pregnancy AND prenatal care

WHO antenatal care recommendations healthy pregnancy nutrition supplements alcohol smoking warning signs

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pregnancy AND prenatal care

ACOG routine tests pregnancy first second third trimester exercise food safety medication warning signs

mkdir -p "/tmp/workspace/pregnancy-reference/src" "/tmp/workspace/pregnancy-reference/output" && python - <<'PY' from reportlab.lib.pagesizes import A4 from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak, KeepTogether from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.lib.units import cm from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.pdfbase.ttfonts import TTFont from reportlab.pdfbase import pdfmetrics from reportlab.lib.colors import HexColor from reportlab.pdfbase.pdfmetrics import registerFontFamily from pathlib import Path out=Path('/tmp/workspace/pregnancy-reference/output/Pregnancy_Reference_Guide.pdf') navy=HexColor('#153D5B'); teal=HexColor('#197278'); pale=HexColor('#EAF4F3'); cream=HexColor('#FAF7F1'); red=HexColor('#A62C2B'); gold=HexColor('#C68A22'); gray=HexColor('#45515C') styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='TitleX', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=25, leading=30, textColor=navy, alignment=TA_CENTER, spaceAfter=10)) styles.add(ParagraphStyle(name='SubTitleX', parent=styles['Normal'], fontName='Helvetica', fontSize=10.5, leading=15, textColor=gray, alignment=TA_CENTER, spaceAfter=18)) styles.add(ParagraphStyle(name='H1x', parent=styles['Heading1'], fontName='Helvetica-Bold', fontSize=16, leading=20, textColor=navy, spaceBefore=12, spaceAfter=7, keepWithNext=True)) styles.add(ParagraphStyle(name='H2x', parent=styles['Heading2'], fontName='Helvetica-Bold', fontSize=11.5, leading=14, textColor=teal, spaceBefore=8, spaceAfter=4, keepWithNext=True)) styles.add(ParagraphStyle(name='Bodyx', parent=styles['BodyText'], fontName='Helvetica', fontSize=9.2, leading=13, textColor=HexColor('#252B30'), spaceAfter=5)) styles.add(ParagraphStyle(name='Smallx', parent=styles['BodyText'], fontName='Helvetica', fontSize=7.6, leading=10, textColor=gray, spaceAfter=3)) styles.add(ParagraphStyle(name='Callout', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=9.3, leading=13, textColor=navy, backColor=pale, borderColor=teal, borderWidth=.5, borderPadding=7, spaceBefore=4, spaceAfter=8)) styles.add(ParagraphStyle(name='Warn', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=9.4, leading=13, textColor=HexColor('#681D1D'), backColor=HexColor('#FBEAEA'), borderColor=red, borderWidth=.6, borderPadding=7, spaceBefore=5, spaceAfter=8)) styles.add(ParagraphStyle(name='BoxHead', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=10, leading=13, textColor=navy, alignment=TA_LEFT)) story=[] def P(t, s='Bodyx'): story.append(Paragraph(t, styles[s])) def H(t, lvl=1): story.append(Paragraph(t, styles['H1x' if lvl==1 else 'H2x'])) def bullets(items): for x in items: P('• '+x) def table(rows, widths=None, header=True, fs=8.2): data=[] for r in rows: data.append([Paragraph(str(x), ParagraphStyle('cell', parent=styles['Bodyx'], fontSize=fs, leading=fs+3, spaceAfter=0)) for x in r]) t=Table(data, colWidths=widths, repeatRows=1 if header else 0, hAlign='LEFT') commands=[('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),.35,HexColor('#C8D4D9')),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)] if header: commands += [('BACKGROUND',(0,0),(-1,0),navy),('TEXTCOLOR',(0,0),(-1,0),colors.white),('FONTNAME',(0,0),(-1,0),'Helvetica-Bold')] for i in range(1 if header else 0,len(rows)): if i%2: commands.append(('BACKGROUND',(0,i),(-1,i),cream)) t.setStyle(TableStyle(commands)); story.append(t); story.append(Spacer(1,7)) def footer(canvas, doc): canvas.saveState(); w,h=A4 canvas.setStrokeColor(HexColor('#C8D4D9')); canvas.line(1.45*cm,1.2*cm,w-1.45*cm,1.2*cm) canvas.setFont('Helvetica',7.5); canvas.setFillColor(gray) canvas.drawString(1.45*cm,.8*cm,'Pregnancy Reference Guide | General education, not a substitute for personal maternity care') canvas.drawRightString(w-1.45*cm,.8*cm,f'Page {doc.page}') canvas.restoreState() # Cover story += [Spacer(1,1.6*cm), Paragraph('PREGNANCY<br/>REFERENCE GUIDE',styles['TitleX']), Paragraph('A practical, printable guide from a positive test through the first weeks after birth',styles['SubTitleX'])] P('<b>For a pregnant person and their support partner</b><br/>Use this as a conversation guide for maternity appointments. Care, screening, medicines, vaccine schedules, and supplements must be tailored to her medical history, pregnancy dating, country, and clinician’s advice.', 'Callout') H('Start here: the first 48 hours',2) bullets(['Book an appointment with an obstetrician, midwife, or qualified maternity clinician. Bring the date of the first day of the last menstrual period, medical records, and a complete medication/supplement list.', 'Start a prenatal vitamin now with <b>folic acid 400-800 micrograms daily</b>. Higher doses are for selected situations and should be clinician-directed.', 'Stop alcohol, smoking/vaping, marijuana, and recreational drugs. Do not stop prescribed medicines on her own: request a prompt safety review.', 'Check for urgent symptoms on page 12. Severe one-sided pain, fainting, shoulder-tip pain, or heavy bleeding early in pregnancy needs urgent assessment.']) story.append(Spacer(1,8)) P('<b>Important:</b> A healthy pregnancy improves the odds of a good outcome, but cannot guarantee a complication-free pregnancy or delivery. The aim is early care, safe habits, prompt treatment, and informed choices.', 'Warn') story.append(PageBreak()) H('How to use this guide') P('Pregnancy is conventionally counted from the first day of the last menstrual period. The due date and timing of tests should be confirmed by the maternity clinician, often with early ultrasound if needed. This guide uses week ranges because local practice varies.') table([['Section','Use it for'],['1. Care plan','Appointments, personal risk review, routine monitoring'],['2. Nutrition','Food pattern, supplements, caffeine, food safety, weight gain'],['3. Lifestyle','Movement, sleep, work, travel, sex, heat, dental and mental health'],['4. Medicines & infections','Medication review, self-care, vaccination, exposure prevention'],['5. Calendar','Typical checks and choices by trimester'],['6. Birth preparation','Labour planning, pelvic floor, support, hospital bag, newborn care'],['7. Safety net','Urgent warning signs before and after birth']],[3.2*cm,13.4*cm]) H('At the first maternity visit',2) bullets(['Review: blood pressure, weight/BMI, prior pregnancies/births, medical and mental-health conditions, surgery, allergies, family/genetic history, domestic safety, work exposures, diet, substance use, and support.', 'Review every product: prescription medicines, pain medicines, acne medicines, herbs, traditional remedies, vitamins, skin products, and supplements. Take photos of labels if useful.', 'Ask about: pregnancy dating, genetic/carrier screening options, blood group/Rh status, anemia, diabetes risk, thyroid or infection tests, vaccination plan, dental care, travel, and the right contact number for urgent symptoms.', 'Tell the clinician immediately about diabetes, high blood pressure, kidney/heart disease, thyroid disease, epilepsy, autoimmune disease, clotting disorder, anemia, eating disorder, bariatric surgery, prior preeclampsia/preterm birth, recurrent loss, twins, or prior cesarean.']) P('Some people need additional measures, for example early specialist referral, aspirin prevention, altered supplements, more scans, or closer fetal monitoring. These are <b>not</b> universal and must be prescribed individually.', 'Callout') H('Nutrition: the big picture') P('Aim for a varied pattern: vegetables and fruit, beans/lentils, whole grains, nuts/seeds, dairy or fortified alternatives, and protein foods such as eggs, well-cooked poultry/meat, tofu, and low-mercury fish. “Eating for two” is not required. Needs rise modestly later in pregnancy, while nutrient quality matters from the start.') table([['Topic','Practical reference'],['Prenatal vitamin','Take daily. Choose a reputable product. Avoid doubling products or taking extra vitamin A/retinol without advice.'],['Folate / folic acid','400-800 micrograms daily from before conception through at least 12 weeks is widely recommended. Higher doses only if clinician advises.'],['Iron','Many prenatal vitamins contain iron. Extra iron can cause constipation/nausea and should follow clinician advice or anemia testing. Pair plant iron foods with vitamin C-rich foods.'],['Iodine','Needed for fetal neurodevelopment. Use iodized salt where appropriate; supplement needs vary, especially with thyroid disease. Ask the clinician.'],['Calcium & vitamin D','Get calcium through foods or clinician-directed supplementation. Vitamin D plans vary by baseline level, diet, sun exposure, and country.'],['Protein & fluids','Include protein in each meal/snack. Drink to thirst; urine should usually be pale yellow. More is needed with heat, vomiting, or activity.'],['Caffeine','Keep total caffeine <b>under 200 mg/day</b>. Include coffee, tea, cola, energy drinks, chocolate, and some medicines. Avoid energy drinks.']],[3.1*cm,13.5*cm],fs=7.8) H('Food safety: reduce avoidable infection and toxin risks',2) bullets(['Avoid alcohol completely. There is no known safe amount or timing in pregnancy.', 'Avoid raw or undercooked eggs, meat, fish/shellfish, and sprouts. Cook foods thoroughly; reheat leftovers until steaming; keep hot foods hot and cold foods cold.', 'Avoid unpasteurized milk, juice, and products made from them. Soft cheeses are safe only if made with pasteurized milk. Heat deli meats/hot dogs until steaming if eaten.', 'Wash produce; wash hands, cutting boards, and utensils. Keep raw meat separate. Follow local food-safety advisories.', 'Choose 2-3 servings/week of low-mercury seafood if she eats fish. Avoid shark, swordfish, king mackerel, marlin, orange roughy, tilefish, and bigeye tuna. Limit albacore/white tuna as advised locally.', 'Avoid liver and liver products in large amounts because of high preformed vitamin A. Do not take retinol-containing vitamin A supplements unless specifically prescribed.']) story.append(PageBreak()) H('Lifestyle that supports pregnancy') H('Movement',2) P('For an uncomplicated pregnancy, moderate activity on most days is usually beneficial. A common target is about <b>150 minutes/week</b> of moderate aerobic activity, plus gentle strengthening and pelvic-floor work. If she was inactive, start with 5-10 minutes of walking and build gradually. Ask before continuing a high-intensity program or if there are medical/obstetric complications.') table([['Usually good choices','Avoid / modify'],['Walking, swimming, stationary cycling, prenatal yoga, light strength training, mobility work, pelvic-floor exercises','Contact sports; activities with a fall or abdominal-trauma risk; scuba diving; skydiving; hot yoga/hot Pilates; overheating; starting high-altitude activity if not already acclimatized']],[8.1*cm,8.5*cm]) P('Stop activity and seek advice for bleeding, fluid leakage, painful regular contractions, chest pain, faintness, severe shortness of breath before exertion, calf pain/swelling, or marked reduction in fetal movement later in pregnancy.', 'Warn') H('Sleep, comfort, sex, and daily life',2) bullets(['Aim for adequate sleep and regular routines. Side sleeping is generally more comfortable later in pregnancy. If she wakes on her back, simply roll to a side; do not panic.', 'Sex is usually safe in an uncomplicated pregnancy. Ask the maternity clinician if there is bleeding, placenta concerns, ruptured membranes, preterm-labour risk, pain, or advice for pelvic rest.', 'Use seat belts correctly: lap belt low across the hips, shoulder belt between the breasts and to the side of the abdomen. Continue to use seat belts.', 'Avoid hot tubs, saunas, and situations causing overheating, especially early in pregnancy. Stay hydrated in heat.', 'Travel is often possible in uncomplicated pregnancy. Discuss timing, destination infections, insurance, access to maternity care, and clot prevention for long journeys. Move regularly, hydrate, and carry records.', 'Use gloves for gardening. Avoid handling cat litter if possible; if unavoidable, use gloves and wash hands. Keep cats indoors and avoid undercooked meat to reduce toxoplasmosis risk.']) H('Mental health, relationships, and work',2) bullets(['Mood changes can occur, but persistent low mood, anxiety, panic, intrusive thoughts, poor sleep, loss of interest, or thoughts of self-harm deserve prompt help. Perinatal mental health is medical care, not a personal failure.', 'A support partner can protect rest, take on practical tasks, attend selected visits, support quitting tobacco/alcohol, help plan meals, and learn emergency signs.', 'Tell the clinician privately about coercion, violence, financial or food insecurity, unsafe housing, or lack of transport. These issues directly affect pregnancy health and help is available.', 'Ask about workplace exposures: heavy lifting, prolonged standing, radiation, solvents, pesticides, anesthetic gases, infectious patients, heat, or night shifts. Occupational adjustments may be needed.']) H('Medicines, supplements, and common symptoms') P('<b>Rule:</b> “Natural” does not mean safe. Before using any medicine, supplement, herbal product, or topical treatment, check with the maternity clinician or pharmacist. This includes cold/flu products, pain relievers, acne treatments, weight-loss products, and medicines purchased online.') table([['Issue','Safe approach'],['Prescribed medication','Do not stop suddenly. Some untreated conditions are more dangerous than an appropriately chosen medicine. Request a pregnancy-specific review early.'],['Pain or fever','Contact clinician/pharmacist for an appropriate plan. Avoid self-starting anti-inflammatory medicines such as ibuprofen, naproxen, or aspirin, especially later in pregnancy, unless specifically prescribed.'],['Nausea','Small frequent meals; dry snacks before rising; fluids in small amounts; ginger or vitamin B6 may be appropriate for some people. Seek help if unable to keep fluids down, losing weight, faint, or urinating very little.'],['Constipation','Fluids, fiber, fruit/vegetables, regular movement. Ask before laxatives or iron changes.'],['Heartburn','Smaller meals; avoid lying down after eating; discuss pregnancy-compatible antacids or medication.'],['Acne / skin','Avoid retinoid medicines/products unless a specialist confirms safety. Bring photos of all products.'],['Herbs / traditional remedies','Do not assume safety or purity. Take the product or label to a pharmacist/clinician.']],[3.2*cm,13.4*cm],fs=7.7) H('Vaccines and infection prevention',2) bullets(['Ask about seasonal influenza vaccine, COVID-19 vaccine, Tdap/pertussis vaccine, and any vaccines indicated by location, season, travel, and prior records. Timing varies by vaccine and country.', 'Avoid live vaccines during pregnancy unless a specialist specifically recommends otherwise. If a vaccine is needed after delivery, plan it.', 'Wash hands, avoid close contact with people who are ill when possible, and seek assessment for fever, rash illness, significant exposure to chickenpox/measles, or flu/COVID symptoms.', 'Use condoms if there is a risk of sexually transmitted infection. Both partners may need testing or treatment.']) story.append(PageBreak()) H('Pregnancy calendar: common milestones') P('This is a discussion framework, not a fixed universal schedule. Local protocols and personal risks determine timing.') table([['Time','Typical care and decisions'],['Now to 10 weeks','Confirm pregnancy location/dating when clinically appropriate; booking visit; medical and medication review; blood pressure/weight; initial blood/urine and infection screening; discuss genetic/carrier screening; begin prenatal vitamin and lifestyle plan.'],['10 to 13+6 weeks','First-trimester genetic screening and/or cell-free DNA screening may be offered; nuchal translucency ultrasound in some settings; review symptoms and test results.'],['18 to 22 weeks','Detailed anatomy ultrasound is commonly offered. Review fetal growth, placenta location, cervix if indicated, and any findings.'],['24 to 28 weeks','Screening for gestational diabetes is often done; repeat anemia testing and Rh-related care where indicated; begin planning for third trimester.'],['27 to 36 weeks','Pertussis/Tdap timing per local recommendations; influenza/COVID vaccine if due; discuss fetal movement, preterm-labour signs, birth preferences, breastfeeding, and contraception after birth.'],['35 to 37 weeks','Discuss group B streptococcus testing where used; confirm birth plan, transport, hospital contact, newborn-care plan, and signs of labour.'],['Term onward','Review fetal movement, blood pressure symptoms, induction options if pregnancy continues beyond due date, and when to call/go in.']],[3.1*cm,13.5*cm],fs=7.45) H('Screening choices: know the difference',2) table([['Test type','What it means'],['Screening','Estimates the chance of a condition. A “high chance” result is not a diagnosis; it may lead to genetic counseling or diagnostic testing.'],['Diagnostic testing','Can confirm or exclude certain genetic/chromosomal conditions, but may have procedure-related risks. Decisions are personal and should be informed.'],['Ultrasound','Checks development and pregnancy structures; it cannot detect every condition. A normal scan is reassuring but not an absolute guarantee.']],[3.3*cm,13.3*cm]) H('Tracking fetal movement',2) P('There is no need for formal kick counting early in pregnancy. Once movements become regular, learn the baby’s usual pattern. Later in pregnancy, a <b>clear reduction or major change</b> from the usual pattern should be assessed the same day. Do not wait until tomorrow and do not rely on home Dopplers or sugary drinks as reassurance.') H('Optimising for labour and birth') bullets(['Attend childbirth education if available. Learn early labour, active labour, pain-relief options, assisted birth, cesarean birth, and when plans change for safety.', 'Maintain regular comfortable activity, hydration, nutrition, and sleep. There is no proven “trick” that guarantees an easy delivery.', 'Practice pelvic-floor contraction and relaxation. Pelvic-floor physiotherapy can help with pain, continence, birth preparation, and recovery, especially if she has pelvic pain or prior issues.', 'Discuss the birthplace, support person, cultural needs, blood products, pain-relief preferences, induction, cesarean preferences, and newborn procedures. Write a short flexible birth-preferences document.', 'Prepare transport, childcare/pet plans, maternity records, emergency contacts, and a hospital bag by about 34-36 weeks, or earlier if risk factors exist.', 'Consider breastfeeding education and identify lactation support before delivery. Formula feeding can also be planned safely with clinician support.']) P('Birth plans are preferences, not contracts. The safest birth may differ from the plan if maternal or fetal conditions change.', 'Callout') H('Prepare for the fourth trimester') bullets(['Arrange practical help with meals, sleep protection, transport, and household tasks for the first 2 weeks after birth.', 'Know the plan for newborn feeding, safe sleep, pediatric follow-up, maternal pain care, mood monitoring, and contraception.', 'Safe infant sleep: on the back, on a firm flat surface, in a separate sleep space, with no loose bedding, pillows, or soft objects.']) story.append(PageBreak()) H('Urgent warning signs: call now, do not wait') P('Call the maternity team urgently, attend emergency care, or call local emergency services depending on severity. Say clearly: “I am pregnant” or “I gave birth within the past year.”', 'Warn') table([['Emergency or urgent symptom','Why it matters'],['Heavy vaginal bleeding; passing large clots; severe or worsening abdominal pain','Pregnancy loss, ectopic pregnancy, placental or other bleeding complications'],['One-sided pelvic pain, shoulder-tip pain, fainting/collapse in early pregnancy','Possible ectopic pregnancy or internal bleeding'],['Fluid leaking from vagina; regular painful contractions before 37 weeks','Possible membrane rupture or preterm labour'],['Severe headache, vision changes, face/hand swelling, severe upper abdominal/right-sided pain, sudden shortness of breath','Possible preeclampsia or severe hypertension'],['Chest pain; trouble breathing; coughing blood; a racing heart with faintness','Heart/lung emergency or blood clot'],['One leg very swollen, red, warm, or painful','Possible deep-vein thrombosis'],['Fever 38°C / 100.4°F or higher, severe illness, stiff neck, widespread rash','Infection needing assessment'],['Severe vomiting with inability to keep fluids down, very dark/low urine, dizziness','Dehydration or hyperemesis'],['Reduced or absent fetal movement once regular movement is established','Possible fetal compromise: needs same-day assessment'],['Seizure, confusion, thoughts of harming self/baby, or feeling unsafe at home','Immediate emergency and mental-health/safety support']],[7.5*cm,9.1*cm],fs=7.7) H('After birth: maternal warning signs are still emergencies',2) bullets(['Heavy bleeding (soaking pads rapidly, large clots), fainting, severe abdominal pain, fever, foul-smelling discharge, worsening redness/pain at a wound, painful swollen leg, chest pain, shortness of breath, severe headache or visual symptoms, seizures, or new confusion require urgent assessment.', 'Postpartum depression and anxiety can begin during pregnancy or after birth. Urgent help is needed for self-harm thoughts, thoughts of harming the baby, hallucinations, paranoia, severe agitation, or inability to sleep for days.']) H('Appointment checklist') table([['Bring / ask','Notes'],['Medication & supplement list','Include doses, photos, and non-prescription products.'],['Symptom log','Bleeding, pain, vomiting, headaches, mood, movement later in pregnancy.'],['Questions','Write them down beforehand; ask which symptoms mean call now.'],['Records','Past pregnancies, medical conditions, allergies, immunization history, family history.'],['Support needs','Interpreter, transport, financial/food support, mental-health care, work letter, domestic-safety support.']],[5*cm,11.6*cm]) H('Reliable sources and medical notes') P('This reference was prepared October 2026 using WHO and ACOG patient guidance, supplemented by standard medical texts available in the medical library. It is general educational material, not diagnosis or treatment. Recommendations and availability vary by country and clinical context.', 'Smallx') bullets(['World Health Organization. <i>Recommendations on antenatal care for a positive pregnancy experience</i> (with updates): https://www.who.int/publications/i/item/9789241549912', 'American College of Obstetricians and Gynecologists. <i>Prenatal Care</i>, <i>Routine Tests During Pregnancy</i>, <i>Exercise During Pregnancy</i>, <i>Having a Baby</i>, and patient safety resources: https://www.acog.org/womens-health/pregnancy', 'Recent evidence: a 2025 systematic review/meta-analysis reported associations between prenatal psychosocial work stress and adverse pregnancy outcomes (PMID 40478210). This does not mean ordinary stress causes harm, but supports discussing significant work stress and practical adjustments with maternity care.']) P('<b>Personal contacts</b><br/>Maternity clinician: ______________________________ Phone: ____________________<br/>Birth unit / hospital: ______________________________ Phone: ____________________<br/>Emergency contact: ________________________________ Phone: ____________________', 'Callout') doc=SimpleDocTemplate(str(out), pagesize=A4, rightMargin=1.45*cm,leftMargin=1.45*cm,topMargin=1.35*cm,bottomMargin=1.55*cm,title='Pregnancy Reference Guide',author='Orris') doc.build(story, onFirstPage=footer, onLaterPages=footer) print(out) PY python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/pregnancy-reference/output/Pregnancy_Reference_Guide.pdf' r=PdfReader(p) print('pages',len(r.pages),'size',__import__('os').path.getsize(p)) for i,x in enumerate(r.pages,1): t=x.extract_text() or '' print(i,len(t),t[:45].replace('\n',' | ')) PY

python - <<'PY' from pypdf import PdfReader from pathlib import Path p=Path('/tmp/workspace/pregnancy-reference/output/Pregnancy_Reference_Guide.pdf') r=PdfReader(str(p)) assert p.exists() and p.stat().st_size > 10000 assert len(r.pages) >= 6 for i,page in enumerate(r.pages,1): text=page.extract_text() or '' assert len(text) > 250, f'page {i} appears unexpectedly sparse' print(f'VALID: {p.name}; {len(r.pages)} pages; {p.stat().st_size} bytes; all pages have extractable text') PY