Antenatal care

Red Flags

Severe vaginal bleeding, severe abdominal pain, persistent vomiting, severe headache, vision change, sudden swelling, reduced fetal movements — same-day maternity assessment^[1]
Suspected pre-eclampsia (BP ≥140/90 with proteinuria, severe headache, RUQ pain, swelling) — same-day obstetric review^[1]
Reduced fetal movements at any gestation ≥24 weeks — CTG and growth assessment within hours^[1]
Pre-existing maternal disease (diabetes, hypertension, cardiac, autoimmune, epilepsy, psychiatric) — joint specialist clinic from booking^[1]

Antenatal care schedule^[1]
Low-risk: 8–10 contacts (WHO 2016) — booking ≤12 weeks, then approximately 20, 26, 28, 32, 34, 36, 38, 40, 41 weeks. Higher-risk: more frequent, joint clinic
Lifestyle and counselling^[1]
Smoking, alcohol, illicit drug cessation; balanced diet; safe foods (avoid raw/undercooked, unpasteurised dairy, high-mercury fish, excess caffeine); seatbelt above and below bump; mild–moderate exercise; sexual health
Vaccination during pregnancy^[1]
Influenza (any trimester), Tdap (28–36 weeks) for whooping cough protection of newborn, COVID-19 per local schedule, RSVpreF (32+0 to 36+6 weeks) where available; do not give live vaccines in pregnancy
Anti-D prophylaxis for RhD-negative women^[1]
Routine antenatal anti-D 1500 IU IM at 28 weeks (or 500–1500 IU at 28 + 34 weeks per local protocol); at any sensitising event; postpartum within 72 h if baby RhD-positive

Drug	Class	Adult	Paediatric	Notes
Folic acid^[1]	B-vitamin	400–500 µg PO daily preconception through 12 weeks; 5 mg/day in high-risk groups (prior NTD, diabetes, ASM, BMI ≥30, sickle cell, thalassaemia)	—	Reduces neural tube defect; widely available combined with iron in Indian government supply
Iron + folic acid^[1]	Iron-folate combination	100 mg elemental iron + 500 µg folic acid PO daily for at least 100 days from second half of pregnancy (Indian public health programme); higher dose for established anaemia	—	Universal supplementation in high-prevalence anaemia settings; switch to therapeutic dose for established IDA; intravenous iron if oral inadequate
Calcium supplementation^[1]	Mineral supplement	1.5–2 g elemental calcium PO daily from 20 weeks where dietary intake <600 mg/day	—	Reduces pre-eclampsia and severe outcomes; take separately from iron supplement to avoid absorption interference
Aspirin (for pre-eclampsia prevention)^[1]	Antiplatelet (low-dose)	150 mg PO at night from 12+0 to 36+0 weeks for women at high risk for pre-eclampsia	—	Prior PE, chronic HTN, T1/T2DM, autoimmune disease, twins, age ≥40, BMI ≥35, family history; combine with calcium where dietary intake low

Folic acid^[1]

B-vitamin

Adult: 400–500 µg PO daily preconception through 12 weeks; 5 mg/day in high-risk groups (prior NTD, diabetes, ASM, BMI ≥30, sickle cell, thalassaemia)
Paediatric: —

Reduces neural tube defect; widely available combined with iron in Indian government supply

Iron + folic acid^[1]

Iron-folate combination

Adult: 100 mg elemental iron + 500 µg folic acid PO daily for at least 100 days from second half of pregnancy (Indian public health programme); higher dose for established anaemia
Paediatric: —

Universal supplementation in high-prevalence anaemia settings; switch to therapeutic dose for established IDA; intravenous iron if oral inadequate

Calcium supplementation^[1]

Mineral supplement

Adult: 1.5–2 g elemental calcium PO daily from 20 weeks where dietary intake <600 mg/day
Paediatric: —

Reduces pre-eclampsia and severe outcomes; take separately from iron supplement to avoid absorption interference

Aspirin (for pre-eclampsia prevention)^[1]

Antiplatelet (low-dose)

Adult: 150 mg PO at night from 12+0 to 36+0 weeks for women at high risk for pre-eclampsia
Paediatric: —

Prior PE, chronic HTN, T1/T2DM, autoimmune disease, twins, age ≥40, BMI ≥35, family history; combine with calcium where dietary intake low

Attend every scheduled antenatal visit even if you feel well — many problems are silent and only picked up on routine screening^[1]
Reduced or absent fetal movements at any gestation ≥24 weeks — call your maternity unit immediately; do not wait until next appointment^[1]
Report bleeding, severe headache, vision changes, severe abdominal pain, persistent vomiting, fever, or sudden swelling — these need same-day review^[1]

Pre-existing maternal disease, prior obstetric complication, or moderate-high-risk medicationJoint obstetric and relevant specialist preconception or early antenatal clinic^[1]
Suspected fetal anomaly on first-trimester or anomaly scanMaternal-fetal medicine and antenatal genetics^[1]
Mental health concerns including suicidal ideation, severe anxiety, eating disorder, intimate partner violencePerinatal mental health and social work^[1]
Antenatal complications (pre-eclampsia, diabetes, FGR, threatened preterm labour)Obstetric daycare or admission per condition^[1]

Schedule of antenatal visits, screening, supplementation, and risk-stratification across the three trimesters of pregnancy.

1.FOGSI Safe Pregnancy — Antenatal Care Recommendations (2019, refreshed); WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience (2016, updated 2024); NICE NG201 (2024)