The importance of prenatal care

According to data from the WHO's 2023 Global Perinatal Health Report, standardized prenatal care can reduce the risk of maternal death by 74% and the risk of adverse perinatal outcomes (preterm birth, low birth weight, birth defects, neonatal death, etc.) by 69%. It is currently recognized as the most cost-effective means of preventing and controlling reproductive risks in the world.

Two years ago, when I worked at a community maternal and child health post, I met a 30-year-old mother of her second child. The natural delivery of her first child went smoothly and she felt that she had experience. However, her second child did not have a single prenatal checkup because she found it too troublesome to wait in line. She did not come to the hospital until she was dizzy and unable to stand at 32 weeks. The blood pressure soared to 160/110, and the protein in the urine increased by 3. It was already severe preeclampsia. An emergency cesarean section was performed on the same day. The baby only weighed 3 pounds and 2 taels. He spent 100,000 yuan in an incubator for 47 days. The adults were also observed in the ICU for three days before they were out of danger. Don’t think this is an extreme case. Just in the maternal and child health hospital where I stayed, every year I encountered about ten pregnant women who became seriously ill because they missed prenatal check-ups.

Of course, there are different voices. When I do science popularization on a daily basis, I often encounter two kinds of doubts: one is from the older generation who say, "We didn't do any examinations at that time, so we gave you a good birth." The other is that many people online complain that "many prenatal examinations are IQ taxes, and hospitals are just to make money." Both of these statements actually have their own realistic basis, and they are not completely nonsense. Thirty or forty years ago, medical resources were scarce, and most areas did not have universal and standardized prenatal check-ups. But if you check the public data at that time, you will know that in 1990, my country’s maternal mortality rate was 88.8/100,000. In 2022, this number will be 1 5.7/100,000, and the perinatal mortality rate has dropped by more than 70%. Those claims that "you can have a good birth without prenatal check-up" are essentially survivor bias - no one will talk about birth defects or maternal accidents every day. As for the suspicion of "excessive medical treatment", it is not groundless. It is true that some institutions will recommend many unnecessary high-priced examinations in addition to the basic prenatal check-up items prescribed by the state. However, the 11 basic prenatal check-ups required by the National Health Commission from 12 weeks to 40 weeks of pregnancy. Each screening indication has been verified by decades of large-sample clinical data, and none of them is redundant.

Many people's understanding of prenatal care is still "to see if the child has any deformities." In fact, it covers much more than that. I met a 26-year-old mother of her first child. She was usually in good health and rarely caught colds. She was diagnosed with gestational diabetes during a glucose tolerance test at 24 weeks of pregnancy. At first, she thought the hospital was making a fuss about it, until I explained to her clearly: If the sugar is not controlled in time, not only will the baby easily grow into a giant baby weighing more than 8 pounds, but it will also lead to tearing and difficulty in delivery. The risk of giving birth was several times higher. Her own risk of developing type 2 diabetes before the age of 40 was three times higher than that of ordinary people. The risk of obesity and diabetes would also be much higher for her children when they grow up. So she followed the nutrition clinic’s diet and gave birth to a healthy baby weighing 6.5 pounds. Her postpartum blood sugar dropped completely to normal levels. There are also some screenings that may seem inconspicuous, but actually have a lifelong impact, such as the thyroid function screening in early pregnancy. If hypothyroidism is detected and timely supplementation of Euthyroxine is found, the risk of cretinism in the child can be completely avoided. If the child is missed and not checked, the intellectual development of the child will be impaired after birth, which will not be remedied in a lifetime.

Let’s talk about an interesting small difference in the industry. Prenatal care is actually divided into two directions. One is the current mainstream obstetrician-led model in China, which focuses on pathological investigation and can intervene immediately if there are problems. It is suitable for pregnant women with high-risk factors such as high blood pressure, heart disease, and past adverse pregnancy history.； There is also a midwife-led continuous care model that is more popular in Europe and the United States and is now being piloted in China. In addition to necessary medical screening, it also spends a lot of time on diet, exercise, psychological counseling, and even accompanying pregnant women during delivery. It is suitable for low-risk pregnant women without high-risk factors. The experience will be much better. Everyone can choose according to their own situation, and there is no need to blindly follow the trend and rush for expert accounts.

This is my seventh year working in maternal and child health care. I have seen too many families who ended up spending hundreds of thousands on medical treatment in order to save hundreds of dollars on prenatal check-ups. I have also seen couples who conscientiously followed the procedures for prenatal check-ups and gave birth to healthy babies smoothly throughout the pregnancy. Sometimes I also feel that prenatal care is actually the same as regular maintenance of a private car. You can't say that you drove 10,000 kilometers without maintenance and it broke down last time. This time you directly save maintenance money. If something goes wrong on the road, the cost of repairing the car and the suffering will be much more expensive than the maintenance fee. To be honest, don’t bet on the odds when it comes to having a baby. If you win the bet, it’s luck, but if you lose the bet, it’s a burden on the entire family. Standard prenatal care is never an unnecessary expense, it is the most cost-effective protection you can buy for your child and yourself.