Preconception and Prenatal Care

Pregnancy care is a timeline, not a single encounter. Before conception, the clinician can reduce risk by correcting uncontrolled disease, replacing potentially harmful medications, updating immunizations, addressing alcohol and other exposures, and beginning folic acid before neural-tube development is complete. Once pregnancy begins, gestational age determines which screening test or preventive treatment is useful; the same intervention can be appropriate at one week and irrelevant or unsafe at another. For each visit, establish three anchors: whether pregnancy is planned or possible, which maternal conditions or medications alter risk, and where the patient is in the gestational schedule. Separate universal screening from testing triggered by history or symptoms. In Canada, provincial prenatal-screening pathways, immunization programmes, and RSV funding differ, so the NP uses the local programme rather than importing US timing, glucose units, or treatment algorithms. The clinical goal is to protect two linked patients: stabilize maternal physiology while preventing avoidable fetal and neonatal complications.