FAQ: What does ACOG's tailored prenatal care guidance recommend?

ACOG issued Clinical Consensus No. 8, Tailored Prenatal Care Delivery for Pregnant Individuals, published online April 17, 2025, and in the May 2025 issue of Obstetrics & Gynecology. The document was developed by the Committee on Clinical Consensus-Obstetrics with committee members Alex Peahl, MD, MSc, Julia C. Phillippi, PhD, CNM, FACNM, FAAN, and Mark A. Turrentine, MD, and it was endorsed by the American College of Nurse-Midwives, the Association of Physician Associates in Obstetrics and Gynecology, the Association of Women's Health, Obstetric and Neonatal Nurses, the National Association of Nurse Practitioners in Women's Health, and the Society for Maternal-Fetal Medicine.¹

The consensus offers guidance on a transformative approach to prenatal care in 3 key areas: addressing unmet social needs, frequency of prenatal visits and monitoring, and incorporation of telemedicine and alternative care modalities. ACOG noted that implementing a sustainable paradigm shift in a century-old care-delivery approach will take time.¹ Three of the consensus authors, Turrentine, Peahl, and Phillippi, discussed the motivation for the framework and how to implement it in a Q&A published by Contemporary OB-GYN on May 16, 2025.²

1. What is tailored prenatal care, and why did ACOG issue this guidance?

Prenatal care is one of the most common preventive services in the United States, yet formalized models of prenatal care delivery have changed little since they were first published in 1930, with in-person visits every 4 weeks until the 7th month, every 2 weeks until the 8th month, and weekly thereafter. The COVID-19 pandemic catalyzed changes such as targeted visit schedules, telemedicine, and home monitoring, and ACOG and the University of Michigan then convened an independent panel of experts, the PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) panel, which used the RAND/UCLA Appropriateness Method to develop consensus recommendations in 3 key areas: addressing unmet social needs, visit frequency and monitoring, and telemedicine and alternative care modalities.¹

In the United States, more than 3.67 million individuals give birth each year, and more than 97.8% access prenatal care, but 23% do not establish care until after the first trimester and almost half do not receive all recommended services in a timely manner. ACOG noted that a change in delivery is not warranted for all patients or all clinical situations and that implementation will require resources at multiple levels, including the health care system, institutions, clinicians, patients, and communities.¹

"The major limitation of the traditional paradigm of prenatal care is the lack of flexibility. The traditional prenatal care model uses a 'one-size-fits-all' approach. This new framework allows a foundation for the delivery of tailored care to be developed between the patient and their healthcare practitioner," wrote Mark Turrentine, MD, a coauthor of the consensus, in a Contemporary OB-GYN Q&A.²

2. What are the consensus recommendations, and how are they graded?

The consensus lists 7 recommendations. Ob-gyns and other maternity care professionals should conduct a comprehensive prenatal needs assessment, including medical, social, and structural drivers of health, ideally before 10 weeks of gestation or when a pregnant individual first presents for care; should engage pregnant individuals in developing their care plans using shared decision making; and should refer or coordinate assistance through the health system and community for individuals with unmet social needs.¹

They may adjust prenatal care delivery to be more accessible, especially for those with unmet needs; may tailor the visit frequency and monitoring schedule as determined by the medical and social needs of the pregnant individual; may offer telemedicine or other visit modalities as long as they support the completion of guideline-based recommended services; and may individualize monitoring options for most routine parameters during pregnancy. All recommendation statements met or exceeded the 75% approval threshold required for consensus.¹

3. What should the comprehensive prenatal needs assessment include, and when should it occur?

The assessment should include a detailed medical and reproductive history and a discussion of social and structural factors that may affect well-being and reproductive outcomes. A sample risk assessment table lists obstetric or gynecologic factors, medical factors, family history, and social drivers of health such as social network and support, material needs, and education and employment. Ideally the assessment is done before fertilization, and if not, within a timeframe that supports detection of ectopic pregnancy and modification of maternal medications and exposures during embryogenesis.¹

Research on the optimal timing to initiate prenatal care is limited, but ACOG said it is reasonable to offer an initial assessment before 10 weeks from the last menstrual period or within a reasonable timeframe after discovery of pregnancy. More rapid evaluation may be appropriate for individuals with medical or mental health conditions, poorly controlled pregnancy symptoms, unmet social needs, or risk factors for ectopic pregnancy, or who desire abortion care.¹

Initial assessments may be completed in person or through telemedicine, and screening may be completed by any trained clinical staff, such as medical assistants, Community Health Workers, or nurses, under the supervision of a maternity care professional. Clinicians should reassess risk regularly and escalate care when needed, and longer visits or planned nurse contacts may be considered to accommodate the added tasks.¹

"Tailoring care should begin with a comprehensive assessment of individuals' pregnancy risks, including preexisting conditions, pregnancy history, and unmet social needs. These risks can be assessed through interviews or standardized questionnaires by any trained member of the care team," wrote Alex Peahl, MD, MSc, a coauthor of the consensus, in a Contemporary OB-GYN Q&A.²

4. How should shared decision making work in tailored prenatal care?

ACOG said preferences for prenatal care delivery may be shaped by prior health care experiences, cultural norms, and social drivers of health such as employment, transportation, and caregiving responsibilities. Tailoring care may optimize access to services, care experience, and health outcomes while improving operational efficiency, and it requires incorporating patient preferences and needs through shared decision making, including discussion of the risks and benefits of preference-sensitive options in light of the individual's values and priorities.¹

The plan of care can be adjusted as pregnancy progresses, but evidence is lacking on how best to engage patients in shared decision making, including the timing of care-planning conversations, the preferred clinician to lead them, and the optimal supporting tools. Practices may use decision aids and can extend new and return visits to allow sufficient time.¹ Peahl said decision grids and prenatal road maps are helpful tools for visualizing and selecting options.²

"Maternity care professionals should also ask about individuals' preferences and priorities for their care. With this information, pregnant individuals and their maternity care professionals can discuss and review flexible, safe, individualized options for their prenatal care delivery. It is important that shared decision-making be an evolving process and that care delivery decisions be revisited over the course of pregnancy," wrote Peahl.²

5. How should clinicians address unmet social needs?

ACOG distinguishes between assistance, meaning resources provided to alleviate an unmet social need, and care adjustments, meaning modifications to care delivery that improve accessibility. For transportation insecurity, examples of assistance include ride share vouchers and coordinated transportation, while adjustments include a targeted visit schedule, telemedicine, and local completion of laboratory tests and vaccinations. For social isolation, assistance includes peer-support programs, doula services, and prenatal support groups, and adjustments include group prenatal care and doula or peer support at prenatal visits.¹

Referral to professionals such as social workers can provide a central point for care coordination, and when such team members are not available, regional partnerships, resource lists, national resources such as 2-1-1, or social needs-prescribing programs may be used. Closed-loop processes, meaning bidirectional communication between social service practitioners and clinicians, may achieve greater success in resolving unmet social needs than resource lists alone. ACOG cautioned that additional prenatal visits with a maternity care professional are unlikely to address underlying social needs and may create additional burden.¹

"Social and structural drivers of health are daily pressures on individuals. For many families, the day-to-day juggle of meeting work expectations and family needs is already a strain. Adding prenatal care to that full schedule can be difficult. Customizing their care schedule around their needs and offering help for overcoming barriers, such as transportation, can make prenatal care not only possible but something to look forward to during a busy phase of life," wrote Julia Phillippi, PhD, CNM, FACNM, FAAN, a coauthor of the consensus, in a Contemporary OB-GYN Q&A.²

6. What does the evidence say about tailoring visit frequency?

Prenatal care has traditionally used a schedule of 12 to 14 in-person visits regardless of individual risk factors. Three systematic reviews have demonstrated equivalent maternal and neonatal outcomes and an overall positive care experience with targeted visit schedules of 6 to 10 visits for average-risk individuals without medical or pregnancy complications, and tailored schedules that adjust visit number and frequency based on risk and parity have been supported by several organizations and peer nations for more than two decades.¹

ACOG acknowledged that modern assessments of tailored visit schedules in diverse populations and nontrial settings are lacking, though existing data on maternal and neonatal outcomes and patient experience are reassuring. The consensus emphasizes that tailored care does not mean less care: patient assessments and visit planning take more time than prior models, health systems can consider longer visits to maintain overall time with the maternity care professional, and patients should have access to a clinician to ask questions or triage concerns between visits.¹

"This approach can allow the care plan to be adapted to the patient's needs. For example, an individual who is with her second pregnancy may not need to be seen every 2 or 4 weeks during the middle of the pregnancy. Whereas, those individuals who need additional time for their clinical situation can be scheduled for longer visits," wrote Turrentine.²

7. How does the guidance address routine monitoring and testing?

Little is known about the optimal frequency of measuring maternal blood pressure, weight, fundal height, and fetal heart tones, so ACOG said it is reasonable to continue routine measurement at the same frequency as routine prenatal visits for individuals not at increased risk of complications. Individuals with chronic hypertension or hypertensive disorders of pregnancy may benefit from more frequent blood pressure measurements. Fundal height is the primary screening tool for fetal growth and should be completed at routine in-person visits after 24 weeks of gestation, and ultrasonograms may replace it if measurement is not feasible or serial ultrasonographic assessment is indicated.¹

No routine antenatal measurement of fetal well-being, such as fetal heart rate or formal kick counts, has demonstrated benefit for stillbirth prevention. Outside select maternal or fetal conditions or specific indications for antenatal testing, there is no additional utility in checking fetal heart rate if the patient can confirm fetal movement, though checking fetal heart tones may offer nonclinical benefits such as reduced maternal anxiety, improved parental bonding, and an improved patient experience.¹

Maternal weight measurement can help diagnose hyperemesis and assess risk for adverse perinatal outcomes, though routine measurement alone has not been associated with reductions in gestational weight gain or development of diabetes, and adjustments such as not displaying the numeric weight can be made for patients with a history of eating disorders. Routine dipstick measurement of urine protein is no longer recommended as part of standard prenatal care assessments because of its low diagnostic accuracy.¹

8. When is telemedicine appropriate, and what does the evidence show?

ACOG said telemedicine is effective when in-person services, such as physical examinations, laboratory tests, imaging, and vaccinations, are not needed or can be completed through alternative means. Telemedicine can improve access, reduce patient and health system costs, and improve patient experience, and if it increases access to care, perinatal outcomes are equivalent to or improved compared with in-person visits. Not all patients preferred telemedicine in observational studies, and satisfaction gains may be greatest for those who live farthest from their care location.¹

A 2023 systematic review that included 2 randomized controlled trials, 4 nonrandomized comparative studies, and 1 survey reported equivalence of maternal and neonatal outcomes and improved maternal experience of care with telemedicine, but the models were heterogeneous (1 to 6 visits), the quality of evidence was low, and the studies were underpowered to detect rare outcomes. Research on maternal mental health effects is mixed, and there is no evidence that video visits are superior to audio-only encounters. Patients need access to audio or video equipment and reliable connectivity for successful telemedicine care.¹

"All the same essential, evidence-based services are delivered. Just more efficiently. The targeted in-office visit times are structured to capture all of the evidence-based services. When in-person services are not needed or can be completed through alternative means, telemedicine is an effective means to continue contact with your patient. Hybrid models of prenatal care delivery (including both in-office and telemedicine contacts) have been demonstrated to provide cost savings for the patient (from less travel time, costs of travel, and time-off costs from work)," wrote Turrentine.²

9. What does the guidance say about group prenatal care and self-monitoring?

Individual studies of group prenatal care have demonstrated improved clinical and patient-reported outcomes compared with individual care, including preterm birth, neonatal intensive care unit admission, patient satisfaction, knowledge of pregnancy topics, and breastfeeding initiation and continuation. A meta-analysis of 10 observational studies and 4 randomized controlled trials did not demonstrate improvements in maternal or neonatal outcomes overall, though a subgroup analysis showed a reduction in preterm birth for African American patients with low incomes (relative risk 0.55; 95% CI, 0.34 to 0.88). Marginalized individuals, including those from minoritized racial and ethnic groups, those living with HIV, and adolescents, may benefit more, especially if groups are organized around a shared identity or condition.¹

Monitoring of routine parameters is increasingly available outside clinical settings, such as at local pharmacies, through home-visiting programs, or by remote self-monitoring. Evidence demonstrates the feasibility, acceptability, and accuracy of self-monitoring of blood pressure and weight, with fewer data on fetal heart tones and fundal height. The PATH panel concluded that self-monitoring of blood pressure and weight could be completed in any trimester, and self-monitoring of fetal heart tones and fundal height could be completed in the second and third trimesters if deemed appropriate by the maternity care professional.¹

Self-measurement is reasonable if the patient desires it, has adequate training to complete the measurement accurately, can access necessary and reliable equipment, is aware of abnormal parameters, and has the means to obtain help with abnormal results. The cost of home devices remains a barrier for many individuals, and ACOG said future policies are needed to improve equitable access.¹

10. How can clinicians keep tailored care equitable, and what research is still needed?

Birthing individuals in the United States who are marginalized by racism, socioeconomic status, and geography are less likely to access timely prenatal care and more likely to report discrimination and bias, mistreatment, and a poor care experience, and these upstream drivers are associated with inequities in pregnancy outcomes, including maternal morbidity and mortality. ACOG said prenatal care tailored to the needs and preferences of each individual has the potential to improve maternal satisfaction and outcomes, especially if implemented with attention to equity.¹

"To avoid widening existing inequities, clinicians and institutions should work to ensure all patients have access to the necessary tools for tailored care, such as broadband internet and devices for self-monitoring. 'Standardizing choice,' creating processes for routinely offering available options to all pregnant individuals, can reduce bias in care delivery. Additionally, incorporating additional support people in shared decision-making discussions, such as family members or Community Health Workers, can help patients from marginalized groups overcome the inherent power differentials in clinical discussions," wrote Peahl.²

On research needs, ACOG noted that bundled and global billing for prenatal care makes many visit numbers and modalities invisible in claims data sets, definitions of quality and outcomes are heterogeneous, and social drivers of health are not assessed routinely. Future research should clearly define prenatal care delivery as an intervention, use the standard outcomes identified by the FORECAST Core Outcome Set, and define the facilitators, barriers, and most effective strategies for implementing person-centered tailored care. Research should also ensure that gains in operational efficiency and access do not come at the expense of patients, particularly those historically marginalized by the health system, and should include a diverse group of stakeholders.¹

References:

1. American College of Obstetricians and Gynecologists. Tailored prenatal care delivery for pregnant individuals. Clinical Consensus No. 8. Obstet Gynecol. 2025;145(5):565-577. Published online April 17, 2025. doi:10.1097/AOG.0000000000005889

2. Turrentine M, Peahl A, Phillippi J. A discussion on ACOG's new clinical consensus on tailored prenatal care. Contemporary OB-GYN. Published May 16, 2025. Accessed November 6, 2026.