You're pregnant
Congratulations — or, if it's complicated, however you feel right now is allowed. This Path covers the first trimester: what happens when, what to keep doing, what you can ask for, and when to call.
Book your first prenatal visit early — ACOG recommends a full assessment ideally before 10 weeks.
It usually includes bloodwork (blood type and Rh, blood count, rubella immunity, hepatitis B, HIV and syphilis), a urine test, and often a dating ultrasound.
Early bleeding is common — spotting happens in about 15 to 25 of every 100 first-trimester pregnancies, and many continue normally. Still always worth a call.
hCG doesn't have to double every two days. Early on a slower rise can still be healthy; your doctor looks at the trend alongside an ultrasound.
Once a heartbeat is seen, miscarriage risk drops steeply each week — in one study from about 9% at 6 weeks to under 1% by 9.
Nausea affects about 70% of pregnancies. It's miserable, and it usually isn't a sign that anything is wrong.
- Strong evidence Keep taking your prenatal. Folate matters most in these first weeks. Check it includes iodine; most don't include choline, which you may want to add. What to look for.
- Strong evidence No alcohol, no smoking, no cannabis. There's no known safe amount of alcohol in pregnancy.
- Moderate evidence Keep caffeine under about 200 mg a day. About two 8-ounce cups of home-brewed coffee.
- Strong evidence For nausea, try vitamin B6 first. Doxylamine can be added if B6 alone doesn't work; ginger can help too.
- Strong evidence Keep moving. About 150 minutes a week of moderate activity if your pregnancy is uncomplicated. Avoid contact sports and anything with a risk of falls.
- Safety consideration Avoid overheating. Skip hot tubs, saunas and hot yoga, especially in the first trimester.
- Eat for safety, not for two. No extra calories are needed yet. Avoid unheated deli meats, unpasteurized cheese, raw fish and high-mercury fish. The full list.
Heavy bleeding, severe belly pain or pain on one side, pain in the tip of your shoulder, dizziness or fainting, a fever of 100.4°F or higher, or vomiting so bad you can't keep fluids down for 8 hours. For thoughts of harming yourself or your baby, call or text 1-833-TLC-MAMA (1-833-852-6262), any time.
Your dating scan
A first-trimester ultrasound is the most accurate way to set your due date. After IVF, the due date is calculated from your transfer date and embryo age instead.Genetic screening
Screening should be offered to everyone, whatever your age. Cell-free DNA, a blood test, can be done from 10 weeks and screens for Down syndrome and two other common chromosome conditions; screening for the sex chromosomes is now optional. A combined blood test and nuchal scan at 10–13 weeks is another option. Screening isn't a diagnosis — a positive result is confirmed with CVS or amniocentesis.Carrier screening
If you and your partner haven't had it, it can still be done in pregnancy.Low-dose aspirin
If you have one high-risk factor for preeclampsia, or more than one moderate one — including a first pregnancy, IVF, age 35 or over, or a BMI over 30 — ask about 81 mg a day from 12 weeks, ideally started before 16. Who qualifies.Early diabetes testing
Routine screening for gestational diabetes is at 24–28 weeks, but with risk factors — such as PCOS, a higher BMI, a family history, or diabetes in a previous pregnancy — you can be tested at your first visit.Vaccines
Flu in any trimester; Tdap at 27–36 weeks; RSV at 32–36 weeks in season. ACOG also recommends COVID-19 vaccination in any trimester; the CDC's page currently describes it as an individual decision, and federal vaccine policy is being contested in court.Your mental health
ACOG recommends screening for depression and anxiety at the first visit and again later in pregnancy. If you're struggling, say so — it's common, and it's treatable.
- Can we confirm my due date with an ultrasound, and when will my first scan be?
- Do I qualify for low-dose aspirin, and should I start by 16 weeks?It's often not offered unless you ask.
- Which genetic screening options do you recommend for me, and what would each one tell us?
- Should I be tested early for diabetes, given my history?
Plus 3 more on your appointment checklist.
Around 10–13 weeks: genetic screening if you choose it, and often another scan.
Around 12–16 weeks: start low-dose aspirin, if you qualify.
In the second trimester: the anatomy scan at around 18–22 weeks, and diabetes screening at 24–28 weeks.
If you have a history of loss, APS or a medical condition, ask whether you should also see a maternal-fetal medicine specialist.
Ask for another opinion, or a referral to a maternal-fetal medicine specialist, if you have a history of loss, APS or a medical condition and your questions about early monitoring or aspirin aren't being answered; if bleeding or pain is dismissed without an exam or scan; or if you're told a single hCG number means something definitive.