Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations: A Practical Guide for Maternity Care Clinicians

Abstract

Prenatal care is an important preventive service designed to improve the health of pregnant patients and their infants. Prenatal care delivery recommendations have remained unchanged since 1930, when the 12-14 in-person visit schedule was first established to detect preeclampsia. In 2020, the American College of Obstetricians and Gynecologists, in collaboration with the University of Michigan, convened a panel of maternity care experts to determine new prenatal care delivery recommendations. The panel recognized the need to include emerging evidence and experience, including significant changes in prenatal care delivery during the COVID-19 pandemic, pre-existing knowledge of the importance of individualized care plans, the promise of telemedicine, and the significant influence of social and structural determinants of health (SSDoH) on pregnancy outcomes. Recommendations were derived using the RAND-UCLA appropriateness method, a rigorous e-Delphi method, and are designed to extend beyond the acute public health crisis. The resulting Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) includes recommendations for key aspects of prenatal care delivery: (1) the recommended number of prenatal visits, (2) the frequency of prenatal visits, (3) the role of monitoring routine pregnancy parameters (blood pressure, fetal heart tones, weight, and fundal height), (4) integration of telemedicine into routine care, and (5) inclusion of (SSDoH). Resulting recommendations demonstrate a new approach to prenatal care delivery that incorporates medical, SSDoH, and patient preferences, to develop individualized prenatal care delivery plans. The purpose of this document is to outline the new MiPATH recommendations and to provide practical guidance on implementing them in routine practice.

Keywords: antenatal care; pregnancy; prenatal care; remote monitoring; social and structural determinants of health; telemedicine.

FIG. 1.

Recommended prenatal care services by gestational age (adapted from the current American College of Obstetricians and Gynecologists Antepartum Record). *Four key contact points identified by the MiPATH panel as minimum required in-person visits to complete recommended prenatal care services. ^†As indicated. ^‡Education about pregnancy, childbirth, the postpartum period, and parenting (e.g., counseling and educational materials). §Identification of social, emotional, and material needs that may affect the pregnancy and connection to appropriate resources (e.g., screening for depression and substance use). CBC, complete blood count; GBS, Group B Streptococcus; MiPATH, Michigan Plan for Appropriate Tailored Healthcare in pregnancy; RhIG, Rho(D) immunoglobulin; TDap, tetanus diphtheria and pertussis vaccine; TM, trimester; US, ultrasound.

FIG. 2.

Key prenatal care recommendations of the MiPATH panel.

FIG. 3.

Schematic for incorporating pregnant people’s risk and preference into prenatal care schedules.

FIG. 4.

Fields to be included in pregnancy risk assessment. *By which one may experience discrimination or limitations in accessing care. ACOG, American College of Obstetricians and Gynecologists.

FIG. 5.

Prenatal visit schedule options for average-risk patients.