First Trimester Checklist: 12 Things to Do After a Positive Test

A positive test brings a rush of feelings and a long list of questions. You do not need to do everything at once. This checklist covers the steps that matter most in the first trimester, roughly weeks 1 to 13, in a sensible order, with the official guidance behind each one.

1. Keep taking folic acid

If you were already taking a prenatal vitamin, keep going. If not, start one today. ACOG recommends a daily prenatal vitamin with at least 400 micrograms of folic acid, ideally from at least 1 month before pregnancy and through the first 12 weeks, to help prevent neural tube defects of the brain and spine.¹ People who have had a pregnancy affected by a neural tube defect need a higher dose (4 milligrams) under a clinician's guidance.¹

Check the label for iodine too: NIH notes that some prenatal supplements contain no iodine and others no choline.¹³ Take one daily serving only; ACOG warns that doubling up can give too much of some ingredients, such as vitamin A.¹ Compare your label with the doses in prenatal nutrient doses.

2. Book your first prenatal appointment

Call a clinician as soon as you have a positive test. NIH says the first visit is usually scheduled sometime after your eighth week, earlier if you have bleeding, pain, severe nausea, a medical condition or a past pregnancy problem.² Read your first prenatal appointment to know what to expect and what to bring.

3. Work out your due date

Pregnancy is counted from the first day of your last period and lasts about 40 weeks.⁵ Use the due date calculator with your last period, ovulation date or IVF transfer date. Your clinician may adjust it after an early ultrasound.²

4. Stop alcohol

CDC states there is no known safe amount of alcohol during pregnancy and no safe time to drink, including before you know you are pregnant.³ If you drank before you knew, you are not alone; tell your clinician, and stop now. ACOG also advises avoiding tobacco, vaping, cannabis and illegal drugs, and says no amount or type of cannabis is safe in pregnancy.⁵

5. Keep caffeine under 200 mg a day

ACOG's committee opinion says moderate caffeine intake, less than 200 mg a day, does not appear to be a major factor in miscarriage or preterm birth.⁴ That is about one 12-ounce cup of coffee.⁵ Remember tea, cola, energy drinks and chocolate count too.

6. Learn the fish rules

Fish is good for you in pregnancy, but some types are high in mercury. FDA and EPA advise 2 to 3 servings (4 ounces each) a week from the "Best Choices" list, such as salmon, sardines, cod, shrimp or canned light tuna, or 1 serving from the "Good Choices" list.⁶ Avoid king mackerel, marlin, orange roughy, shark, swordfish, Gulf of Mexico tilefish and bigeye tuna.⁶ ACOG also advises avoiding raw fish and shellfish.¹

7. Avoid foods that can carry listeria

CDC says about 1 in 25,000 pregnant women in the United States get a listeria infection each year, and it can harm the pregnancy even when the mother feels only mildly ill.⁷ To lower the risk, avoid:⁷

• unheated deli meat, cold cuts, hot dogs and dry sausages (reheat to 165°F or until steaming)
• queso fresco and similar fresh soft cheeses, and any cheese made from unpasteurized milk
• refrigerated smoked fish, premade deli salads, and raw or lightly cooked sprouts
• cut melon left out for more than 2 hours

Our full guide to pregnancy nutrition covers what to eat as well as what to skip.

8. Review your medications

Tell your clinician about every prescription, over-the-counter medicine, herbal product and supplement. ACOG notes that most medications do not cause harm in pregnancy, and that if one does pose a risk, there may be a safer alternative. Do not stop a prescribed medication until you have spoken with the clinician who prescribed it.⁵

9. Reduce infection risks

• Cat litter: toxoplasmosis can spread through cat feces. CDC advises pregnant people to take steps to reduce risk, such as wearing gloves for gardening and washing hands after touching soil or litter, and, if you have a cat, changing the litter box daily.⁸
• Vaccines: CDC recommends a seasonal flu shot (inactivated or recombinant) during pregnancy, and Tdap in each pregnancy, preferably early in weeks 27 to 36.⁹

10. Keep moving

ACOG advises at least 150 minutes of moderate-intensity aerobic activity a week, which can be 30 minutes on 5 days. If you were very active before pregnancy, you can usually keep doing the same workouts; if you are new to exercise, start with 5 minutes a day.¹⁰ Check with your clinician first if you have complications.

11. Manage nausea early

Nausea and vomiting usually start before 9 weeks and ease by 14 weeks for most people.¹¹ Small, frequent meals, ginger and plenty of fluids help; ACOG recommends treating it early so it does not become severe. Call your clinician if you cannot keep fluids down. More in early pregnancy symptoms.

12. Know the warning signs, and look after your mind

Early pregnancy can be anxious, especially after a long time trying, treatment or a loss. If low mood or worry fills most days, read perinatal anxiety and depression, and see miscarriage signs for what bleeding does and does not mean.

Your first trimester checklist at a glance

If eating well feels hard with nausea or a condition like diabetes, a registered dietitian can help, and some services, such as Fay, connect you with dietitians who take insurance. The Pregnant hub has all our first-trimester guides.