Severe morbidity affects more than 50,000 pregnant individuals in the U.S. each year and has been steadily rising, due in part to factors such as increased age, chronic health conditions and behavioral and cardiovascular issues. Providing pregnant individuals with complete prenatal care through benefits is key to addressing the long-term health and financial consequences of this expanding crisis before they arise.
While it’s natural to think of prenatal care solely as the care received during pregnancy, the process should actually begin before conception. The preconception period can be extraordinarily consequential, and the first trimester may be too late to intervene for certain elements of care like:
- beginning folic acid intake to help prevent birth defects,
- re-examining prescription medications to ensure they’re safe to take during pregnancy
- and optimizing glycemic control for people with diabetes
This means it’s important for prospective parents to maintain good health even before they’re actively trying to conceive. And because approximately half of all pregnancies in the U.S. are unplanned, people of reproductive age should keep this guidance in mind whether or not they are considering having a child.
In this stage, it’s important for prospective parents to ensure that their care team is aware of their medical and family history, medication use and vaccination history—all factors that may increase the risk of complications.
What does prenatal care look like during the first trimester of pregnancy?
For pregnant individuals who were unable to receive preconception care, an early first trimester appointment is especially key to help address any comorbidities. At this first appointment, patients can expect a discussion about their medical history, a physical exam and lab tests including a panel of prenatal blood tests, urine culture and urinalysis. Optional testing may be done to screen for genetic or chromosomal conditions.
Providers will also establish a due date, allowing them to monitor growth and development during the pregnancy, as well as schedule future appointments. Care needs to be individualized: those with previous negative pregnancy outcomes and known medical problems can and should be seen more often.
Second trimester appointments include exams to assess the fetus’ growth, heartbeat and fetal movement (also referred to as quickening). They also may include blood tests to screen for gestational diabetes and anemia and ultrasounds to scan the anatomy of the fetus for anomalies.
What does prenatal care look like during the third trimester of pregnancy?
In the third trimester, visits increase in frequency and include check-ins on the fetus’ movement and position. The provider may attempt to physically maneuver the fetus or discuss a cesarean delivery (C-section) if the fetus is not positioned headfirst. The third trimester is an extremely important time to monitor for signs of complications such as gestational hypertension and preeclampsia.
Comprehensive prenatal care helps minimize complications that risk the pregnant individual’s and/or baby’s life. In order to ensure patients are receiving the full spectrum of care, it’s important that they have access to multiple providers throughout their pregnancy, in addition to their OB/GYN.
This comprehensive care is especially important in pregnancies affected by high-risk health conditions. Receiving a nutritionist’s counsel or having a cardiologist readily available to treat issues like heart failure can have major implications for both the pregnant individual and child.
The gestational environment can affect children well beyond pregnancy, increasing the risk they’ll develop conditions like diabetes and obesity. These conditions, along with pregnancy complications such as gestational diabetes, gestational hypertension or preeclampsia, can be optimally managed to minimize poor pregnancy outcomes with proper education about maintaining a healthy weight, engaging in regular physical activity and abstaining from substance use.
Full prenatal care gives pregnant individuals the ability to meet potential pregnancy challenges head-on. These challenges may be caused by factors such as:
- Age - People are having children older than in the past—the median birthing age is 30, the highest it’s ever been. The risk of complications increases with age, compounding each year for pregnant individuals over 35.
- Occupation - While there is no direct link between working during pregnancy and a higher rate of complications, some occupations can be physically demanding, emotionally stressful and might involve exposure to harsh chemicals, all of which can be harmful to both the pregnant individual and baby.
- Social determinants of health - Recent Evernorth Research Institute data shows that from 2020 to 2021, the largest increase in pregnancies occurred in areas with the highest unmet social needs. There are also racial and ethnic disparities in mortality rates, with Black people three to four times more likely to die from pregnancy-related causes than white people.
A dedicated prenatal provider equipped with an individualized care plan can help patients navigate these challenges and optimize their pregnancy outcomes.
The cost of the 10 to 20 necessary prenatal care visits, along with any associated tests and screenings, can be overwhelming for prospective parents, especially if they are not financially stable. The average cost of pregnancy, childbirth and postpartum care in the U.S. is over $18,000, with the average out-of-pocket cost for an insured pregnancy nearly $3,000.
There are other barriers to prenatal treatment and care beyond cost. While some people in the commercial population may have coverage through their employer, frequent prenatal care visits are difficult to make and keep, and may require the use of paid or unpaid time off to attend—a luxury that many people do not have.
Medicaid covers nearly 50% of births in the U.S., however income eligibility for prenatal and pregnancy care varies by state, as do covered services. Federal law requires Medicaid to cover pregnancy care for 60 days postpartum, but the American Rescue Plan Act of 2021 allows states to extend coverage for up to a year after birth, which to date, 34 states have done. Most Medicaid offices require both proof of a positive pregnancy test and qualifying income level before patients can be seen for prenatal care. This may delay access to a prenatal provider, impeding the diagnosis and management of common pregnancy complications like fetal anomalies and pre-existing medical conditions.
Addressing prenatal care coverage—in particular, lowering out-of-pocket costs and increasing access across providers to ensure truly comprehensive care—is paramount when it comes to achieving better pregnancy outcomes.