It’s normal for your blood pressure to decrease when you’re pregnant due to the increase in blood volume, but sometimes it can be abnormally high.

Monitoring your blood pressure is an important part of prenatal care, so you’ll be checked at each prenatal visit.

Regular blood pressure checks are an easy way to detect and treat pregnancy complications like gestational hypertension (i.e., high blood pressure during pregnancy) early.

Your weight will be checked at every prenatal visit—starting with your first. This initial weigh-in will be used as a baseline for all future weigh-ins.

And based on your BMI, you’ll be expected to gain a certain amount of weight during your pregnancy.

Regular weigh-ins can check for sudden fluctuations in your weight and help your provider to see how your pregnancy is progressing.

You’ll be asked a lot of questions about you and your immediate family’s medical history (e.g., diabetes, high blood pressure, asthma, heart disease, allergies etc.).

You might also be asked about your partner’s medical history, as well as the medical history of your partner’s immediate family.

All of this information will help your provider to determine if you’re at risk for certain pregnancy complications and conditions.

If there are any concerns or an increased risk for genetic conditions, you’ll be given the opportunity to receive genetic counseling and genetic testing.

Any prior surgeries? They’ll want to know this because this info can shape your prenatal care.

For example, letting your provider know you’ve had a prior c-section can help them set up a TOLAC (trial of labor after c-section) if your goal is to have a VBAC (vaginal birth after c-section).

Any prior pregnancies, including miscarriages and abortions? They’ll need to know this too.

They will assess you for GTPAL to get a complete reproductive history:

• Gravida: Number of pregnancies you’ve had
• Term: Number of babies delivered after 37 weeks gestation
• Preterm: Number of babies delivered between 20- 36 weeks gestation
• Abortion/miscarriage: Number of losses before 20 weeks gestation
• Living: Number of living children you have

Your provider will want to know any current or past gynecological issues.

This is to determine if you have any potential or actual risks for birth defects and other pregnancy complications.

What’s your STD history? (e.g., herpes, HIV, chlamydia, gonorrhea, syphilis, genital warts, trichomoniasis and more).

It’s BEST to be honest here, so you and your partner can be treated if necessary!

Plus, untreated STDs during pregnancy can be really dangerous for your developing baby.

Your provider will want to know what medications you take (prescribed and over the counter) to assess whether or not it’s safe for you to take during pregnancy.

For any medications that aren’t safe, an alternative one may be provided. But usually the pros and cons of continuing that specific medication during pregnancy are weighed against each other. Meaning—do the benefits outweigh the risks? And vice-versa.

Your OB/midwife will also need to know if you’re allergic to any medications, so it can be entered into your patient record.

Your provider will want to know if you have any previous or current use of alcohol and/or drugs. This includes cigarettes, marijuana and other illicit drugs.

Being transparent can make it easier to get whatever help you may need.

For example: If you smoke cigarettes, but want to stop now that you’re pregnant, your provider can offer a smoking cessation program and other helpful resources to help you.

You will be asked about your lifestyle habits (e.g., exercise, diet, career, hobbies, etc.).

It’s important to be honest, so your provider can give you the best recommendations based on your situation.

Your provider can also let you know what things are safe vs unsafe for you to continue to do while you’re pregnant.

Tips may also be shared about how you can improve the health of your pregnancy.

You’ll be asked about your social history (e.g., emotional support system) and mental health history (e.g., depression, anxiety, prior mental health counseling, etc.).

These questions are asked to get a better idea of how your provider can best support you during your pregnancy.

Domestic violence tends to start or spike during pregnancy ( source ), so you’ll be asked if you’re experiencing any kind of abuse.

Studies have associated domestic violence (aka intimate partner violence) during pregnancy with:

• Poor maternal nutrition and inadequate weight gain
• A negative impact on a woman’s ability to receive regular prenatal care.
• Prenatal and postpartum depression
• A higher risk of substance use
• Adverse neonatal outcomes like low birth weight and premature birth
• An increased risk of miscarriage, stillborn death and induced abortion

If you’re experiencing abuse during pregnancy, your provider can give you all the resources and help that you need.

This includes connecting you with a domestic violence specialist to help you set up a safety plan .

You will also get the proper advice on how to get out of your abusive situation in the SAFEST way possible.

But, of course, you will NOT be forced or coerced to leave your situation if you don’t feel ready to.

You’ll get a full physical exam after you’re done answering questions and asking questions of your own . This usually involves a breast and pelvic exam.

A pap smear with cultures might also be done, especially if you’re due for one.

All of these exams check for infections, STDs and other abnormalities that may complicate your pregnancy.

Your provider will ask you to lie down and expose your abdomen, so a fetal doppler can be used to listen to your baby’s heartbeat.

Just so know, it’s not always possible to detect a fetal heart beat with a doppler in the very early weeks of pregnancy.

Your blood will be drawn at the end of your appointment to check for things like your blood type, Rh factor, blood count, HIV status and immunities.

Lastly, you’ll be told to make your next prenatal appointment.

This is usually done at the front desk, but your provider may set up your next appointment while you’re still in the exam room.

Here is the typical prenatal care schedule for a normal (i.e., uncomplicated) pregnancy:

• Weeks 4-28: every four weeks
• Weeks 28-36: every two weeks
• Weeks 36-birth: every week

The standard schedule is only a general guideline and might look different for you.

Your prenatal care schedule can increase in frequency if you:

• Have a medical history that requires extra monitoring
• Have a high risk pregnancy
• Experience a complication anytime during your pregnancy

The best way to prepare for your first prenatal visit is by gathering all the information you would need to answer all of their questions.

Before heading to your first prenatal visit, make sure you prepare all of the following information:

• Your insurance cards and ID: If a co-payment is required, make sure to have the money together.
• The first day of your last menstrual period: If you don’t know the first day of your LMP, you can give a rough estimate. Or let them know your conception date if you’ve been tracking your fertility. An ultrasound can be used to calculate an estimated due date.
• Your medical history: This includes your gynecological, reproductive, surgical and mental health history
• The medical history of you and your partner’s immediate family: It would be beneficial to have your partner with you, if possible.
• All of the medications you are currently taking: Including prescription, OTC, vitamins, supplements and herbal supplements (e.g., teas, pills, powders, liquids, patches, topical creams, etc) It’s BEST to put all of your medications into a large ziplock bag to bring with you. It will be easier for your provider to know what’s safe or unsafe for you to take during pregnancy.
• Previous or current substance use: This includes tobacco, cannabis, alcohol, vaping products and other illegal or recreational drugs.
• Social history and lifestyle habits: Your career, hobbies, diet, exercise, emotional support system, housing situation, domestic violence history, etc.
• Any questions you may have: Find out all the essential to ask at your first prenatal visit here .

There are 50+ questions you can ask at your first prenatal appointment , but here are a few to get you started:

• How often will I have my prenatal appointments?
• How much weight in total should I gain during my entire pregnancy? How much weight should I be gaining each week?
• How can I help support my baby’s development?
• What lifestyle changes do I need to make during my pregnancy?
• Is there a nurse line to call if I have questions or concerns?
• When should I go straight to the emergency room? (e.g., heavy bleeding, severe cramping, fainting, etc.)
• Are my prescribed and OTC medications safe for me to use during my pregnancy?
• What changes do I need to make to my diet during my pregnancy?

How to make the most of your prenatal appointments

Did you know that getting regular prenatal care from the start of your pregnancy increases health outcomes for you and your baby ( source )?

Prenatal care is SO IMPORTANT for managing the health of your pregnancy, reducing your risks for complications, early detection and treatment of complications and much more!

• Go to all of your prenatal visits: Don’t skip your appointments even if you have a normal, low-risk pregnancy. If you can’t make it to your appointment, call to reschedule but try your best to make it to each appointment.
• Prepare to give a urine sample at each appointment: I would drink water before each of my prenatal visits to make sure I had urine to collect.
• Prepare to have your blood pressure taken at each visit: You might be having your BP taken outside of the exam room, so wear something that will make it easy for you to expose your arm to get a proper BP measurement.
• Wear clothes that allow easy access to your belly: Fetal dopplers, fundal height measurements and checking for baby’s position all require easy access to your belly. I’d skip the maxi dresses, rompers, jumpers and go for T-shirts instead.
• Keep important info within easy reach: This includes your provider’s name and number, other emergency contact info, signs and symptoms to report ASAP and other helpful reminders on your fridge, mirror or anywhere else you think would be good for you
• Prepare your questions beforehand: Write down all of your questions, as they come up, in a notes app on your phone or in a notebook you won’t forget to put in your purse. That way you don’t leave your appointment to then realize you forgot to ask the question(s) you wanted to ask.
• Have your partner or support person go with you, if possible: Especially during the first prenatal visit when questions are being asked about past medical history and family medical history. If they can’t make it, ask if you are able to do a video call. Another tip: if your partner has to take off of work to make it to your prenatal visit, ask the receptionist for a letter for your partner to have proof for their employer. Also, the BIG VISITS to attend are the first prenatal visit, 12 week visit, 20 week anatomy scan (where you can find out the gender!) and one or two late pregnancy appointments nearing your due date.
• Have your insurance cards and ID ready to present to the receptionist when checking in to your appointment. And know beforehand if you have any co-pays to make because if you do, you’ll be expected to pay the day of your visit.

There you have it, mama! Now you know what to expect at your first prenatal visit, how to prepare, what questions to ask and how to make the most of your prenatal appointments. And then some!

I hope you found this post to be really helpful to you and, if so, I hope you share this post with all of your friends!

Seriously—knowing just what to expect, how to prepare and even what questions to ask at your first prenatal visit can really help to get rid of some of those jitters.

Your turn! When is your first prenatal visit and what have you been doing to prepare for it? What tips or info did you find the most surprising or helpful in this post? Let me know in the comments!

Enjoy your first prenatal visit, mama!

Pin to share!

• Alhusen, J. L., Ray, E., Sharps, P., & Bullock, L. (2015). Intimate partner violence during pregnancy: maternal and neonatal outcomes . Journal of women’s health (2002), 24(1), 100–106. https://doi.org/10.1089/jwh.2014.4872
• https://americanpregnancy.org/resources/pregnancy-calculator/
• https://www.thehotline.org/plan-for-safety/create-a-safety-plan/
• https://www.marchofdimes.org/find-support/topics/pregnancy/abuse-during-pregnancy

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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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Top 13 Pregnancy Fears (and Why You Shouldn't Worry)

Doctors share the truth about your biggest fears about pregnancy—and why they're not as scary as you think.

It's only natural to worry a bit throughout your pregnancy. After all, this whole thing is new and nail-bitingly unpredictable. All you want is for your nine-month gestation to go smoothly. And guess what? It usually does.

While some things warrant vigilance—such as limiting your exposure to uncooked meat, the litter box, and alcohol, for example—other things don't need to take up mental space. The good news is that pregnancy risks are generally low for most healthy people.

Read on to learn the real facts about the pregnancy fears that freak you out most, from miscarriage to congenital disabilities and everything in between.

I'll Experience a Pregnancy Loss

One of the biggest fears about pregnancy is the fear of losing a pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), up to 10% of clinically recognized pregnancies (confirmed on an ultrasound) end in miscarriage. When you consider unconfirmed pregnancies, the rate is likely higher.

According to Karyn M. Solky, MD, OB-GYN at Cedars-Sinai Medical Center in Los Angeles, most pregnancies result in healthy babies. She also says to remember that most miscarriages happen within the first few weeks of pregnancy when many people don't realize they're pregnant and wouldn't know if they did miscarry. "They'd just get a normal-looking period," she says.

Most miscarriage statistics are incomplete because many miscarriages occur before people know they are pregnant and miscarriages are under-reported. For example, according to the National Institutes of Health (NIH), people generally have their first prenatal visit after their eighth week of pregnancy. That means miscarriages that occur prior may not be officially recorded.

That said, older studies suggest that after a health care provider can detect fetal cardiac activity (usually around 6 to 8 weeks), the risk of miscarriage drops significantly to about 4%. And the odds continue to drop as your pregnancy advances. And the chances of having a second miscarriage are very small—less than 3%, says Diane Ashton, MD, MPH, former deputy medical director for the March of Dimes.

So what causes a miscarriage ? Often, it's due to a chromosomal abnormality that prevents the fetus from developing typically, and miscarrying is unavoidable—not because of anything you did or didn't do. According to a 2014 study, risk factors include:

• Advancing maternal age
• Alcohol use
• Being underweight or having obesity
• Heavy lifting

You can lower your risk by not smoking or drinking alcohol and reducing your caffeine intake (aim for 200 milligrams or less, or one large cup of coffee, a day).

Morning Sickness Means My Baby Isn't Getting Enough to Eat

Pardon the comparison, but babies are very good parasites, says Dr. Solky. "They'll absorb all of the nutrition from the foods you do give them—so even if you're living on only crackers and juice, you don't need to worry," she notes.

Dr. Ashton agrees: "Unless you're sick to the point that you become severely dehydrated—and if you were, you'd feel so lousy that you'd call your doctor anyway—morning sickness isn't going to cause any nutritional imbalance or affect the fetus."

According to ACOG, morning sickness does not harm you or your fetus's health. In fact, morning sickness can be a good sign . However, if you cannot keep anything down and begin to lose weight—a severe form of morning sickness called hyperemesis gravidarum —it may affect your baby's weight at birth.

There are some things that may help you manage your morning sickness , including:

• Taking your prenatal vitamins
• Eating small, frequent meals
• Avoiding certain foods that trigger nausea

If you constantly find yourself over the toilet bowl, you may need an anti-nausea medication that is safe for the baby. Hang in there: Most people can stomach a wider variety of healthy foods after about 16 weeks, which is coincidentally about when your baby needs to start gaining more weight.

I'll Eat or Drink the Wrong Thing and Harm My Baby

A common pregnancy fear is the fear of eating something bad that will harm the fetus. Expecting parents feel a lot of pressure to do all the "right" moves during pregnancy, says Dr. Solky. But agonizing over every decision will drive you bananas—and there's no need for it.

A health care provider should outline the big no-nos at your first prenatal visit, and you can ask about any major concerns then. Remember: No one can follow every rule and guideline to the letter.

Avoiding Listeria —a bacteria that leads to food poisoning—is important in pregnancy. According to ACOG, it can lead to pregnancy complications and cause serious infections in a fetus. During pregnancy, you are 10 times more likely to contract listeria. So, to be safe, avoid the following foods:

• Raw (unpasteurized) milk and cheese
• Hot dogs and lunch meats
• Unwashed raw produce such as fruits and vegetables
• Sushi with raw meat
• Raw or undercooked meat

"Even the risks associated [with] things like eating unpasteurized cheese or dying your hair during your first trimester—both of which doctors advise against—are probably very, very small, and we're just being extra cautious," says Dr. Ashton.

So don't fret if you accidentally order a turkey sandwich (oops...forgot that cold cuts are off-limits!) or sip a glass of juice at brunch, then realize it's unpasteurized. Chances are, it'll be just fine.

My Stress Is Hurting the Baby

Between pregnancy hormones , sheer exhaustion, and planning for a baby, it's normal to feel on edge occasionally. But stressing over your stress is useless, says Dr. Solky—especially because a super-taxing day at work will not harm your baby.

According to the NIH, high levels of stress during pregnancy can lead to the following:

• Trouble sleeping
• Loss of appetite or a tendency to overeat
• High blood pressure
• Increased chance of preterm labor or a low-birth-weight infant

That said, most run-of-the-mill, day-to-day stress doesn't pose these risks. But it doesn't hurt to incorporate stress relief into your routine. This might involve a mindfulness practice , writing in your journal, venting to your partner, or going to bed an hour earlier.

My Baby Will Have a Birth Defect

Like many parents-to-be, one of your fears about pregnancy may involve worrying about your baby's risk of being born with a congenital abnormality. You may hold your breath during every single prenatal test, hoping the results will prove your baby is healthy and developing on track. And it's overwhelmingly likely that they are.

According to the Centers for Disease Control and Prevention (CDC), around 1 in 33 babies are born with a birth defect. That translates to just a 3% risk—or more optimistically, your baby is 97% likely to be born without a congenital disability.

These stats include both the more severe congenital disabilities as well as thousands of other identified abnormalities, many of which are small and insignificant. For example, a problem with a toenail or a tiny heart defect that goes away soon after birth without causing any long-term health issues are both considered birth defects.

Even if a screening test (like an ultrasound or quad screen) comes back abnormal, it doesn't necessarily mean there's a problem. In many cases, subsequent tests confirm that everything is fine, says Dr. Solky.

You can't always prevent birth defects because many are caused by a complex mixture of factors, including genes and environment. However, some have known behavioral causes, so the CDC recommends some things that can reduce your risk, including:

• Receiving prenatal care as soon as you know you're pregnant
• Taking 400 micrograms (mcg) of folic acid every day
• Avoiding drinking alcohol and smoking
• Discussing your medications with a health care provider
• Preventing infections during pregnancy
• Treating fevers with Tylenol (acetaminophen)
• Avoiding hot tubs and saunas
• Having medical conditions under control before becoming pregnant

You should also talk to a health care provider about your specific concerns. They should be able to give you a clear idea of the actual risks, given your family history and age, and help put your "what if" worries into perspective.

I'll Go Into Labor Too Early

This pregnancy fear is on many pregnant people's worry radar. According to the CDC, about 1 in 10 babies are born prematurely (before 37 weeks), or about 10%. But for Black Americans, that rate is closer to 15%.

Certain things place people at greater risk for preterm birth, including:

• Being pregnant in your teens or over 35
• Being Black
• Being low-income
• Having had a previous preterm birth
• Having an infection
• Carrying multiples
• Drinking, smoking, or using other substances
• Having high levels of stress

While you can't change some things, like your age, race, or income level, avoiding exposure to illness, avoiding alcohol and other substances, and reducing stress can lower your overall risk of premature birth.

I'll Have Pregnancy Complications

Many fears about pregnancy center around the potential complications that could arise for you and your baby. According to the NIH, some common complications of pregnancy include:

• Gestational diabetes
• Preeclampsia
• Preterm labor
• Depression and anxiety
• Miscarriage and stillbirth

According to the CDC, about 1 in 25 people develop dangerously high blood pressure (preeclampsia) . That's a risk factor of about 4%. It's more common in people over 40 and those with high blood pressure during pregnancy. "But if you had any of these factors, your doctor would be monitoring you closely from the very beginning and would likely catch the condition early," says Dr. Ashton.

Gestational diabetes occurs in 2% to 10% of pregnancies in the US, according to the CDC. Since gestational diabetes can lead to fetal problems, like being very large, being born early, and developing type 2 diabetes later in life, health care providers routinely screen for this condition. Fortunately, gestational diabetes is treatable.

It's not always possible to prevent pregnancy complications, but getting regular prenatal checkups and alerting your doctor to any concerning symptoms will ensure they are caught early when they are most manageable.

Sex Will Never Be the Same

If one of your fears about pregnancy involves sex after giving birth , you're not alone. Lots of people worry their bodies won't feel the same or they won't have the same amount of privacy or time for sex as before.

After your baby arrives, you'll need to give your body time to heal. During the first few months, odds are you and your partner will crave sleep more than sex, anyway.

Once a health care provider gives you the green light, don't hesitate to take it slow. Sex may hurt or feel uncomfortable the first few times (lube will be your new best friend). But the human body is an amazing thing with an incredible ability heal.

In fact, studies show that 89% of people resume sexual activity within six months of giving birth. And once your muscles regain strength, some new parents find their sex lives improve post-baby.

Labor Will Be Too Painful

Many parents' top fears about pregnancy involve worrying about the pain of labor and delivery. First, take a step back and realize that people have been doing this since the dawn of time—and there's plenty you can do about the pain these days.

Studies have found that labor pain is highly individual, meaning no one experiences it exactly the same way. Researchers say that cognitive, social, and environmental factors influence how people experience labor pain. In addition, when people believe the pain is purposeful and productive, they tend to experience it as non-threatening.

Some techniques that people have found helpful in managing labor pain include:

• Attending childbirth classes to prepare
• Exercising regularly to build stamina
• Using medication (like an epidural, analgesics, and nitrous oxide)
• Using relaxation techniques
• Having labor support from a professional doula

Dr. Solky says that regardless of your worrying style, having a health care provider you trust who can chat openly about your fears and wishes and talk you through what to expect is most important. "That will go a long way toward putting your mind at ease," she says.

Delivery Will Be Embarrassing

You've likely heard about people in labor who poop on the table , throw up on their doctors, or curse out their partner in front of everyone. So, these stories may fuel another one of your fears about pregnancy: Embarrassing yourself.

But remember, your health care providers have supported countless laboring people, so they've likely seen everything before. "Nothing grosses us out," says Dr. Solky. "So put it out of your mind!"

If it will ease your nerves, you can always institute a "stay north of my waist" rule for any family or friends keeping you company.

I'll Need an Emergency C-Section

Nearly one-third of babies in the US are born via C-section, according to the CDC. So it's only natural for major abdominal surgery to be one of your fears about pregnancy.

According to ACOG, reasons for C-sections include:

• Labor does not progress
• The fetus is in distress
• You are birthing multiples
• You have problems with your placenta
• Your baby is very large
• Complicated presentation (like breech, for example)
• You have a health condition that makes vaginal birth risky

But many of these surgeries are scheduled in advance. In other words, they're not the scary last-minute, rush-into-the-OR kind, says Dr. Solky. A C-section might be planned, for example, if the baby is breech or very large, if there are problems with the placenta, or if you had a previous C-section.

"I can tell you from my own experience that emergency C-sections are not common," Dr. Solky notes. "But if something happens and you do need one? That's why you're in the hospital."

I Won't Make It to the Hospital in Time

Maybe you read one story about someone who birthed their baby in a car, which scarred you for life. While lightning-fast labor can happen, the reality is it's not common. In truth, you'd probably have enough time to fly across the country between your first contraction and hearing your baby's first cries.

According to the Office on Women's Health, first-stage labor usually lasts 12 to 19 hours, with the second stage lasting 20 minutes to two hours. Of course, some people will have longer or shorter labors. Precipitous labor —a labor that results in birth less than three hours after contractions begin—is rare. Research suggests it only occurs in 0.1% to 3% of pregnancies in the US.

"It's usually toward the longer end of the range for firstborn children," says Christiane Northrup, MD, author of Women's Bodies, Women's Wisdom . Have a chat with your OB-GYN or childbirth instructor to make sure you're completely clear on when to head to the hospital. Doing a trial run, so you'll know exactly how long it takes to drive there, may also quell any lingering apprehension.

I'm Not Going to Be a Good Parent

You know exactly who you are as an individual now and perhaps as a partner, a professional, and even a pet owner. But some pregnancy fears center around who you'll be as a parent.

What will happen when you throw a child into your established mix? Will you be able to balance the needs of your new life with your old one—not to mention figuring out how to teach your child, discipline them, and build their self-confidence?

"Our ability as humans to bond is endless," says Steven R. Goldstein, MD , a professor of obstetrics and gynecology at New York University School of Medicine. "If you're concerned about being a good parent , it's a positive sign," he adds. "It means you really, deeply care." And that's a sign you're perfectly suited to your new role.

Key Takeaways

While plenty of fears can consume you when you're newly pregnant, the good news is that most of them aren't worth your time worrying over. Many common pregnancy fears are overblown. The reality is that statistical data is on your side: Most people have uncomplicated pregnancies, give birth to healthy babies, and become wonderful parents. Chances are good this is true for you, too!

Early pregnancy loss . American College of Obstetricians and Gynecologists. 2018.

What happens during prenatal visits? . Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2017.

Miscarriage risk for asymptomatic women after a normal first trimester prenatal visit . Obstetrics and Gynecology. 2008.

Risk factors for miscarriage from a prevention perspective: a nationwide follow-up study .  BJOG . 2014.

Morning sickness: Nausea and vomiting of pregnancy . American College of Obstetricians and Gynecology. 2021 .

Listeria and pregnancy . American College of Obstetricians and Gynecologists. 2022.

Will stress during pregnancy affect my baby? . National Institutes of Health . 2023.

What are birth defects? . Centers for Disease Control and Prevention . 2023.

Preterm birth . Centers for Disease Control and Prevention . 2022.

What are some common complications of pregnancy? . National Institutes of Health . 2021.

High blood pressure during pregnancy . Centers for Disease Control and Prevention . 2023.

Gestational diabetes . Centers for Disease Control and Prevention . 2022.

Postpartum female sexual function: Risk factors for postpartum sexual dysfunction .  Sex Med . 2020.

The nature of labour pain: An updated review of the literature .  Women and Birth . 2019.

Births: Method of delivery . Centers for Disease Control and Prevention . 2023.

Cesarean birth . American College of Obstetricians and Gynecologists . 2022.

Labor and birth . Office on Women's Health . 2021.

Precipitous delivery complicated by uterine artery laceration and uterine rupture in an unscarred uterus: A case report .  Case Rep Womens Health . 2022.

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What to expect at your first prenatal appointment

Your kickoff prenatal visit sets the stage for the rest of your pregnancy. Here's what to expect at this information-packed first appointment and how you can prepare.

When to schedule your first prenatal visit

When will your first appointment be, what happens at the first prenatal visit, how to prepare for your first prenatal appointment, what questions to ask at the first prenatal visit.

As soon as you get a positive result on a home pregnancy test , book an appointment with an obstetrician, family physician, or midwife . Depending on the practice, it's normal for another provider in the office, like a nurse practitioner or physician assistant, to handle your first visit.

If you haven't yet chosen a healthcare provider for your pregnancy, that's okay. It's still important to see someone now to start your prenatal care. You can always switch to another provider later. 

Many healthcare providers will schedule your first visit for when you're about 8 weeks pregnant . Some will see you sooner, particularly if you have an existing health condition, had problems with a pregnancy in the past, or are having new or severe symptoms such as vaginal bleeding or abdominal pain .

If you're taking any medications or think you may have been exposed to a hazardous substance, let your provider know as soon as possible.

The first visit will probably be the longest of your prenatal appointments (unless you have complications with your pregnancy along the way). At this and all future visits, don't be afraid to raise any questions or concerns you've been wondering about – it helps to keep a running list between appointments.

Here's what your provider will likely do during your first prenatal visit.

Take your health history. Your provider will ask questions about your gynecological health, personal medical history, and lifestyle habits. Topics commonly covered include:

• Whether your menstrual cycles are regular and how long they tend to last
• The first day of your last period (to determine your due date )
• Symptoms or problems you've noticed since your last period, whether they're related to pregnancy or not
• Current or past gynecological conditions, including sexually transmitted infections
• Details about previous pregnancies
• Current or past diseases and conditions
• Past surgeries or hospitalizations
• Mental health difficulties and diagnoses
• Whether you are being or have been abused , or have another situation that could affect your safety or emotional well-being
• Smoking, drinking, and drug use
• Medications, supplements, vitamins, and herbal drugs you take
• Drug allergies

Your healthcare provider will also ask about your family medical history. Many genetic issues and birth defects are at least partly hereditary, so learning about your family history helps your medical team keep an eye out for potential issues. Let your provider know whether a relative in your or your partner's family has a chromosomal or genetic disorder, had developmental delays, or was born with a structural birth defect.

It's also important to mention any potential exposure to toxins, especially if you live or work near toxic materials.

Check you out and run some tests. You can expect a number of standard exams and tests at your first prenatal visit. Some healthcare providers will do an ultrasound , but if you don't have any medical problems or concerns, it may not be part of the routine. Here's what's typical:

• A thorough physical exam
• A pelvic exam, including a Pap smear (unless you've had one recently) to check for infections such as chlamydia and gonorrhea or abnormal cells that could indicate cervical cancer
• A urine sample to test for urinary tract infections and other conditions

Your provider will also order blood tests to:

• Identify your blood type and Rh status
• Look for anemia
• Check for HIV, syphilis, hepatitis B and, in certain cases, hepatitis C
• Determine immunity to rubella (German measles) and chickenpox

Discuss any high-risk pregnancy concerns. Many people are considered to have high-risk pregnancies , meaning there's a higher-than-average chance of health issues during pregnancy, labor, and birth. High-risk groups include those who:

• Become pregnant for the first time at age 35 or older
• Become pregnant for the first time before age 18
• Have certain medical issues that develop during pregnancy, such as preeclampsia and gestational diabetes
• Have certain preexisting health problems, such as high blood pressure , thyroid disease , or type 1 or type 2 diabetes

High-risk pregnancies need extra care. While many potential complications are treatable or temporary, some can be dangerous to both you and your baby. Your provider will talk through the risks at your first visit and throughout your pregnancy – and don't be afraid to ask questions at any point.

Explain your options for prenatal genetic testing. Your provider will offer you various prenatal screenings that can give you information about your baby's risk for birth defects and chromosomal conditions. These tests include:

• Noninvasive prenatal testing (NIPT) , also called cell-free fetal DNA testing. Performed at 9 weeks or later, it's used to examine the little bits of your baby's DNA present in your blood.
• A first trimester screen, also called a first-trimester combined test. Typically done between weeks 11 and 13, it consists of a blood test and a type of ultrasound called a nuchal translucency .
• A carrier screening if you haven't had one already. It's a simple blood or saliva test done to see whether your baby is at risk for any of 100 genetic disorders such as cystic fibrosis, sickle cell disease, thalassemia, and Tay-Sachs disease.

Finally, if you're high-risk, there are invasive genetic diagnostic tests that can tell you for sure whether your baby has Down syndrome or certain other conditions. These tests include chorionic villus sampling (CVS) , generally performed at 10 to 13 weeks, and amniocentesis , usually done at 16 to 20 weeks.

CVS and amniocentesis are invasive and may carry a small risk of miscarriage , so women who choose to have these procedures are usually those with a higher risk for genetic and chromosomal problems. Some moms-to-be choose to wait for the results of screening tests before deciding whether to have one of these diagnostic tests.

For more information, your provider can refer you to a genetic counselor .

Give you advice and let you know what's ahead. Your healthcare provider will give you information about eating well , foods to avoid , healthy weight gain , and prenatal vitamins . They'll also give you a heads-up about the common discomforts of early pregnancy and let you know which pregnancy symptoms require immediate attention .

Your emotional health is very important. Your provider may screen you for signs of depression during pregnancy . But don't wait to be asked. If you're feeling depressed or anxious, let your provider know so they can refer you to someone who can help.

The dangers of smoking , drinking alcohol, using drugs, and taking certain medications will be a topic of discussion, as well. If you need help quitting smoking or any other substance, your provider can recommend a program or counselor.

Other topics include the do's and don'ts of exercise , travel , and sex during pregnancy ; environmental and occupational hazards that can affect your baby; and how to avoid certain infections, such as toxoplasmosis . Your provider will also discuss recommended vaccinations , like the flu shot and the COVID-19 vaccine .

To help your visit go as smoothly as possible, try taking the following steps.

Review your medical history. Brush up on your health status so you can better answer questions. This includes information about your:

• Overall physical and mental health
• Current and past diseases, conditions and other health issues
• Current medications, including prescriptions, supplements, vitamins and herbal supplements and teas
• Fertility and pregnancy history
• Family medical history
• Partner's medical history

If possible, bring documentation along, such as immunization records or a list of your medications. You may even want to bring a baggie containing the medications themselves.

Take your partner, a family member, or friend. Another person can write down notes, ask questions, and provide emotional support during this information-dense first visit.

Get there on time or a little early. This can be helpful for filling out forms and reviewing your insurance. Make sure to bring your insurance information and cash or a credit card for any necessary co-pays.

Just as your provider will ask you questions at your first prenatal visit, it's a good idea to come prepared with a list of questions for your provider. Ask anything – and don't be shy. Again, try to keep a running list in the weeks before the appointment, so nothing important slips your mind.

Here are some questions to consider if your provider doesn't bring up the topic first.

• How much weight gain is healthy for me? The first prenatal visit is a great opportunity to learn about how your body will change. It's also a good time to ask about nutrition, including which foods to prioritize in your diet.
• What are the foods I should avoid ? Raw fish and unpasteurized cheeses are long-established no-no's for pregnant people, but ask your provider for a full list of what to skip, since the accepted wisdom has changed over the years. Ask about caffeine and alcohol, too. Coffee is typically alright in limited doses, but no amount of alcohol is considered safe when you're having a baby.
• Are prenatal supplements a good choice? Your provider will likely recommend a prenatal vitamin containing folic acid and iron, both of which are needed more during pregnancy.
• Can I exercise? What about sex? With some exceptions, both are usually okay when you're pregnant. They're important to discuss, however, since certain conditions may complicate matters.
• Is it safe to keep working? If you have a physically or emotionally demanding job , you may want to ask how you can ease the effects on your body and mind.
• Is travel okay? While planes, trains, and automobiles are typically safe well into pregnancy, people with particular complications may need to limit or avoid traveling.
• Which medications are safe to take? Ask about your current prescriptions, herbal products, teas, supplements, and any over-the-counter drugs you may use, such as pain relievers and cold medicines. Non-steroidal inflammatory drugs (NSAIDs) like ibuprofen and naproxen are not recommended, for example.
• What are common symptoms of pregnancy? Your provider can tell you what to expect and how to cope. Remember to ask what symptoms are uncommon, too, and what red flags to watch for.
• What should I do in an emergency? Find out who to contact and where to go if you begin to experience new, unusual, severe, or long-lasting symptoms.
• Who will treat me over the course of my pregnancy? If your provider is part of a group practice, you may see other members of the group during appointments. They may even deliver your baby.
• Do you recommend taking prenatal classes? Whether they're in a hospital, at a university, online, or somewhere else, prenatal classes can be invaluable learning experiences for parents-to-be. On top of the usual childbirth classes you hear about, you can also find courses in everything from stress management to good nutrition and even breastfeeding.

Last but not least, ask about your next visit and schedule the appointment before leaving the office. Until your 28th week of pregnancy, you'll likely see someone every four weeks or so.

You may also want to ask whether future visits will be in-person or virtual. Certain practices offer virtual visits for low-risk patients, those whose providers aren't close by, or even higher-risk patients that need to be evaluated more often.

Was this article helpful?

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

March of Dimes. 2017. Prenatal Care Checkups.  https://www.marchofdimes.org/pregnancy/prenatal-care-checkups.aspx Opens a new window  [Accessed March 2024]

MedlinePlus. 2022. Prenatal care in your first trimester.  https://medlineplus.gov/ency/patientinstructions/000544.htm Opens a new window  [Accessed March 2024]

Mayo Clinic. 2022. Prenatal care: 1 st  trimester visits.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882 Opens a new window  [Accessed March 2024]

American Pregnancy Association. (2021). Your First Prenatal Visit.  https://americanpregnancy.org/healthy-pregnancy/planning/first-prenatal-visit/ Opens a new window  [Accessed March 2024]

Kids Health. 2022. Prenatal Visits: First Trimester.  https://kidshealth.org/en/parents/tests-first-trimester.html Opens a new window  [Accessed March 2024]

Mount Sinai. 2021. Prenatal care in your first trimester.  https://www.mountsinai.org/health-library/selfcare-instructions/prenatal-care-in-your-first-trimester Opens a new window  [Accessed January 2024]

Centers for Disease Control and Prevention. 2022. Recommended Clinician Timeline for Screening for Syphilis, HIV, HBV, HCV, Chlamydia, and Gonorrhea.  https://www.cdc.gov/nchhstp/pregnancy/screening/clinician-timeline.html Opens a new window  [Accessed March 2024]

Alabama Perinatal Excellence Collaborative. 2015. APEC Guidelines for Routine Prenatal Care.  http://apecguidelines.org/wp-content/uploads/2016/07/Routine-Prenatal-Care-6-30-2015.pdf Opens a new window  [Accessed March 2024]

Kids Health. 2019. Toxoplasmosis.  https://kidshealth.org/en/parents/toxoplasmosis.html Opens a new window  [Accessed March 2024]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2017. What is a high-risk pregnancy?  https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk Opens a new window  [Accessed March 2024]

Kids Health. 2022. What's a “High-Risk” Pregnancy?  https://kidshealth.org/en/parents/high-risk.html Opens a new window  [Accessed March 2024]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. 2018. What are some factors that make a pregnancy high risk?  https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors Opens a new window  [Accessed March 2024]

March of Dimes. 2020. Prenatal Tests.  https://www.marchofdimes.org/pregnancy/prenatal-tests.aspx Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2022. Carrier Screening.  https://www.acog.org/womens-health/faqs/carrier-screening Opens a new window  [Accessed March 2024]

March of Dimes. 2020. Chorionic Villus Sampling.  https://www.marchofdimes.org/pregnancy/chorionic-villus-sampling.aspx Opens a new window  [Accessed March 2024]

Office on Women's Health. 2021. Prenatal care and tests.  https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests Opens a new window  [Accessed March 2024]

MedlinePlus. 2021. What is noninvasive prenatal testing (NIPT) and what disorders can it screen for?  https://medlineplus.gov/genetics/understanding/testing/nipt/ Opens a new window  [Accessed March 2024]

Voyage Healthcare. 2021. Prenatal Care Overview.  https://www.voyagehealthcare.com/how-to-make-the-most-of-your-first-prenatal-visit-guide Opens a new window  [Accessed March 2024]

Gifford Health Care. Undated. Preparing for Your Appointment.  https://giffordhealthcare.org/patients/preparing-for-your-appointment/ Opens a new window  [Accessed March 2024]

Mayo Clinic. 2023. Pregnancy nutrition: Foods to avoid during pregnancy.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20043844 Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2023. Nutrition During Pregnancy.  https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy Opens a new window  [Accessed March 2024]

Mayo Clinic. 2022. Prenatal vitamins: Why they matter, how to choose.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-vitamins/art-20046945 Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2022. Exercise During Pregnancy.  https://www.acog.org/womens-health/faqs/exercise-during-pregnancy Opens a new window  [Accessed March 2024]

Mayo Clinic. 2022. Sex during pregnancy: What's OK, what's not.  https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/sex-during-pregnancy/art-20045318 Opens a new window  [Accessed March 2024]

Kids Health. 2022. Sex During Pregnancy.  https://kidshealth.org/en/parents/sex-pregnancy.html Opens a new window  [Accessed March 2024]

American College of Obstetricians and Gynecologists. 2023. Travel During Pregnancy.  https://www.acog.org/womens-health/faqs/travel-during-pregnancy Opens a new window  [Accessed March 2024]

March of Dimes. 2020. Over-the-counter medicine, supplements and herbal products during pregnancy.  https://www.marchofdimes.org/pregnancy/over-the-counter-medicine-supplements-and-herbal-products.aspx Opens a new window  [Accessed March 2024]

• First Trimester
• OB-GYN & Prenatal Care

What to Expect at the First Prenatal Visit

You got a positive pregnancy test —congratulations are in order! Now it’s time to plan your first prenatal visit. You might be feeling nervous (or is that morning sickness already?!), and you probably have lots of questions, but not to worry—your provider will be there every step of the way. In the meantime, you might want to brush up on what to expect at your first pregnancy appointment. Ready for answers? We’ve consulted with ob-gyns on all the important info.

When Should You Schedule Your First Prenatal Visit?

After you get that positive test, you can take a day or two to soak in the news and celebrate, but it’s a good idea to book that first prenatal visit with your chosen ob-gyn or midwife pretty soon after. (If you haven’t picked a provider yet , you’ll want to get on that ASAP!)

Andrea Braden , MD, IBCLC, an ob-gyn and founder of the lactation company Lybbie , advises to “be on the safe side and give the office a call as soon as you find out you’re pregnant.”

When Will Your First Prenatal Visit Happen?

It’s ideal to schedule your first prenatal visit for when you’re around 7 to 8 weeks pregnant, says Braden. Doctors recommend this timing because that’s when an ultrasound can likely detect baby’s heartbeat . (The earliest a fetal heartbeat can be detected is around week 6, according to Cleveland Clinic .)

If you’ve had complications in an earlier pregnancy, you may want to go in earlier than 7 to 8 weeks. “Sometimes we want to watch these early pregnancies closer because with a history of complications, you have an increased risk of having complications in a subsequent pregnancy,” notes Braden.

On the other hand, if you miss the 7-to-8-week mark, Braden says the goal would be to get you in before 12 weeks, when the first trimester ends. “After that point, just get in as soon as you can because there will be some catching up to do!” she adds.

How Can You Prepare for Your First Pregnancy Appointment?

Want a handy checklist for your first prenatal appointment? Here’s what you need to prepare, according to the experts.

• The date of your last menstrual period (LMP). During your first pregnancy appointment, your ob-gyn will compare the LMP to an ultrasound to determine your due date , says Braden. “If the last period was irregular or unpredictable, sometimes you need to know the first day of the period before that one,” she adds.
• Your medications and medical history. Gather a list of medications and dosages to bring to your provider to discuss their safety during pregnancy, advises Michael Platt-Faulkner , DO, an ob-gyn at St. Elizabeth Physicians in Northern Kentucky. “Writing down any significant personal medical or surgical history and family history of genetic diseases is also helpful information for your visit,” he adds.
• Your pharmacy information. Your doc might prescribe prenatal vitamins or other medications, depending on your medical history, so make sure you have a convenient pharmacy in mind.
• Any questions about symptoms or other concerns. Those first-trimester symptoms—nausea, fatigue, peeing all the time—can cause anxiety. Plus, figuring out what to eat (and not to eat) and questions like “ Can I have coffee while pregnant? ” can be confusing. Platt-Faulker suggests writing all your questions and concerns down for your provider, so you don’t forget them in the heat of the moment.
• Somewhere to track the rest of your pregnancy appointments. “There will be a lot of information coming at you,” says Braden. “You want to have a place to write down future appointments and take any notes.”

What Happens at Your First Prenatal Visit?

What happens at your first prenatal visit can vary widely depending on your state and the type of practice you’re visiting, says Braden. In some practices, you get both an ultrasound and a consultation during your first pregnancy appointment, while other providers’ offices split up these to-dos.

Here’s generally what to expect at your first prenatal appointment.

Your provider may perform an ultrasound to confirm the pregnancy, help determine your due date, check baby’s heart rate and check for any complications, according to Cleveland Clinic . “Oftentimes, an early-pregnancy ultrasound may use a vaginal probe and can be mildly uncomfortable—which can be helpful to know in order to be best prepared for your visit,” says Platt-Faulkner. By about 12 to 14 weeks of pregnancy, your provider will be able to hear baby’s heartbeat with a small device called a Doppler ultrasound, according to Mayo Clinic .

Medical history

“Your provider will review your pregnancy, medical and surgical histories in detail,” says Platt-Faulkner. “Your ob-gyn will [also] review how any medical diagnoses, pregnancy complications or surgical history may affect your pregnancy.” Your provider will also take a look at your medication list and discuss any pregnancy-related safety concerns with the medications you’re taking. Omoikhefe Akhigbe , MD, an ob-gyn at Pediatrix Medical Group in Maryland, adds that your provider may also discuss whether there are any specialty doctors you should start seeing or continue to see.

Lifestyle discussion

Your provider will discuss the lifestyle choices you plan to make during pregnancy. (Remember that, for starters, that means no smoking or alcohol .) “You’ll learn about foods that are safe to eat in pregnancy and the way to keep yourself healthy,” says Braden. “They will answer questions about exercise, diet, nutrition, rest, common symptoms and how to treat them and what to do if you do have discomfort in pregnancy.”

Genetic testing

At your first pregnancy appointment, your provider might perform or discuss future genetic testing. “There are genetic tests that are time-sensitive and can be done as early as 10 weeks,” says Braden. “There are some that are done with an ultrasound around 12 or 13 weeks pregnant, and some that are done in the second trimester. Depending on your history and what you desire, that’ll likely be brought up.” There are some specific tests your provider may offer based on your age or family history too, she adds.

Blood testing

You’ll likely get blood drawn during your first prenatal visit. You’ll be tested for a variety of conditions, including anemia, hepatitis B, syphilis and HIV, as well as for your blood type and Rh factor .

Urine testing

For starters, your provider might test a urine sample to confirm your pregnancy, as well as to test kidney function and screen for the presence of protein, as noted by the Cleveland Clinic .

Physical exam

You can expect a full physical exam at your first prenatal visit, which may include a pelvic examination and a breast exam. “If you’re due for a pap smear and you’re over 21 years of age, then you can expect that you’ll have a pap smear screening test done for cervical cancer along with an HPV test if indicated,” says Braden. “Typically, we also test for sexually transmitted infections at the time of the first prenatal visit.”

Questions to Ask at Your First Prenatal Visit

You’re likely full of questions—and that’s completely normal! Make sure to write them down—and bring this list to your first prenatal appointment in case you feel like you’re forgetting something.

• Questions about symptoms. Of course, you should bring any questions about symptoms to your appointment. Akhigbe says it’s also important to ask “when and where to call for an urgent question, what constitutes an emergency, what is an urgent question and what is a routine question that could probably wait for normal business hours.”
• Questions about testing. Which tests will you need during pregnancy? What will your insurance pay for? “Ask about common resources to use and where you can find the evidence-based information about your pregnancy and guidelines and information about tests,” advises Braden. A lot of people also want to know when they’ll find out baby’s sex , she adds. (Spoiler alert: With non-invasive prenatal testing (NIPT) , you can find out as early as 10 weeks.)
• Questions about your ultrasound plan. How many ultrasounds will you get? “Sometimes it depends on insurance, sometimes it depends on your medical history and sometimes it depends on your provider. Do they do them in-house or at a different center?” says Braden.
• Questions about lifestyle choices. Your doctor will review information about how to eat a healthy pregnancy diet with you, but if you have any specific concerns—such as about drinking alcohol or eating sushi—be sure to let them know.
• Questions about logistics. You’ve got a long journey ahead of you! Your provider will likely “review their practice structure, visit schedule and confirm the hospital where you’ll deliver,” says Platt-Faulkner. But if they’ve missed anything, Akhigbe recommends asking follow-up logistical questions, like how many providers you’ll see and which doctor is most likely to deliver baby. (Remember, there are no guarantees!)

There’s a lot of information to take in at your first prenatal visit. It might seem overwhelming, so make sure to bring questions, take notes and do whatever else you need to feel comfortable. Bringing your partner or a good friend along for the ride can help ease some nerves too. “If you have a support person that will be going along this journey with you, it’s always great to bring them to this visit if that’s allowed,” says Braden.

While it might feel like a lot to take in, know that your provider is there to make sure you and baby are healthy during your first prenatal visit and throughout your whole pregnancy—and that you’re making a wonderful first step in your pregnancy journey.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

15 Early Signs of Pregnancy

Pregnancy Checklist: Your First Trimester To-Dos

When Do You Start Showing in Pregnancy?

Omoikhefe Akhigbe , MD, is an ob-gyn and medical director at Pediatrix Medical Group in Maryland. She earned her medical degree from Meharry Medical College School of Medicine in Nashville, Tennessee.

Andrea Braden , MD, IBCLC, is an ob-gyn, board-certified lactation consultant and founder of the lactation company Lybbie . She earned her medical degree from the University of South Alabama School of Medicine.

Michael Platt-Faulkner , DO, is an ob-gyn at St. Elizabeth Physicians in Northern Kentucky. He earned his medical degree from the Heritage College of Osteopathic Medicine at Ohio University.

Cleveland Clinic, Fetal Development , March 2023

Cleveland Clinic, Ultrasound in Pregnancy , September 2022

Mayo Clinic, Prenatal Care: 1st Trimester Visits , August 2022

Nemours KidsHealth, Prenatal Tests: First Trimester , July 2022

Cleveland Clinic, NIPT Test , October 2022

Cleveland Clinic, Your First Prenatal Appointment: What to Expect , December 2022

Learn how we ensure the accuracy of our content through our editorial and medical review process .

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SARAH INÉS RAMÍREZ, MD, FAAFP

Am Fam Physician. 2023;108(2):139-150

Related AFP Community Blog:   Practice Ancestry-Based Medicine, not Racial Essentialism

Related editorial:   Perinatal Care of Transgender Patients, Adolescent Patients, and Patients With Opioid Use Disorder

Author disclosure: No relevant financial relationships.

Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater satisfaction, and lower pregnancy-associated morbidity and mortality. Care initiated at 10 weeks or earlier improves outcomes. Identification and treatment of periodontal disease decreases preterm delivery risk. A prepregnancy body mass index greater than 25 kg per m 2 is associated with gestational diabetes mellitus, hypertension, miscarriage, and stillbirth. Advanced maternal and paternal age (35 years or older) is associated with gestational diabetes, hypertension, miscarriage, intrauterine growth restriction, aneuploidy, birth defects, and stillbirth. Rh o (D) immune globulin decreases alloimmunization risk in a patient who is RhD-negative carrying a fetus who is RhD-positive. Treatment of iron deficiency anemia decreases the risk of preterm delivery, intrauterine growth restriction, and perinatal depression. Ancestry-based genetic risk stratification using family history can inform genetic screening. Folic acid supplementation (400 to 800 mcg daily) decreases the risk of neural tube defects. All pregnant patients should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella and should receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines. Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection. Because of the impact of social determinants of health on outcomes, universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy. Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients. People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks. Chronic hypertension should be treated to a blood pressure of less than 140/90 mm Hg.

Family physicians provide family-centered care for individuals and families before, during, and after the birth of a child. Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater care satisfaction, improved perinatal outcomes, and mitigates pregnancy-associated morbidity and mortality. 1 Family physicians are uniquely positioned to address social determinants of health while ensuring quality of care.

Prenatal Care Visits

Initiation of care between six and 10 weeks allows for identification of preexisting conditions that negatively affect maternal-fetal outcomes (e.g., diabetes mellitus, hypertension, obesity) 2 ; however, 22% of pregnant patients do not receive care during this time. 2 The COVID-19 pandemic resulted in a reevaluation of the number of physician visits needed, with an emphasis on increased flexibility, allowing for a combination of virtual and in-person visits depending on risk. 3 Table 1 outlines the components of prenatal care. 1 , 4 – 22 Table 2 provides opportunities for educating pregnant patients during prenatal care visits. 6 , 8 , 14 – 19 , 23 – 29

PHYSICAL EXAMINATION

Weight, height, and blood pressure should be measured at the first prenatal visit. Early identification of periodontal disease and treatment decreases adverse pregnancy outcomes. 7 Treatment may be performed in the second trimester, and emergent treatment may be completed at any time during pregnancy. 7 A bimanual pelvic examination has poor predictive value for clinical pelvimetry and screening for disease (i.e., sexually transmitted infections and cancer) but may be used as a diagnostic aid in patients with a discrepancy between uterine size and gestational age, which warrants ultrasonography assessment. 30 A pelvic examination is also useful in a symptomatic patient for evaluating spontaneous labor (e.g., cervical dilation, rupture of amniotic membranes). The clinical breast examination is a diagnostic aid in the symptomatic patient and addresses breastfeeding concerns or barriers but does not demonstrate benefit in patients already receiving screening mammograms and does not decrease mortality. 31 – 33

MATERNAL WEIGHT GAIN AND NUTRITION

A prepregnancy body mass index (BMI) greater than 25 kg per m 2 is associated with preterm delivery, gestational diabetes, gestational hypertension, and preeclampsia. A BMI greater than 30 kg per m 2 is also associated with an increased risk of miscarriage, stillbirth, and obstructive sleep apnea. 6 Prepregnancy BMI informs the timing of fetal surveillance, nutritional counseling, and goals for gestational weight gain. Table 3 lists general dietary guidelines for pregnant people. 8 , 17 , 34 , 35 For Black and Hispanic people, a prepregnancy BMI greater than 25 kg per m 2 and the associated poor outcomes are worse compared with non-Hispanic White people. 36

PARENTAL AGE AT CONCEPTION

Advanced maternal and paternal age (35 years and older) is associated with poor outcomes (i.e., aneuploidy, birth defects, gestational diabetes, hypertension, intrauterine growth restriction [IUGR], miscarriage, and stillbirth). Activities focused on improving perinatal outcomes for this group, such as a detailed fetal anatomic screening on ultrasonography, may decrease morbidity and mortality. 37

PREGNANCY DATING AND ULTRASONOGRAPHY

Accurate gestational age estimation is critical to quality care because it enables more precise timing of interventions (e.g., aspirin for preeclampsia prevention, steroids for fetal lung maturity), screening tests, and delivery. Up to 40% of people estimate their last menstrual period incorrectly; therefore, ultrasonography is recommended if uncertainty exists and for patients with irregular menstrual cycles, irregular bleeding, and discrepancy between uterine size and gestational age. 1 , 38 Ultrasonography before 24 weeks decreases missed multiple gestations and post-term inductions. 39 Although routine third-trimester ultrasonography may increase detection of IUGR, it does not improve outcomes. 40 If malpresentation is suspected on physical examination, confirmation with ultrasonography is recommended. 4

ALLOIMMUNIZATION

For patients who are RhD-negative and carrying a fetus who is RhD-positive, the alloimmunization risk is 1.5% to 2% in the setting of spontaneous abortion and 4% to 5% with dilation and curettage. The risk is decreased by 80% to 90% with anti-D immune globulin. 41 Testing for the ABO blood group and RhD antibodies should be performed early in pregnancy. A 300-mcg dose of anti-D immune globulin is recommended for RhD-negative pregnant patients at 28 weeks and again within 72 hours of delivery if the infant is RhD-positive. 41

Iron deficiency anemia increases the risk of preterm delivery, IUGR, and perinatal depression. The U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for anemia in pregnancy. 42 Screening is recommended by the American College of Obstetricians and Gynecologists early in pregnancy, with iron treatment if deficient. 43 Intravenous iron should be considered for patients who cannot tolerate oral iron or in whom oral iron has been ineffective at correcting the deficiency. 43 Patients with non–iron deficiency anemia, or if iron repletion is ineffective within six weeks, should be referred to a hematologist for further evaluation. Iron supplementation in the first trimester decreases the prevalence of iron deficiency. 43

INHERITED CONDITIONS

Pregnant patients should be counseled and offered aneuploidy (extra or missing chromosomes) screening in early pregnancy, regardless of age. 44 In the United States, 1 in 150 infants has a chromosomal condition, the most common being trisomy 21 (Down syndrome). 44 Table 4 compares screening tests for Down syndrome. 1 , 45 , 46 If a screening test is positive, amniocentesis at 15 weeks or more or chorionic villous sampling between 11 and 13 weeks is recommended. Both procedures have similar rates of fetal loss. 47 At 35 years of age, the risk of Down syndrome (1 in 294 births) is similar to that of fetal loss from amniocentesis. 47 Serum and nuchal translucency testing can screen for other trisomies, including 13 and 18, the protocols for which have lower sensitivities and higher specificities compared with screening protocols for trisomy 21 because they are rarer. 47

Additional genetic screening should be based on maternal and paternal personal and family histories. Race is a social construct, necessitating a shift in genetic risk stratification from race-based to ancestry-based. Sickle cell disease affects up to 100,000 people in the United States, but its inheritance pattern (1:10) is based on people with African ancestry, which includes much of the world. 48 Cystic fibrosis is inherited mainly by people of European ancestry (1:25), but ignoring the possibility of European ancestry in certain racial and ethnic groups results in an underestimation of its prevalence: African (1:61), Hispanic (1:40), and Mediterranean (1:29). 49

NEURAL TUBE DEFECTS

In the United States, neural tube defects affect approximately 2,600 infants per year, with the highest prevalence in Hispanic populations. 35 , 50 All pregnant patients should be counseled and offered screening with maternal serum alpha fetoprotein. 35 Folic acid, 400 to 800 mcg daily, started at least one month before conception and continued until the end of the first trimester, decreases the incidence of neural tube defects by nearly 78%. 35 Patients taking folic acid antagonists (e.g., carbamazepine, methotrexate, trimethoprim) or who have a history of carrying a fetus with a neural tube defect should take 4 mg of folic acid daily, starting at least three months before conception. 35

THYROID DISORDERS

There is no evidence that screening for thyroid disorders improves pregnancy outcomes. Thyroid-stimulating hormone levels should be measured if there is a history of thyroid disease or symptoms of disease. If the level is abnormal, a free thyroxine test helps determine the etiology. 51 Hypothyroidism complicates 1 to 3 per 1,000 pregnancies and increases the risk of fetal loss, preeclampsia, IUGR, and stillbirth. Hyperthyroidism occurs in 2 per 1,000 pregnancies and is associated with miscarriage, preeclampsia, IUGR, preterm delivery, thyroid storm, and congestive heart failure. 51 The effect of subclinical hypothyroidism on a child's neurocognitive development is not well understood, and the effectiveness of treatment with levothyroxine is unproven. 51

CERVICAL CANCER

Intervals for cervical cancer screening are based on patient age, cytology history, and history of the presence of high-risk human papillomavirus (HPV). Routine screening for people at average risk of cervical cancer should begin at 21 years of age. Screening can be performed with either cytology alone every three years, HPV screening alone every five years, or cytology plus HPV screening every five years starting at 25 years of age. Screening is not indicated for people 65 years and older with negative screening in the previous 10 years, and no history of cervical intraepithelial neoplasia grade 2 or higher in the past 25 years. 52 Colposcopy is indicated when the risk of cervical intraepithelial neoplasia grade 3 is greater than 4%. Surveillance of high-grade lesions should be performed every 12 to 24 weeks. 52 , 53 Although colposcopy and cervical biopsy can be safely performed during pregnancy, endocervical sampling should be deferred until postpartum. 53

Infectious Disease

Bacteriuria.

Asymptomatic bacteriuria complicates up to 15% of pregnancies in the United States, 30% of which progress to pyelonephritis if untreated. 54 All pregnant patients should be screened for bacteriuria at the first prenatal visit. 54 A culture from a midstream or clean-catch sample with greater than 100,000 colony-forming units per mL of a single pathogen is considered positive and treated to decrease the risk of pyelonephritis and subsequent preterm delivery. 54

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections can affect prenatal outcomes. 55 – 57 Table 5 lists routine screening and treatment for sexually transmitted infections in pregnancy. 55 , 56

Rubella immunity screening during the first prenatal visit is recommended. Postpartum vaccination should also be offered if the patient is not immune to prevent congenital rubella syndrome in subsequent pregnancies. 1 , 58 The presence of rubella immunoglobulin G should be interpreted with caution in patients recently migrating from areas where rubella is endemic because this may indicate a recent infection. 58 Rubella is a live vaccine and should not be administered during pregnancy but is safe during lactation after delivery. 59 , 60

Maternal varicella can result in congenital varicella syndrome (i.e., IUGR and limb, ophthalmologic, and neurologic abnormalities) and neonatal varicella; infection can occur from approximately five days before to two days after birth. A negative history of varicella infection or vaccination warrants serologic testing, and if immunoglobulin G is negative, varicella exposure should be avoided. Postpartum vaccination should be offered. 61

Although tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination is recommended for anyone in close contact with the infant, only antenatal maternal vaccination ensures increased protection against neonatal pertussis. 62 Pregnant patients should receive a Tdap vaccine beginning at 27 weeks to maximize time for passive immunity to the fetus through the placental transfer of maternal antibodies; vaccination is recommended in each subsequent pregnancy. 62

INFLUENZA AND COVID-19

Influenza and COVID-19 infection in pregnancy increase the risk of intensive care unit admission, preterm delivery, stillbirth, and maternal death. 63 , 64 COVID-19 infection almost doubles the risk of developing preeclampsia 64 ; therefore, initiating low-dose aspirin (81 mg daily) starting at 12 weeks should be considered. 5 Pregnant patients and their household contacts should be vaccinated for influenza and COVID-19. 63 , 64

GROUP B STREPTOCOCCUS

In the United States, group B Streptococcus (GBS) is the leading cause of infection in the first three months of life; 25% of all pregnant patients are GBS carriers. 65 , 66 Screening with a vaginal-rectal swab for culture between 36 and 37 weeks is recommended. 67 Intrapartum antibiotic prophylaxis decreases neonatal mortality. Antibiotics are recommended when there is GBS bacteriuria with the current pregnancy, a history of a previous infant affected by GBS (e.g., septicemia, meningitis, pneumonia, death), or unknown GBS status and risk factors (e.g., preterm labor, rupture of membranes more than 18 hours before delivery, GBS in previous pregnancy). 67 Patients with GBS bacteriuria in the current pregnancy are assumed to be colonized and do not need subsequent screening. 67

Social Determinants of Health

Social determinants of health represent up to 80% of the factors that directly affect a person's health. 68 Physicians who provide prenatal care play a critical role in mitigating the burden that social determinants of health play on maternal-child health without compromising the quality of care delivered. 69 An increased burden from social determinants of health increases the risk of depression, anxiety, intimate partner violence, substance use, and food insecurity 70 , 71 ; therefore, universal screening is recommended early in pregnancy.

DEPRESSION AND ANXIETY-RELATED DISORDERS

After the COVID-19 pandemic, rates of perinatal depression and anxiety have increased. People who are non-White, 24 years or younger, or who have 12 years or less of education, lower socioeconomic status, or a history of intimate partner violence or sexual trauma are at higher risk. 11 , 72 , 73 If untreated, depression and anxiety-related disorders increase the risk of preeclampsia, preterm delivery, IUGR, substance use, maternal suicide, infanticide, psychosis, and homicide. 11

INTIMATE PARTNER VIOLENCE

Intimate partner–related homicide is the leading cause of death in the United States in pregnancy. Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes, IUGR, and preterm delivery. 13 Family physicians should be aware of the signs of intimate partner violence (e.g., frequent sexually transmitted infections, repeated requests for pregnancy tests when pregnancy is not desired, fear of asking a partner to use a condom), the effect of violence on health, and the increased risk of child abuse after delivery. 13

SUBSTANCE USE

Substance use during pregnancy increases the risk of IUGR, preterm delivery, stillbirth, fetal malformations, and maternal death. 74 The use of prescription opioids complicates 7% of pregnancies in the United States; of these, 20% of patients report misuse. 75 Opioid use in pregnancy increased by 131% from 2010 to 2017 in the United States, and the incidence of babies born with withdrawal symptoms in that time increased by 82%. 76 Fetal alcohol exposure is the leading cause of preventable neurodevelopmental disorders in the United States. 14 However, 14% of pregnant patients report current drinking, and 5% report binge drinking in the past 30 days. 77 Exposure to cigarette smoking in utero increases the risk of sudden intrauterine and infant death. 15

FOOD INSECURITY

Maternal food insecurity increases the risk of poor outcomes (e.g., IUGR, preterm delivery, gestational diabetes, hypertension, depression, anxiety). However, few patients disclose this due to concerns about social stigma; therefore, a universal approach to screening is encouraged. The Hunger Vital Sign tool may be used. 12

Complications of Pregnancy

Gestational diabetes.

Gestational diabetes complicates up to 14% of U.S. pregnancies, with up to 67% of patients developing type 2 diabetes later in life. 78 Racial and ethnic minorities are at the highest risk. 79 Gestational diabetes is associated with hypertension, macrosomia, shoulder dystocia, and cesarean deliveries. 80 Screening for undiagnosed type 2 diabetes at the initial prenatal visit is recommended for people at increased risk 80 ( Table 6 5 , 80 ) . Universal screening for gestational diabetes should occur between 24 and 28 weeks with a one-hour (50-g) glucose tolerance test and, if results are abnormal, should be followed by a confirmatory, fasting, three-hour (100-g) test. 80

HYPERTENSION

Blood pressure should be monitored at each prenatal visit, and education should be provided on preeclampsia warning signs. 5 Patients at increased risk of preeclampsia should be screened for thrombocytopenia, transaminitis, and renal insufficiency, including proteinuria, during the first or second trimester and started on prophylactic daily low-dose aspirin (81 mg) between 12 and 16 weeks 5 ( Table 6 5 , 80 ) . Screening for proteinuria in isolation has little predictive value for detecting preeclampsia. 5 Chronic hypertension (hypertension before 20 weeks) is treated to less than 140/90 mm Hg. 81

PRETERM DELIVERY

Preterm delivery (between 20 and 37 weeks) is a significant cause of neonatal morbidity and mortality, complicating 10.5% of U.S. pregnancies. 2 Modifiable risk factors include prepregnancy BMI (less than 18.5 kg per m 2 and greater than 25 kg per m 2 ), substance use, and short interval between pregnancies (i.e., less than 18 months). 82 Several options are available for the prevention of preterm labor in a singleton pregnancy. 82 Patients with a previous preterm delivery before 34 weeks should have a cervical length assessment starting at 16 weeks through 24 weeks. 82 These patients should be treated with progesterone supplementation (vaginal or intramuscular). In the asymptomatic patient with a short cervix and without a history of spontaneous birth before 34 weeks, vaginal progesterone (200 mg) started between 16 and 20 weeks and continued through 36 weeks is recommended. 82

POST-TERM DELIVERY

Stillbirth complicates 3 per 1,000 post-term (42 weeks or greater) pregnancies. 20 Antenatal testing should be initiated at 41 weeks; if the results are not reassuring, induction of labor is recommended. 20 , 21

Cultural Considerations

Maternity care improves outcomes; however, vulnerable populations (i.e., racial, ethnic, and religious minorities) are less likely to engage in care if it is not culturally centered, which acknowledges the effect of culture on health conditions (e.g., depression) and enhances patient-physician trust. 83 Addressing cultural needs (e.g., doula, community health workers, interpreters) throughout pregnancy helps mitigate barriers and improves outcomes.

This article updates previous articles on this topic by Zolotor and Carlough 1 ; Kirkham, et al. 17 ; and Kirkham, et al. 84

Data Sources: A search was completed using the key terms prenatal care, COVID-19, oral health, pelvic examination, prepregnancy body mass index, pregnancy dating and ultrasound, maternal and paternal age and impact on pregnancy outcomes, aneuploidy screening, inheritance patterns of sickle cell disease and cystic fibrosis, anemia, cell-free DNA analysis, thyroid disease, cervical cancer screening, management of abnormal cervical cytology, screening guidelines for sexually transmitted infections in pregnancy, group B Streptococcus screening, social determinants of health and prenatal outcomes, intimate partner violence, polysubstance abuse, food insecurity, maternity care deserts, hypertension in pregnancy, progesterone for preterm birth prevention, post-term delivery, and preconception care. Also searched were PubMed, Essential Evidence Plus, the Cochrane database, U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Cancer Society, American Family Physician , and reference lists of retrieved articles. Search dates: July 1, 2022; February 19, 2023; and June 16, 2023.

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Peahl AF, Zahn CM, Turrentine M, et al. The Michigan Plan for appropriate tailored healthcare in pregnancy prenatal care recommendations. Obstet Gynecol. 2021;138(4):593-602.

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Tips to ease anxiety before the first prenatal appointment

I’m 6 weeks with baby #2 and my first appointment is March 12th. I’ll be 10 weeks ��

It helps me to break it down into smaller segments… so my first goal was to make it to today, 6 weeks/appointment in 4 weeks. 4 weeks is the time between appointments until 28 weeks. It feels more manageable now that I have 4 weeks left.

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• Open access
• Published: 10 May 2022

How do prenatal people describe their experiences with anxiety? a qualitative analysis of blog content

• Shayna K. Pierce   ORCID: orcid.org/0000-0002-5490-6495 1 ,
• Kristin A. Reynolds   ORCID: orcid.org/0000-0001-5367-7021 1 ,
• Madison P. Hardman   ORCID: orcid.org/0000-0003-4246-7218 1 &
• Patricia Furer   ORCID: orcid.org/0000-0003-1662-7396 2  

BMC Pregnancy and Childbirth volume  22 , Article number:  398 ( 2022 ) Cite this article

1575 Accesses

2 Citations

Metrics details

Despite elevated prevalence rates of prenatal (antenatal) anxiety across studies (13–21%), and prenatal people’s use of the Internet to search for pregnancy-related information and support, research investigating prenatal people’s experiences with online mental health communication, such as blogs, is lacking. This study examined blog entries focused on anxiety in pregnancy to better understand prenatal people’s Internet discourse concerning their experiences with anxiety.

A Google search using the keywords “anxiety,” “pregnant,” and “blog” resulted in N  = 18 blogs that met inclusion criteria (public blog written in English describing a personal experience with prenatal anxiety in 250 words or more). Blog content was analyzed using a thematic analytic approach based on grounded theory principles.

Three main themes capturing prenatal people’s experiences with anxiety as written in public blog content were developed from qualitative analyses: 1) etiology (subthemes: before pregnancy, during the current pregnancy, related to a previous pregnancy), 2) triggers (subthemes: uncertainty, perceived lack of control, and guilt and shame for not having a normal pregnancy), and 3) symptoms (subthemes: intertwined emotional, cognitive and physical symptoms, in addition to behavioural symptoms).

Conclusions

Our findings demonstrate a need for perinatal professionals to address anxiety symptoms and triggers in pregnancy. One way to address this may be by providing credible information regarding prenatal mental and physical health to pregnant people through online mediums, such as blogs. Bloggers often discussed experiencing a combination of emotional, cognitive, physical, and behavioural symptoms, which suggests that medical and mental health professionals should work collaboratively to provide care for prenatal people experiencing anxiety. Furthermore, Cognitive Behavioural Therapy (CBT) addresses these types of symptoms, which suggests that interventions developed or adapted to meet this populations’ needs could employ this therapeutic approach. Future research should explore the reasons why prenatal people experiencing anxiety engage with blogs, the characteristics of bloggers and readers, the impact of the blogging experience on both the blogger and their audience, and the information quality of blog content.

Peer Review reports

For most prenatal people (those who identify as pregnant), pregnancy and childbirth pose significant life changes and challenges that are often associated with mood fluctuations. When short-lived, anxiety and worry are a natural response to the many changes and feelings of uncertainty experienced throughout pregnancy. However, prolonged anxiety that is difficult to manage can be disruptive to everyday functioning and indicate an anxiety disorder. Qualitative research exploring pregnant and postpartum people’s experiences with prenatal, otherwise known as antenatal, anxiety have identified common elements across these experiences, including help-seeking barriers, a discrepancy between pregnancy expectations and lived experience, and the importance of peer support [ 1 , 2 , 3 , 4 ]. One online resource that allows prenatal people to ask questions about their physical and mental health and receive advice is blogs. Blogs are an online medium where people can share self-dialogue regarding various topics or experiences, including those related to anxiety in pregnancy, and receive commentary from readers [ 5 ]. There has yet to be an analysis of the content of prenatal anxiety blogs, which was the focus of the current study.

Anxiety disorders in the Diagnostic and Statistical Manual-Fifth Edition (DSM-5) are distinguished based on the anxiety’s primary focus (e.g., worry about multiple life domains for Generalized Anxiety Disorder) [ 6 ]. For people experiencing prenatal anxiety, the primary focus of the anxiety is related to various aspects of the pregnancy, such as maternal health, childbirth, and fetal development [ 7 ]. Research has explored the prevalence of anxiety across the perinatal period, with some studies offering distinct rates for the prenatal and postpartum periods. Across such studies, prenatal anxiety has been found to have an estimated prevalence of 13–21% [ 8 , 9 , 10 , 11 , 12 ] and has been linked to adverse effects on both maternal and fetal health. During pregnancy, anxiety increases cortisol in the mother’s blood for prolonged periods, raising the risk of harmful outcomes such as spontaneous abortion and preterm labour [ 13 , 14 , 15 , 16 ]. Beyond pregnancy, anxiety may be linked to cognitive, behavioural, and emotional problems in the infant as they grow older, in addition to increasing the risk for maternal postpartum mental health concerns (e.g., postpartum anxiety or depression) [ 17 , 18 , 19 ]. Despite the prevalence and severity of perinatal anxiety (anxiety occurring in pregnancy and up to 12 months postpartum), postpartum depression is the only perinatal mental health condition classified in the DSM-5.

Until recently, there has been a lack of discourse around prenatal anxiety in society and the literature [ 9 , 11 , 20 ], which has perpetuated several of the help-seeking barriers faced by prenatal people experiencing anxiety. Limited knowledge among the general public and healthcare providers about symptoms of perinatal anxiety and treatment options, which constitutes a key component of mental health literacy, can hinder pregnant and postpartum people’s help-seeking endeavours [ 2 , 21 , 22 , 23 , 24 ]. Research by Ponzini et al. [ 21 ] suggests that there is a lack of clarity around symptoms of postpartum anxiety disorders, with perinatal people exhibiting greater familiarity with symptoms associated with postpartum depression. Further to this, qualitative research suggests that pregnant and postpartum people experiencing anxiety may not always associate their symptoms with a perinatal anxiety disorder, which can make it difficult for them to locate information and supports that address their mental health concerns [ 2 ]. Additionally, the stigma surrounding perinatal anxiety may make prenatal people reluctant to disclose their symptoms [ 2 , 21 , 22 ], thereby limiting opportunities for both informal and formal supports.

The Internet is an accessible resource that can help prenatal people anonymously gather information about their symptoms of anxiety. The Internet has become an increasingly popular source of health information, with over two-thirds of Canadians searching for online health information in 2020 [ 25 ]. The Internet can help users, including perinatal people, to make informed treatment decisions by both supplementing and validating information received from healthcare providers [ 26 , 27 ]. Qualitative focus group research revealed that people typically have the most health-related questions during early pregnancy and felt there were too few patient-centred prenatal visits to receive sufficient information, leading them to Google for answers [ 28 ]. This need for information is reflected across the literature, with studies showing between 86–99% of people sampled having searched the Internet for pregnancy and childbirth-related information while pregnant [ 29 , 30 ].

There are a range of online resources available to prenatal people experiencing anxiety who are seeking information and peer support. Focus group research suggests that some resources, such as large-scale forums, are less preferred by perinatal people with anxiety, given that the breadth of contrary opinions can muddle evidence-based information [ 2 ]. Rather, moderated online peer-support resources that allow perinatal people to hear about the experiences of other pregnant and postpartum people and normalize their own experiences appear to be more acceptable [ 2 ]. Considering the widespread demand for pregnancy-related information, blogs may be a useful resource for pregnant people as they allow users to write about their personal experiences, ask questions, and receive answers from respondents. Blogs may provide pregnant and postpartum people with genuine depictions of pregnancy, which qualitative research suggests may help to normalize perinatal people’s experiences with anxiety [ 2 , 4 ]. Blogs are unique in that while other forms of qualitative data, such as focus groups and interviews, allow researchers to explore questions that they deem important regarding prenatal people’s experiences with anxiety, analyzing blogs allows for researchers to determine which topics prenatal people want to discuss or receive information about organically, outside of the research context. With regards to prenatal mental health-focused blogs, the literature is currently limited to an evaluation of blogs focused on pregnancy loss and termination [ 31 ]. As such, research on pregnant people’s experiences with prenatal anxiety as expressed through blog posts is absent from the existing qualitative literature. Given the elevated rates of prenatal anxiety and the increased reliance on the Internet and blogs for information and support, the aim of this research was to explore how pregnant people describe their experiences with prenatal anxiety by analyzing the content in public blog entries.

Blog selection

The first author (SP) used Google.com (United States) to search various combinations of the keywords pregnancy (prenatal, pregnant, pregnancy), anxiety (anxious, anxiety, stress) and blog (personal blog, blog). “Antenatal” was later added as another word for prenatal, as the bloggers commonly used this term. Previous research reveals that readers typically do not look at webpages beyond the third page of Google results [ 32 ]. Thus, we only analyzed blogs found on the first three pages of each search. Twenty-six open-access blog entries accessed in March 2017 were analyzed (see Table 1 for n per search). Blogs were written between 2011–2017. Through consultation with and approval to proceed from the University of Manitoba Research Ethics Board, formal submission of ethics and consent were not needed as blogs are publicly accessible. This study was performed with relevant guidelines and regulations. Quotes included within this manuscript have been labelled with a participant code.

The authors analyzed each blog entry to determine whether they met the following inclusion criteria: 1) Online public blog entries; 2) Written in English; 3) Describe personal experiences with prenatal anxiety; 4) 250 words at minimum to ensure sufficient data for analysis. Given the high comorbidity of perinatal depression and anxiety [ 33 ], blog entries describing depression and anxiety were included. Of the 26 resulting blog entries, 18 met inclusion criteria. Eight were excluded: five for having less than 250 words and three for focusing on postpartum experiences. Dialogue from the 18 useable blog entries was copied into a Microsoft Word document for analysis.

Participants

The included blog entries were written by 18 prenatal people who were experiencing prenatal anxiety. There was variation across blogs regarding which pregnancy was discussed (e.g., first, second, or third). Some of the prenatal people described their experiences with miscarriage(s) or labour complications in a previous pregnancy. Prenatal people varied in their pre-pregnancy experiences with anxiety. Participant characteristics that were mentioned by bloggers are reported in Table 2 .

Data analysis

We completed a thematic analysis based on grounded theory principles, including the specific tenets of the coding process (e.g., specify levels of coding, memoing, etc.) [ 34 , 35 ]. The identification of themes was achieved in three stages: initial coding, focused coding, and theoretical coding [ 36 ]. Initial coding involved the first (SP) and second authors (KR) independently coding each line with gerunds, in vivo codes, or direct quotes to allow us to stay as close as possible to the data and the processes being described by bloggers. Memoing was achieved during this stage by having each coder keep a coding journal to track coding decisions and preliminary thoughts regarding themes. Our coding became more conceptual as we progressed through the analysis of blog content, within the focused and theoretical coding stages. In the focused coding stage, conceptual codes were developed by comparing preliminary themes and grouping together themes from multiple blogs. During the theoretical coding stage, codes were refined and employed into a relational explanation of the main themes and subthemes emergent from the data. These stages were moved through reflexively rather than sequentially as new data was coded. Each coder keep a coding journal throughout, which acted as an audit trail for coding decisions. Coding challenges were reviewed and resolved collaboratively in line with previously established standards for rigorous qualitative research [ 35 ].

Three main themes and related subthemes regarding prenatal people’s experiences of anxiety emerged from the analysis of blog entries: 1) etiology (subthemes of before pregnancy, during the current pregnancy, related to a previous pregnancy), 2) triggers (subthemes of uncertainty, perceived lack of control, and guilt and shame for not having a normal pregnancy), and 3) symptoms (subthemes of a combination of emotional, cognitive, and physical symptoms, in addition to behavioural symptoms). Figure  1 provides a diagram illustrating the main and subthemes. Supporting quotes for each subtheme can be found in Table 3 .

Model of themes capturing bloggers’ experience of prenatal anxiety. Dark grey represents the topic. Light grey represents main themes. White represents subthemes

Main theme: etiology

All bloggers discussed the ways their anxiety developed, which we categorized into three main etiological pathways: anxiety developing before pregnancy, during the current pregnancy, or related to a previous pregnancy. Many bloggers described having pre-existing non-perinatal anxiety and how their anxiety worsened throughout pregnancy (Table 3 , quote 1). A few bloggers described developing anxiety during pregnancy, particularly during the first trimester (Table 3 , quote 2). These bloggers mentioned that their anxiety levels only decreased after delivering their baby (Table 3 , quote 3). Lastly, some bloggers described developing anxiety in their current pregnancy due to challenges encountered in a previous pregnancy, such as miscarriage(s) (Table 3 , quote 4) or life-threatening complications during labour (Table 3 , quote 5).

Main theme: triggers for prenatal anxiety

All bloggers discussed at least one trigger for their prenatal anxiety, with many describing multiple triggers. Triggers resulting in worsened anxiety included three subthemes: uncertainty, perceived lack of control, and guilt and shame for not having a “normal” pregnancy free of anxiety.

Uncertainty

The bloggers described six areas of uncertainty: waiting for their first prenatal appointment, their baby’s health, their health, the possibility of miscarriage, the experience of labour, and how having a baby would impact their life. Many bloggers described feeling the most uncertain during their first trimester (Table 3 , quote 6). Uncertainty sprouted from having to wait 8–10 weeks into their pregnancy for their first prenatal appointment (Table 3 , quote 7) and uncertainty around their baby’s health. Health concerns included their babies’ development, rare medical conditions that their baby might have, and symptoms that might indicate pregnancy complications (e.g., abdominal cramps creating concern of ectopic pregnancy). The mere thought of their baby not being healthy triggered anxiety (Table 3 , quote 8). Additionally, many bloggers discussed how uncertainty around how the changes occurring to their body would impact their physical health triggered their anxiety (e.g., difficulty breathing as their stomach grows throughout pregnancy; Table 3 , quote 9).

A few bloggers discussed how the fear of miscarriage triggered their anxiety. For some, this fear pertained to whether their regular activities, such as sleep, would harm their developing baby or even cause a miscarriage (Table 3 , quote 10). For others, this fear involved previously experiencing a miscarriage (Table 3 , quote 11). Thoughts regarding the experience of labour also triggered anxiety (Table 3 , quote 12). For one blogger, this was due to their experience in their previous labour (Table 3 , quote 13). Lastly, many bloggers expressed uncertainty regarding how having a baby would affect aspects of their lives, including their relationships, finances, and whether they could learn how to be a parent (Table 3 , quote 14).

Perceived lack of control

Related to the aforementioned areas of uncertainty, many bloggers expressed a perceived lack of control over their privacy, their choices regarding labour and delivery procedures, the various changes happening to their bodies, and their anxiety during their pregnancy. Regardless of the cause, bloggers expressed that their perceived lack of control increased their prenatal anxiety. Concerning privacy, one blogger described feeling attacked in social interactions when asked intrusive questions about their pregnancy (Table 3 , quote 18). Some bloggers expressed feeling a lack of control over their bodies, particularly over choices related to labour and delivery procedures (e.g., whether to have an unmedicated or medicated labour and delivery; Table 3 , quote 19), the changes occurring to their bodies to support the developing fetus (Table 3 , quote 20), and deciding whether to continue their pregnancy (Table 3 , quote 21). Lastly, a few bloggers described feeling they lacked control over their anxiety during pregnancy, referring to it as negative and uncontrollable (Table 3 , quote 22). For a few bloggers, their anxiety elicited such distress that they felt that termination of the pregnancy or suicide was their only option (Table 3 , quote 23).

Guilt/shame for not having a “normal” pregnancy

A few bloggers elaborated on the stigma surrounding what emotions prenatal people ‘should’ feel during pregnancy (Table 3 , quote 15). Bloggers described how experiencing negative emotions during pregnancy, rather than the expected positive emotions, triggered their anxiety. Many felt guilt and shame for not having a “normal” pregnancy filled with positive emotions (Table 3 , 16). For a few bloggers, this guilt and shame led them to question whether they would be good mothers (Table 3 , quote 17).

Main theme: symptoms of prenatal anxiety

Discussion of the symptoms of anxiety that bloggers experienced during pregnancy revealed two categories of symptoms commonly experienced during the first trimester: 1) An inter-woven experience of emotions, thoughts, and physical symptoms; and 2) Behavioural symptoms. Emotions and thoughts described by bloggers included feeling selfish, negative, guilty, ashamed, embarrassed, disconnected, fretful, worried, impatient, and intolerant (Table 3 , quotes 24 and 25). Bloggers discussed these in conjunction with physical symptoms, including changes to their bodies that increased anxiety (i.e., hormone changes, body changes) and physiological aspects of anxiety (i.e., irregular breathing, heart palpitations, panic, and difficulty sleeping; Table 3 , quote 26). Lastly, many bloggers discussed their behavioural symptoms, including withdrawing from conversations and relationships, isolating, and pulling back from previously enjoyed activities and goals (Table 3 , quote 27, 28, and 29).

The findings from this study are additive and complementary to the existing qualitative literature focused on prenatal people’s experiences with anxiety. The themes captured in this study reflect common themes highlighted across the literature, including stigma around perinatal mental health concerns and pregnancy as a period of uncertainty, in particular during the first trimester [ 1 , 2 , 4 ]. Of note, this study is the first to examine prenatal people’s experiences with anxiety using online public blog entries. Though it was beyond the scope of the current study, in terms of objective and methodology, to explore why bloggers chose to use blogs as a means to share their experiences, based on the content shared across blogs, there appeared to be a desire to share information to make meaning from experiences, to offer support to others such that they may feel less alone in their experiences, and to obtain support in comments and feedback on the blog itself. Following a thematic analytic approach based on grounded theory principles, we identified three main themes evident to the online discourse presented in 18 prenatal anxiety blogs analyzed:  etiology ,  triggers , and  symptoms of prenatal anxiety .

Regarding etiology, most bloggers reported anxiety before becoming pregnant or noted having developed anxiety due to previous pregnancy experiences. This highlights the importance of and need for early detection and intervention to prevent prolonged prenatal anxiety and the associated adverse consequences for the mother and developing fetus [ 13 , 14 , 15 , 16 ]. Further, early detection and intervention are suggested to be helpful for prenatal anxiety given the lack of understanding among the general public of what constitutes normal versus abnormal anxiety in pregnancy [ 12 ]. With regards to triggers, the most common trigger to anxiety in the first trimester was a perceived lack of control, which was distinct from but often discussed in conjunction with uncertainty regarding the blogger’s health and that of their developing fetus.

Uncertainty concerning upcoming labour and delivery was also commonly discussed, especially by those who experienced prior labour and delivery complications or traumatic events. Bloggers often discussed uncertainty in the context of the first trimester, with many noting that the 8 – 10 week wait-time for their first prenatal appointment contributed to feelings of anxiety. Intolerance of uncertainty is a key component in the development and maintenance of anxiety disorders, thereby highlighting the need for early access to prenatal medical and psychological care in order to create opportunities for prenatal people to voice their concerns and receive prenatal education and support [ 37 , 38 ]. Our findings pertaining to uncertainty are consistent with those of previous studies, highlighting the ways in which maternal health and birth outcomes serve as triggers for anxiety and pregnancy-specific stress [ 4 , 39 , 40 , 41 ]. While blogs allow for prenatal people to obtain experiential based answers to their questions concerning the wide range of uncertainties experienced in pregnancy, there is room for healthcare providers to engage with blogs by commenting on existing blogs. Such engagement may help bloggers navigate uncertainties by providing validation and credible information and resources around prenatal physical and mental health. Further, given the increasing use of the Internet by prenatal people to find health information [ 29 ], developing a comprehensive and credible online resource, such as a blog, that focuses on the maternal prenatal experience could address these uncertainties. Within focus group research, perinatal people have voiced a need for online evidence-based information as well as moderated peer-support resources, suggesting that a clinican-led blog containing both of these elements would be well-received by this population [ 2 ]. An online resource could help to provide information to pregnant people before their first prenatal appointment, thereby having implications in anxiety management. Interventions that aim to improve intolerance of uncertainty may also help to mitigate anxiety throughout pregnancy.

Various prenatal anxiety symptoms were mentioned by bloggers, most of which were described as disrupting their daily functioning. These symptoms overlapped with several characteristics of clinical anxiety, as outlined in the DSM-5 [ 6 ]. Many of these symptoms, such as fatigue, panic attacks, lack of emotional control and excessive worry, have all been shown to evoke negative consequences for both maternal and fetal health [ 13 , 14 , 15 , 16 ]. These results support the need for increased assessment and treatment of prenatal anxiety, particularly early in the prenatal journey given that symptoms were most distressing in the first trimester. This aligns with research findings that prenatal anxiety is highest for primiparous mothers during early pregnancy, further highlighting the need for early detection of prenatal anxiety [ 42 ]. Challenges associated with early detection and treatment of prenatal anxiety symptoms include perinatal people’s preference to seek informal supports (e.g., friends or family), disconnected communication between healthcare providers, and limited availability of mental health resources [ 22 , 43 ].

The complex emotional experiences described by the bloggers further demonstrate this need. Bloggers’ discussion around feeling guilt and shame for not having a “normal” pregnancy reflects the lack of recognition of prenatal anxiety, as reported in previous literature [ 44 ]. This finding aligns with the existing qualitative literature, which has found that mothers experience higher levels of anxiety during their first pregnancy as they navigate greater levels of uncertainty around what can be expected, both physically and emotionally, throughout pregnancy [ 4 ]. The lack of societal discussion and clinical recognition of perinatal anxiety does little to reduce the stigma surrounding anxiety during pregnancy. Stigma may explain why many bloggers experienced guilt or shame over their symptoms and chose not to share their negative feelings with their friends or family. Qualitative findings suggest expecting mothers are often hesitant to disclose their symptoms to loved ones or healthcare providers given societal expectations that pregnancy should be a joyous time [ 1 , 3 ]. Recognizing prenatal anxiety as a clinical disorder may decrease the guilt and shame experienced by many prenatal people experiencing anxiety and may promote effective support seeking.

Limitations

Researchers, practitioners, and clinicians should consider these novel findings along with their limitations. The analysis of public blogs meant that we could not determine our sample’s diversity, as blogs did not always mention sample characteristics. Contextualizing the sample is important, as prenatal people of varying socioeconomic statuses and sociodemographic backgrounds may experience prenatal anxiety differently. Furthermore, though not an objective of the current study, we were not able to follow-up with blog authors to explore their reasoning for engaging with blogs and ask clarifying questions, as bloggers’ contact information was not publicly available. Future research should explore why pregnant people engage with blogs, in addition to gathering more information about the characteristics of prenatal anxiety bloggers. There are also several limitations associated with the search strategy that we employed. We used Google to complete our search, as over 70% of Internet searches are conducted using this search engine; however, other search engines may have yielded different results [ 45 ]. Furthermore, we also only analyzed blogs that were written in English. Those written in other languages may contain different perspectives on anxiety in the prenatal period. Additionally, our search was conducted in 2017 and does not include more recent blogs that may have been posted on prenatal anxiety. An updated search may expand upon the thematic framework developed within the present study by revealing additional themes or nuances within created themes. As with all studies involving websites and blogs, online content changes rapidly; however, our objective was not to conduct an exhaustive search of all prenatal anxiety blogs, but rather, to provide a preliminary understanding of prenatal people’s experiences with anxiety as expressed through blogs, which are a relatively novel source of qualitative data within perinatal mental health research. Despite these limitations, utilizing public blogs is a novel advancement of qualitative methodology that offers access to people’s perspectives while limiting research bias.

This is the first study to examine public blog entries to gain a rich understanding of prenatal people’s experiences with anxiety. The main themes uncovered through our analyses reveal important implications for perinatal professionals such as family physicians, obstetricians and gynecologists, nurses, and mental health professionals. First, these findings demonstrate a need for perinatal professionals to address misinformation and the misconception that a ‘normal’ pregnancy does not include negative emotions. Increasing the provision of credible information to perinatal populations around healthy fetal development, the breadth of physical and emotional changes commonly experienced in pregnancy, recognition of perinatal mental health symptoms, and the types of professionals who can help may serve to address these triggers. This information could be provided to prenatal people digitally in the form of a blog or through comments on existing blogs. Second, prenatal people’s engagement with online blogs highlights to perinatal professionals that the Internet is an accessible, commonly used resource for this population and suggests that online information, peer support, and treatments for perinatal mental health could be useful and are needed. Third, bloggers often discussed experiencing a combination of emotional, cognitive, and physical symptoms in conjunction with behavioural symptoms, which suggests that interdisciplinary professional teams (i.e., medical professionals and mental health professionals) may be most effective when caring for people experiencing prenatal anxiety. Furthermore, these types of symptoms are commonly addressed through Cognitive Behavioural Therapy (CBT), identifying important implications for the development or adaptation of interventions for prenatal anxiety.

Future research involving prenatal anxiety blogs should aim to better understand the characteristics of prenatal people using blogs, the reasons bloggers and readers engage with blogs (e.g., to share their experiences, to seek support from peers), the impact of the blogging experience on both the blogger and their audience, and the quality of information that is being shared. Additional areas for future research include an exploration of the information and intervention needs of prenatal people experiencing anxiety using a mixed-methods approach, such as surveys including open and closed questions to assess endorsed anxiety symptoms, severity of symptoms, and the impact of prenatal anxiety among a broader sample. By fully understanding the experiences and needs of pregnant people, researchers, practitioners, and clinicians can develop more effective assessment and intervention techniques, or tailor already-established anxiety interventions, such as CBT, to this population’s needs.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files ].

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This research was supported by the University of Manitoba (University of Manitoba Start-Up Funds: Principal Investigator Dr. Kristin Reynolds).

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The first author, S.P., contributed to the study by participating in designing the study, conducting the literature review, collecting data, acting as the first coder for data analysis, and writing the manuscript. The second author, K.R., contributed by planning the study design, acting as a second coder for data analysis, and editing the manuscript. The third author, M.H., contributed to the literature review and editing of the manuscript. The fourth author, P.F., contributed by providing consultation as an expert in perinatal mental health and editing the manuscript. The author(s) read and approved the final manuscript.

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Pierce, S.K., Reynolds, K.A., Hardman, M.P. et al. How do prenatal people describe their experiences with anxiety? a qualitative analysis of blog content. BMC Pregnancy Childbirth 22 , 398 (2022). https://doi.org/10.1186/s12884-022-04697-w

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