Prenatal care

Prenatal care includes:

• Regular appointments with your health professional (see below Regular appointments)
• Blood tests, urine analyses, and vaginal swabs (see below Blood tests and urine analyses and Vaginal swabs)
• Ultrasounds (see below Ultrasound)
• Genetic screening tests, in some cases (see below Screening tests)

Regular appointments allow you to check that your pregnancy is going well and to get screened for potential problems. These appointments also give you the opportunity to get answers to your questions and help you prepare for delivery and the arrival of your newborn.

How often?

The frequency of prenatal appointments may vary. If you have a specific health problem, more frequent appointments may be necessary, but generally appointments will be scheduled as follow:

• During the first 11 weeks of pregnancy: first appointment
• Between 12 and 30 weeks: one appointment every 4 to 6 weeks
• Between 31 and 36 weeks: one appointment every 2 to 3 weeks
• From 37 weeks until the baby is born: one appointment per week.

To prepare for your next appointment, you can write down questions you want to ask as you think of them so you don’t forget.

If you have questions at any time, you can call Info-Santé by dialing 8-1-1.

Starting at 20 weeks of pregnancy, it is often possible to contact your hospital or birthing centre if you have questions about your pregnancy.

Regular appointments

First appointment

Usually, the first prenatal appointment will take place between 8 and 11 weeks of pregnancy.

This first appointment will generally last longer than subsequent appointments. You’ll be given the opportunity to undergo a physical exam. Your health professional will take the time to ask about your health history.

Examples of topics covered

At your first prenatal appointment, your health professional will probably ask about the following:

• If you have ever been pregnant before, including any miscarriages or abortions you may have had.
• Your baby’s biological heritage, i.e., any diseases that run in your child’s family, as well as their community of origin.
• If you have ever had gynecological problems, such as cervical surgery, or if you or your partner have herpes.
• Your living conditions (sources of income, family situation, support network).
• Your lifestyle (diet, physical activity, tobacco, alcohol, drugs).
• Your religious beliefs and practices.
• If there are any sources of stress in your life, and if so, what kind.
• The type of work you do to determine if it poses any risks during pregnancy.

Feel free to bring up anything that’s important to you (i.e. your preferred pronouns, your intention to put your child up for adoption, any phobias you have, or any experience of violence). This will make it easier for them to support you during your pregnancy.

Are you hesitant to have certain tests done? Do you think other tests might be helpful? Now is the time to talk these things over so you can make informed decisions. Some exams, such as genetic screening should ideally be performed between 11 and 13 weeks of pregnancy (se below Screening tests). If you have questions, your first prenatal appointment is a good time to ask them.

Physical exam

The health professional you see will offer to perform a full physical exam, which may include a gynecological exam.

They will check your weight and blood pressure and may listen to your baby’s heartbeat.

A PAP test to screen for cervical cancer will be suggested. This exam can also be performed later during the pregnancy, or after the birth.

You may notice light bleeding within 24 hours of the gynecological examination. Don’t worry, the bleeding is from the cervix, which is more sensitive during pregnancy.

Subsequent appointments

Subsequent appointments are usually shorter.

During the appointments, you’ll be asked how your pregnancy is going and checked for:

• Your weight
• Your blood pressure
• The height of your uterus (starting around 20 weeks)
• The baby’s heartbeat

Blood tests and urine analyses

During your appointments, you may be prescribed blood tests and urine analyses to determine:

• If you are anaemic.
• If your blood sugar level (blood glucose) is normal:
  • Between 24 and 28 weeks of pregnancy, your health professional will suggest a screening test for gestational diabetes (see Gestational diabetes). This test measures your blood sugar after you drink a sugary liquid.
• If you have a disease that you could transmit to your baby (such as syphilis, HIV/AIDS, or hepatitis B).
• Your blood type and rhesus factor (Rh factor):
  • If you are Rh negative, some precautions must be taken. You may be given anti-Rh immunoglobulin (also called WinRho®) at 28 weeks of pregnancy, and sometimes after the delivery. You may also be given WinRho® if you have a miscarriage, undergo amniocentesis, or you have bleeding.
• If you have anti-rubella antibodies.
• If you have bacteria in your urine, even if you don’t have any symptoms.
• If you have protein in your urine.

Depending on your condition, additional tests may be suggested at different times during your pregnancy.

Vaginal swabs

It is also recommended that pregnant women be tested for certain sexually transmitted infections (STIs) like chlamydia and gonorrhoea. Many of these diseases can go undetected and affect your health and that of your baby. STI screening is completely confidential.

If you think you may have had contact putting you at risk for an STI after your initial screening, don’t hesitate to talk to your health professional about repeating the tests.

At around 36 weeks, a vaginal and anal swab will be suggested to check for Group B Streptococcus. This type of bacteria poses no risk for you, but can in rare cases harm the baby if it is not treated. If it is present, you will be treated with antibiotics during labour.

Ultrasound

Ultrasound is a type of exam that will be offered by your health professional. Ultrasound enables your health professional to:

• Determine how far along you are and when your due date is.
• Check that your baby is the right size for his/her age.
• See most of your baby’s organs (heart, liver, kidneys, stomach, bladder, brain, etc.) and limbs.
• Confirm how many babies there are.
• Determine the location of the placenta.

At the time of the ultrasound, it is often (but not always) possible to determine your baby’s biological sex, although there is a slight risk of error. If you want to keep the baby’s sex a surprise, be sure to say so at the start of the ultrasound to avoid any misunderstanding.

Screening tests

Screening tests for chromosomal anomalies may be offered to you as part of your prenatal care.

Prenatal Screening Program of Québec

At your first prenatal appointment, your health professional will ask if you want to take part in the Prenatal Screening Program of Québec. This program screens for trisomy 21 but may also detect trisomy 18 or 13.

Prenatal screening is not mandatory. It is up to you to choose whether or not to do the screening tests and whether or not to use their results. The decision is yours at every step. The steps are:

1. Biochemical test, with or without ultrasound (see below Ultrasound)
2. A genomic test (fetal DNA test) or a diagnostic test (see below Diagnostic test) if the biochemical test shows the probability is high.

The genomic test may also be offered right away if you meet one of the following criteria:

• You will be over 40 years old at the time of the birth.
• You have already had a pregnancy with trisomy 21, 18, or 13.
• You have a multiple pregnancy.
• You recently had a prenatal genetic consultation where the test was recommended to you.

In Québec, most of the tests under the screening program are offered free of charge.

These tests are described on the following pages.

Biochemical test

The biochemical test involves testing your blood during pregnancy.

The test takes into account your age and the blood test results to determine whether your probability of having a baby with trisomy 21 is low or high. Depending on the results, the test may also indicate a high probability of your baby having trisomy 18. At this stage, it isn’t possible to distinguish between trisomy 18 and trisomy 13.

If your probability of having a baby with trisomy 21 or 18 is high, you will be offered the genomic test (fetal DNA test). In certain specific situations, you may be offered a diagnostic test right away.

Ultrasound

Along with the biochemical test, you may be offered an ultrasound between weeks 11 and 13 of your pregnancy.

This ultrasound is used to measure nuchal translucency, i.e. the space between the skin of the neck and the spine of the fetus. A higher than normal measure of nuchal translucency may indicate a high risk of trisomy 21, other chromosomal abnormalities, or fetal malformations.

Genomic test

The genomic test is designed to screen for trisomy 21, 18 and 13. If the biochemical test shows a high risk of trisomy 21 or 18, the genomic test can also be used to better determine the risk level before offering a diagnostic test.

This test is offered because it is reliable and safe. It is performed with a simple blood test.

Diagnostic test

If the genomic test shows that the risk is high, a diagnostic test will be offered to you.

The diagnostic test is a reliable way to determine whether the baby has a chromosomal anomaly, but it does carry some risk of complication, including miscarriage.

If you are faced with the difficult choice of continuing or terminating your pregnancy after completing these tests, you may need help. Don’t hesitate to discuss this with your loved ones or your prenatal care team.

You may also want to contact trisomy 21 parent groups. They can help you better understand their reality and make the decision that is best for you. To find groups in your area, contact your CLSC.

For information about the program, visit quebec.ca/ en/health/advice-and-prevention/screening-and- carrier-testing-offer and click on "Québec Prenatal Screening Program".

Other screening tests

After the birth, you will be given the option of testing your baby’s blood and urine for diseases that are rare, but require early monitoring or treatment (see Neonatal screening).