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Evidence LibraryPregnancy and prenatal testingWhat prenatal care is
Evidence Library · What prenatal care is

The visit schedule is mostly tradition

Twelve to fourteen visits is not an evidence-based number.

The standard American schedule, roughly monthly to 28 weeks, then every two weeks, then weekly, adds up to about 12 to 14 visits. It dates from the 1930s. The researchers who ran the largest US trial of an alternative model described the standard schedule bluntly as "expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care."

That does not mean fewer visits are safe. A review of 7 trials covering more than 60,000 women found that reducing the number of visits was associated with more deaths around the time of birth, not fewer: relative risk 1.14, right at the edge of statistical significance. The signal came mainly from lower-income countries where the reduced schedules were much shorter. In high-income countries no clear difference was found, but the numbers were small.

A separate analysis of one of those trials found fetal death in 1.4% of the reduced-visit group against 1.1% of the standard group, with the excess concentrated between 32 and 36 weeks.

What to take from thisThe exact number of visits is not sacred. Cutting them substantially has not been shown to be safe. Both statements are true, and the honest position is that nobody has established the right number.
Where this comes from:
137. Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D, et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2015;(7):CD000934.
138. Vogel JP, Habib NA, Souza JP, Gülmezoglu AM, Dowswell T, Carroli G, et al. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Reprod Health. 2013;10:19.
139. Butler Tobah YS, LeBlanc A, Branda ME, Inselman JW, Morris MA, Ridgeway JL, et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol. 2019;221(6):638.e1-638.e8.

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