Early Pregnancy Care: Your First Trimester Checklist

The short answer: Book your first antenatal visit as soon as you think you are pregnant, and certainly before 12 weeks. Start folic acid straight away if you have not already. At that first visit expect a set of routine blood tests and a scan between 11 and 14 weeks to confirm your dates. Take no medicine, not even a familiar painkiller, without checking first. And learn the handful of warning signs that mean call the same day.

What you will learn

Exactly when to book your first visit, and what happens at it
Which blood tests and scans come when, and why each one is done
Who needs ordinary folic acid and who needs the high dose
What is safe and what to avoid: medicines, travel, exercise, hair dye
The warning signs that mean call today, not next week

This is the practical checklist. If you also want to understand what is happening inside your body in these weeks, and which symptoms are normal when, read my companion guide on the first trimester week by week.

Your first trimester checklist

When should I book my first appointment?

As soon as you suspect you are pregnant. In India the guidance is to register and have your first check-up as soon as pregnancy is suspected, and the World Health Organization schedules the first contact within the first trimester, up to 12 weeks.

Please do not wait for a "proper" symptom or for a relative to confirm it. Early registration is what lets us date the pregnancy accurately, pick up anaemia and thyroid problems while there is time to correct them, and start your supplements at the point they do the most good.

The full schedule is eight antenatal contacts for a normal pregnancy: the first before 12 weeks, then around 20 and 26 weeks, then more often as you approach delivery. That replaced the older four-visit pattern.

Which tests happen, and when?

At the first visit you can expect a set of routine blood tests. Every pregnant woman gets these; they are not a sign that anything is wrong.

Test	When	Why it is done
Blood group and Rh factor	First visit	Rh-negative mothers need specific care later
Haemoglobin	First visit, again at 28 weeks	Anaemia is very common in Indian pregnancies
Blood sugar	First visit, again at 24 to 28 weeks	Picks up diabetes in pregnancy
Thyroid (TSH)	First visit	Thyroid problems are treatable and matter early
HIV, hepatitis B, syphilis	First visit	All treatable; treating protects the baby
Urine routine	First visit	Infection and protein check
Dating scan	11 to 14 weeks	Confirms your due date and how many babies
NT scan	11 to 13 weeks plus 6 days	Optional screening test, if you choose it
Anomaly scan	18 to 22 weeks	Detailed check of the baby's development

An early scan is worth having in every pregnancy. Done in the first trimester it gives your correct due date, tells us whether there is more than one baby, and gives a first look at how things are growing.

One thing I have to say plainly, because I am asked: finding out the baby's sex before birth is illegal in India under the PC-PNDT Act. No scan in this country will tell you, and please do not ask any doctor to. It is the law, and it exists for a good reason.

About the thyroid test

Here the guidelines genuinely disagree, and you deserve to know that rather than be given a false rule. In India, most doctors including me check thyroid in every pregnant woman at the first visit. Some international guidelines test only women already at higher risk. The level that counts as too high has also changed over the years, and it can depend on your own laboratory's range.

So do not compare your report with your friend's, and do not panic at a number you read online. Bring it to me and I will read it against the right range. If you want more background, I have written about thyroid problems in Indian women in detail.

How much folic acid do I need?

Folic acid protects your baby's developing brain and spine, and it works in the earliest weeks, often before you even knew you were pregnant. Start it the day you find out, if you have not started before conception.

Most women need the ordinary dose. India's national antenatal programme supplies iron with folic acid, and your doctor will start you on the right one.

A much higher dose is advised only for specific reasons. UK guidance lists these: a previous pregnancy affected by a brain or spine defect, or another birth defect; you or your husband having such a condition yourselves; a family history of one on either side; diabetes that you had before pregnancy; a blood condition such as sickle cell disease or thalassaemia; or medicines that affect how your body handles folic acid, including epilepsy medicines and some HIV medicines.

The family-history part is the one couples most often miss, so please mention any birth defect on either side of the family when we meet, even a distant one, and not only conditions of the brain and spine.

Two cautions. Never move yourself up to a high dose on your own; ask me first. And the widely repeated line that a higher body weight means you need the high dose is not settled guidance, so do not act on it without asking.

What is safe in the first trimester?

Medicines

The rule that matters most: almost everything you swallow reaches the baby too. Before you take any tablet, including a simple painkiller and including anything from the medical shop, check with me or your pharmacist.

Paracetamol is considered safe in pregnancy. UK regulators have confirmed it remains safe and that there is no evidence it causes autism.
Ibuprofen and similar painkillers should be avoided in pregnancy unless a doctor or pharmacist has told you to take them. Paracetamol is usually the better choice.
For bad sickness, there is an effective first-line medicine combining vitamin B6 with an antihistamine. It needs a prescription and the right dose for you, so ask rather than self-medicating.
If you already take regular medicine for anything, thyroid, epilepsy, diabetes, blood pressure, mental health, tell me as soon as you know you are pregnant. Just as important: do not stop it on your own either.

Everyday life

Exercise is not dangerous for your baby, and active women tend to have fewer problems later. Thirty minutes of walking a day is a good target, and if you cannot manage that, anything is better than nothing. The simple test is whether you can still hold a conversation while you move; if you are too breathless to finish a sentence, slow down. Avoid anything where you could be hit, and after 16 weeks do not exercise lying flat on your back.
Travel is not banned early on. Many women simply find it miserable because of sickness and tiredness, and the middle months are usually the most comfortable. On any journey over four hours, get up and move regularly, because long trips carry a small clot risk. In the car, the lap belt goes under your bump, never across it.
Hair colour is considered safe. If it worries you, wait until after the first three months. Ordinary henna is fine. Stay away from so-called black henna, which has a chemical called PPD added to darken it. Published case reports describe reactions ranging from eczema to blistering and permanent scarring, and lasting sensitivity that can later make you react to hair dyes too.
Food deserves its own guide. The short version for these weeks: avoid unripe papaya, keep caffeine to about 200 mg a day, which is roughly two mugs of instant coffee, and cook meat and eggs through. My pregnancy diet guide has the full picture.

Fasting, and things I cannot answer from a guideline

Women ask me about religious fasting, about long-distance travel for a family function, about their particular job. I will be honest: there is no clean international guideline I can quote you on Indian fasts. What I can do is look at your haemoglobin, your sickness, your sugar readings and your particular fast, and give you advice for your situation. Please ask me rather than following what worked for a cousin.

Bleeding or pain: what do I do right now?

Keep this one simple. The question that decides your next step is whether the bleeding is heavy, or comes with severe pain, shoulder-tip pain, or feeling faint. By heavy I mean soaking through a pad soon after putting it on.

Go to hospital now if you have

Heavy bleeding, meaning you soak through a pad soon after putting it on, or you are passing clots
Sharp, sudden, severe tummy pain, especially low down on one side
Bleeding with feeling faint, dizzy, very pale, or losing consciousness
Pain at the tip of your shoulder

Call me the same day if you have

Any bleeding or brown watery discharge, however light
Nothing staying down for 24 hours, dark urine, or no urine for 8 hours
Feeling weak, dizzy or faint on standing
Fever, or burning when you pass urine

Your questions, answered

I am 10 weeks and have not seen anyone yet. Am I too late?

No, and please do not let embarrassment delay you further. Come now. You are still inside the window for the dating scan and for the first round of tests, and there is plenty we can put right from here.

Do I need a scan every month?

No. A normal pregnancy needs far fewer scans than most people expect: one early to date it, the anomaly scan around 18 to 22 weeks, and others only if there is a reason. Extra scans at private centres are usually money you do not need to spend.

Can I take my regular thyroid tablet?

In almost all cases yes, and stopping it suddenly is the more dangerous choice. Thyroid medicine needs its dose reviewed in pregnancy, often upward. Tell me as soon as you know, bring your latest report, and we will adjust it properly.

Is it safe to travel by bus or train to my mother's place?

Generally yes in an uncomplicated pregnancy. Break the journey to walk around if it is over four hours, carry water and something to eat, and keep your reports with you. If you have had bleeding, pain, or a previous complication, ask me before you book.

My mother-in-law says I should not tell anyone until three months. Does that matter medically?

Not medically, no. Whom you tell is entirely your choice. I would only say this: if something does go wrong, the women who told nobody often grieve alone. Tell whoever will support you.

What should I bring to my first appointment?

The date your last period started, any previous pregnancy details, a list of every medicine and supplement you take including ayurvedic and home remedies, any old reports, and your questions written down. That last one matters more than people expect.

My free First Pregnancy Starter Kit

I have put this checklist and much more into a free kit for first-time mothers: what to eat, which tests come when, the warning signs, and the questions to bring to each visit. Written for Indian families, in plain language.

Get the free starter kit

Not sure how far along you are? My free due date calculator works it out from your last period in a few seconds.

Sources for this article (14)

WHO: Recommendations on Antenatal Care for a Positive Pregnancy Experience, 2016 (accessed July 2026)
National Health Systems Resource Centre, India: Care During Pregnancy and Childbirth, training manual (accessed July 2026)
FOGSI: Routine Antenatal Care for the Healthy Pregnant Woman (accessed July 2026)
NHS: Ultrasound scans in pregnancy (accessed July 2026)
NICE evidence review: high-dose folic acid supplementation before and during the first 12 weeks of pregnancy (accessed July 2026)
NHS: Medicines in pregnancy (accessed July 2026)
NHS: Exercise in pregnancy (accessed July 2026)
NHS: Travelling in pregnancy (accessed July 2026)
NHS: Ectopic pregnancy (accessed July 2026)
Government of India: PC-PNDT Act, prohibition of prenatal sex determination (accessed July 2026)
NHS: Ibuprofen in pregnancy and breastfeeding (accessed July 2026)
Hyperemesis Gravidarum, StatPearls, NCBI Bookshelf, National Institutes of Health (accessed July 2026)
ACOG: Moderate Caffeine Consumption During Pregnancy (accessed July 2026)
Paraphenylenediamine in Black Henna Tattoos, Journal of Clinical and Aesthetic Dermatology, 2011 (accessed July 2026)

This article is for your information and learning. It is not a substitute for a consultation. For advice about your own health, talk to me or your own doctor.