After nearly a century of a “one-size-fits-none” approach to prenatal care, the American College of Obstetricians and Gynecologists (ACOG) has announced essential updates to its practice guidelines for expectant parents.
On April 17, 2025, ACOG introduced pioneering clinical recommendations that seek to replace the antiquated 12-to-14 visit framework with prenatal care customized to individual circumstances. This shift aims to accommodate varying situations, including those with demanding work schedules, limited internet access in rural areas, or the challenges of caring for young children.
Let’s delve into the significance of this shift and explore how it could signal a true modernization of U.S. prenatal care.
What are the changes?
Historically, the standard practice dictated regular checkups on a fixed schedule, regardless of whether a pregnancy was classified as low- or high-risk: visits every four weeks until the seventh month, biweekly until the eighth month, and then weekly thereafter. While this model suited many low-risk pregnancies, those with higher risks often needed more frequent appointments and specialized attention.
Under this system, the same rigid schedule applied regardless of individual circumstances like job constraints, child care responsibilities, or transportation challenges.
ACOG’s revised guidance, driven by comprehensive research and a reassessment following the COVID-19 pandemic, seeks to overturn this conventional approach. Now, patients considered low to average risk can receive prenatal care personalized to their specific requirements, taking into account risk factors and social determinants of health such as race, employment status, and transportation access.
Dr. Christopher Zahn, ACOG’s Chief of Clinical Practice and Health Equity and Quality, emphasized this point, stating, “Research has shown that the standard 12 to 14 visits do not ensure that patients receive the recommended prenatal care…To enhance access and outcomes, we have to adapt the system and meet patients where they are.”
Translation: Less rigidity, more reality
The move toward personalized prenatal care signifies that rather than following a predetermined number of appointments, ob-gyns and patients can work together to find a schedule that suits each individual’s needs. As a mother who dealt with Hyperemesis Gravidarum, it is comforting to know that more proactive support could have been available, especially during those initial weeks when women often go extended periods without appointments.
ACOG’s proposed updates include:
– Fewer in-person visits (recognizing that not everyone needs that many)
– Customized appointments for specific conditions requiring attention, even in early pregnancy
– Telemedicine check-ins, enhancing access for rural mothers and those without paid time off
– Longer, more focused visits when they occur
– Support addressing practical challenges such as transportation and childcare issues
This shift is not about reducing care. As Dr. Alex Peahl from the University of Michigan stated, “Tailored care means delivering the right care, by the right professional, through the right modality.”
Why it truly matters: health equity
If you’ve been following our coverage on maternal health, you may know that the U.S. has a concerning history, particularly for Black, Indigenous, and other mothers of color. These groups face disproportionately high rates of maternal mortality and morbidity—issues that have been worsened by outdated systems.
ACOG’s guidance emphasizes the necessity to screen for social determinants of health and adapt care accordingly. This means acknowledging factors like when a mother may struggle to attend appointments due to work obligations or when systemic biases have fostered distrust in the healthcare system.
The new framework introduces the PATH model—Plan for Appropriate Tailored Healthcare in Pregnancy—which outlines how and when to monitor essential metrics like blood pressure and fetal growth in a practical, real-world context.
What this means for you:
– Discuss with your ob-gyn the possibility of personalizing your prenatal schedule to align with your lifestyle and health needs.
– Ask if telehealth check-ins are available.
– If transportation or childcare is a concern, bring it up early, as ACOG’s new guidelines highlight its importance.
– Keep a record of your symptoms between visits to ensure nothing is missed during fewer in-person checkups.
Will this truly lead to change?
Realizing this level of change will not happen overnight. Many healthcare providers still lack the staffing, technology, or financial resources needed for comprehensive telehealth or community support. Furthermore, substantial advancements will depend on insurance companies, hospital systems, and lawmakers aligning with the needs of families.
Nevertheless, this marks a significant first step.
It recognizes that pregnant individuals are not a homogeneous group and that modern prenatal care should reflect this diversity.
