Your Complete Guide to Prenatal Care — Visit by Visit, Test by Test

Good prenatal care is mostly unglamorous: regular visits, a handful of well-timed tests, and someone who knows your history watching for the small changes that matter. Done consistently, it lowers the risk of preterm birth, preeclampsia complications, and untreated infection — and it means that when something does come up, you catch it early instead of in an emergency room.

This guide walks through what a full course of prenatal care looks like at the Women's Health Center of Chicago: how often you'll be seen, what happens at each appointment, when each test is offered, and what to eat, avoid, and watch for.

When to schedule your first visit

Call as soon as you have a positive home pregnancy test. Most first prenatal visits happen between 8 and 10 weeks, but earlier contact matters if you have bleeding, significant pain, a history of ectopic pregnancy or miscarriage, diabetes, high blood pressure, a thyroid condition, or take medications that need review.

Start a prenatal vitamin with folic acid immediately if you are not already taking one. Neural tube closure is complete by about week 6, so the benefit is front-loaded.

To book, use our appointment page or see our locations.

The prenatal visit schedule

For a healthy, low-risk single pregnancy, ACOG describes a traditional schedule of roughly 12 to 14 visits:

1. Weeks 8–28: every 4 weeks
2. Weeks 28–36: every 2 weeks
3. Week 36 to delivery: every week

That schedule is a starting point, not a rule. Twins, chronic hypertension, diabetes, prior preterm birth, or a growth concern all mean more frequent visits and added ultrasounds. Some low-risk patients do well with a modified schedule that combines in-person visits with telehealth check-ins and home blood pressure monitoring. We decide together at the first visit and adjust as the pregnancy goes.

What happens at each visit

The first visit (8–10 weeks)

This is the long one. Plan for an hour.

• Full history: past pregnancies, surgeries, medications, supplements, mental health, vaccination status, family and genetic history, and a confidential conversation about safety at home
• Physical exam, including a pelvic exam and, if you are due, a cervical cancer screening
• Dating: last menstrual period plus an ultrasound. A crown-rump length measurement in the first trimester is the most accurate way to establish your due date, and that date anchors every test window that follows
• Baseline labs: blood type and Rh status, antibody screen, complete blood count, rubella and varicella immunity, hepatitis B and C, HIV, syphilis, urine culture, and thyroid or diabetes testing if indicated
• Counseling on genetic screening options, medications you can and cannot continue, work and travel, and what nausea relief is safe

Routine visits (every visit after the first)

Short and focused. Every time we will check:

• Weight and blood pressure
• Urine when indicated (protein, glucose, signs of infection)
• Fundal height, from about 20 weeks — a rough check that growth is tracking
• Fetal heart rate, audible by Doppler from about 10–12 weeks
• Fetal position, in the third trimester
• Swelling, headaches, contractions, fluid, bleeding, and how the baby is moving

Bring your questions written down. The visit belongs to you, and the list is the difference between remembering to ask and getting to the parking lot first.

The screening and testing timeline

Here is the same information visit by visit, in the order it arrives.

First trimester

• Dating ultrasound, 6–12 weeks. Confirms location, number, heartbeat, and due date.
• Cell-free DNA screening (NIPT), from 10 weeks. A blood test screening for trisomy 21, 18, and 13. ACOG recommends that prenatal screening for chromosomal conditions be offered to every pregnant patient regardless of age. It is a screen, not a diagnosis — a positive result is followed by diagnostic testing.
• Nuchal translucency ultrasound, 11+0 to 13+6 weeks. This window is fixed. Measured too early or too late, the result is not interpretable. Often combined with first-trimester serum markers.
• Carrier screening, ideally before or early in pregnancy — cystic fibrosis, spinal muscular atrophy, hemoglobinopathies, and an expanded panel if you choose.
• Diagnostic testing, if you want it: chorionic villus sampling at 10–13 weeks, amniocentesis from 15 weeks.

Second trimester

• Quad screen, 15–22 weeks, if first-trimester screening was not done.
• Anatomy ultrasound, 18–22 weeks. A detailed head-to-toe survey of the baby's brain, heart, spine, kidneys, limbs, and abdominal wall, plus placental location, cord, and amniotic fluid. This is the most important ultrasound of the pregnancy.
• Fetal movement typically becomes noticeable between 18 and 22 weeks in a first pregnancy, sometimes earlier after that.

Third trimester

• Glucose tolerance testing, 24–28 weeks. Usually a 1-hour 50-gram screen; if elevated, a 3-hour confirmatory test. Testing happens earlier for patients with obesity, prior gestational diabetes, PCOS, or a strong family history.
• Repeat CBC and antibody screen, around 28 weeks, to check for anemia.
• RhoGAM (Rh immune globulin) at 28 weeks if you are Rh-negative, with a second dose within 72 hours of delivery if the baby is Rh-positive. Additional doses go with bleeding, trauma, amniocentesis, or an external version. This single injection is why Rh disease is now rare.
• Tdap vaccine, 27–36 weeks, every pregnancy. CDC recommends it in the earlier part of that window so maternal antibodies cross the placenta and protect the newborn from whooping cough before their own vaccines start.
• Flu vaccine any time during flu season, and RSV and COVID-19 vaccination per current CDC seasonal recommendations — decided by where your due date falls.
• Group B strep (GBS) culture, 36+0 to 37+6 weeks. A vaginal-rectal swab. About 1 in 4 women carry GBS harmlessly; carriers receive IV antibiotics in labor to protect the baby.
• Position and planning, 36 weeks on. If the baby is breech, we discuss external cephalic version and delivery options. We also talk through labor signs, pain relief, and your birth preferences. See labor and delivery.

Vaccination in pregnancy deserves a plain statement: inactivated vaccines — flu, Tdap, COVID-19, RSV — are recommended in pregnancy and protect both you and a newborn too young to be vaccinated. Live vaccines such as MMR and varicella wait until after delivery.

Nutrition and prenatal vitamins

You do not need to eat for two. In the second trimester you need roughly 340 extra calories a day, and about 450 in the third. What matters far more is what those calories contain.

Take a prenatal vitamin daily. Look for:

• Folic acid 400–800 mcg. Everyone who could become pregnant should take at least 400 mcg daily. A higher dose (4 mg) is prescribed if you have had a prior pregnancy affected by a neural tube defect, take certain seizure medications, or have specific risk factors — that dose is prescribed, not self-selected.
• Iron, about 27 mg daily. Blood volume rises sharply and iron-deficiency anemia is the most common deficiency of pregnancy. Take it with vitamin C, away from calcium, coffee, and tea. If it constipates you, tell us — every-other-day dosing often works as well and is gentler.
• Vitamin D, at least 600 IU daily, more if your level is low.
• DHA, about 200–300 mg daily, for fetal brain and eye development. Two to three servings a week of low-mercury fish covers this; a supplement works if you do not eat fish.
• Calcium, about 1,000 mg daily, from food where possible.
• Iodine and choline, often under-supplied — check your label.

On the plate: protein at every meal, plenty of vegetables and fruit, whole grains, and enough fluid that your urine stays pale. Salmon, sardines, and trout are excellent low-mercury choices. If you are vegetarian or vegan, plan for B12, iron, and DHA specifically.

What to avoid

• Alcohol. No amount and no trimester has been shown safe. CDC guidance is complete avoidance.
• Smoking, vaping, and nicotine pouches. Tobacco raises the risk of growth restriction, placental abruption, preterm birth, and stillbirth. Quitting at any point helps; ask us for help rather than doing it alone.
• Cannabis. Not recommended in pregnancy or while breastfeeding, including for nausea. Safer options exist.
• High-mercury fish: shark, swordfish, king mackerel, tilefish, bigeye tuna. Limit albacore tuna to 6 oz a week.
• Unpasteurized dairy and juice, deli meats and hot dogs unless steaming hot, refrigerated pâté, raw or undercooked meat, fish, eggs, and sprouts — listeria and toxoplasmosis risk.
• Cat litter and raw garden soil without gloves, for the same reason.
• Hot tubs, saunas, and fever above 102°F, especially in the first trimester. Treat fever with acetaminophen and call us.
• Certain medications: NSAIDs such as ibuprofen and naproxen (particularly after 20 weeks), isotretinoin, most ACE inhibitors and ARBs, and some antibiotics. Do not stop a prescribed medication on your own — for epilepsy, depression, thyroid disease, or hypertension, untreated illness usually carries more risk than the drug. Bring every bottle, including supplements, to your first visit.
• Caffeine above roughly 200 mg a day (about one 12-oz coffee).

Exercise is the opposite of a risk. Aim for 150 minutes a week of moderate activity — walking, swimming, stationary cycling, prenatal yoga, light strength work. Avoid contact sports, activities with fall risk, and scuba diving. Sex is safe in an uncomplicated pregnancy.

Weight gain by pre-pregnancy BMI

Institute of Medicine ranges, endorsed by ACOG, for a single pregnancy:

• BMI under 18.5 (underweight): 28–40 lb
• BMI 18.5–24.9 (normal): 25–35 lb
• BMI 25–29.9 (overweight): 15–25 lb
• BMI 30 or above (obesity): 11–20 lb

Most of the gain belongs in the second and third trimesters, at roughly half a pound to one pound per week. Twin pregnancies have separate, higher ranges.

These are targets, not grades. Gaining outside your range is worth a conversation about nutrition and screening, not shame — and rapid gain of more than 4 pounds in a week, especially with swelling, is a preeclampsia signal rather than a diet problem.

Warning signs: call the same day

Do not wait for your next appointment. Call the office, and if you cannot reach us, go to labor and delivery or the emergency department.

• Vaginal bleeding, any amount, at any stage
• Leaking fluid — a gush or a persistent trickle
• Severe or persistent headache that does not respond to acetaminophen
• Vision changes: blurring, flashing lights, spots, or partial loss of vision
• Pain under the ribs on the right side, or new severe upper abdominal pain
• Sudden swelling of the face, hands, or feet, or rapid weight gain
• Blood pressure at home of 140/90 or higher on two readings
• Decreased fetal movement after 28 weeks. Lie on your side after a meal and count. Fewer than 10 movements in two hours, or any clear drop from your baby's normal pattern, means call now — not tomorrow.
• Regular contractions before 37 weeks, pelvic pressure, low backache, or a change in vaginal discharge
• Fever above 100.4°F, burning with urination, or flank pain
• Persistent vomiting with inability to keep fluids down
• Calf pain, swelling, chest pain, or shortness of breath — pregnancy raises clot risk
• Any fall, car accident, or blow to the abdomen, even if you feel fine
• Thoughts of harming yourself, or feeling unable to cope. Depression and anxiety in pregnancy are common and treatable. Tell us.

The headache, vision changes, upper abdominal pain, and swelling cluster together for a reason: they are the signs of preeclampsia, which can appear after 20 weeks and for the first time up to six weeks after delivery. It is why we take your blood pressure at every single visit.

After delivery

Prenatal care does not end at birth. ACOG now frames the postpartum period as an ongoing process, with contact within the first 3 weeks and a full visit by 12 weeks covering bleeding, mood, blood pressure, breastfeeding, contraception, and any pregnancy complication that needs follow-up. Read more about postpartum care and birth control options.

Care at the Women's Health Center of Chicago

Dr. Adeeb Alshahrour is a board-certified obstetrician-gynecologist and Fellow of the American College of Obstetricians and Gynecologists, caring for patients in Arabic and English. You see the same physician through your pregnancy, and the same physician knows your chart when you call at 2 a.m.

Learn more about Dr. Alshahrour, browse our services, or book an appointment.

Medical disclaimer

This article is general health information, not individual medical advice. Every pregnancy is different, and recommendations here may not fit your situation. Talk with your obstetrician or midwife about your own care, and do not delay seeking medical attention because of something you read here. In an emergency, call 911.