Navigating a pregnancy in Bangkok can be daunting: researching hospitals, doctors, doulas and care packages, as well as navigating health-insurance schemes. It can be a costly affair, both in time and money. It helps to know what tests, vaccines and medications you may be offered, and what they are for, so you can plan.
When you decide on a hospital to birth in, you will either choose or be allocated an obstetrician to oversee your care. Discuss your preferences for birth as soon as possible, so you know if your doctor’s approach is aligned with your plan. Each doctor dictates their own plan of care, so it is important you find the one that is right for you. You have the right to change doctor and hospital during pregnancy if you are unhappy with the care. Some hospitals will insist on repeating blood tests if they were done in an external lab.
Like all medical treatments or tests, you can decline any test, or ask your doctor for more details — including the costs — before you consent. Insurance plans vary greatly in their cover for prenatal care, so it is important that you fully understand what is being offered. These are the basic tests offered in a typical low-risk pregnancy.
Blood pressure and urine
These are the basic tests that screen for pre-eclampsia, which is diagnosed by a marked rise in blood pressure and protein in the urine. Blood pressure and urinalysis are checked at each appointment, usually by a nurse or midwife before you see the doctor. Blood pressure should be taken on both arms at the first visit, and thereafter using the right arm. When collecting a urine sample, capture the mid-stream: let urine flow for a few seconds before collecting the sample in a clean container. That gives an untainted sample.
Height and weight
These are taken at your first appointment to calculate your body mass index. A high or low BMI (over 30 or under 17) may indicate increased risk in pregnancy. In a healthy singleton pregnancy you can expect to gain between 10 and 15 kg, mostly in the late second and third trimesters. Weighing at each appointment is not necessary, but it often happens as the standard nursing pre-check before you see the doctor.
Scans
Ultrasound scans are very popular among obstetricians here, though they can be a costly addition if they happen at every appointment. Clinically, ultrasound is recommended between 8 and 12 weeks to date the pregnancy, and between 18 and 22 weeks for an anomaly scan to check for structural differences in the organs and limbs. In a healthy low-risk pregnancy, no further scans are clinically indicated. Reasons for further scans include the baby’s growth, the amount of amniotic fluid, placental position (a low placenta at 20 weeks usually means a repeat scan at 32 weeks), queries about presentation (for example breech or transverse), reduced fetal movement, or maternal conditions including high blood pressure or diabetes. Extra scans, while not always medically indicated, are often offered as standard and charged as an extra line on the visit bill. If you are not sure of the indication, ask why.
Genetic screening is a choice
At booking you will be offered screening to estimate the chance of your baby having a genetic condition such as Down’s syndrome. The tests vary greatly in sensitivity and price. The older triple test, taken before week 12, involves a blood screen and a nuchal-fold measurement on scan. It is around 65% sensitive, with about a 5% false-positive rate. More sophisticated and expensive tests such as NIPT (brands you will hear as NIFTY, Panorama and others) detect tiny strands of fetal DNA in the maternal bloodstream from as early as week 9. These are around 95–97% sensitive, with a less than 1% false-positive rate. If you test as high risk by any of these methods, you will be offered further diagnostic testing and counselling. Any genetic screening test is optional. Discuss your wishes with your doctor.
Blood tests
Serology
You will be offered screening at the start of pregnancy for certain sexually transmitted or blood-borne infections that could affect your baby: hepatitis B, syphilis and HIV. If you test positive, tailored care in pregnancy can help protect the baby. Some doctors will look to repeat these tests several times through pregnancy and in labour. It is up to you whether you accept or decline, though declining may affect the plan made by the baby doctors once your baby is born. You will also be checked for immunity to German measles (rubella), which can cause birth defects if contracted in pregnancy. If you are not immune, you will be offered immunisation after the baby is born to protect future pregnancies.
Blood group
The hospital will establish your blood group (A, B, AB or O) and your rhesus status (positive or negative). This matters especially for rhesus-negative mothers carrying a potentially rhesus-positive baby, because micro-mixing of maternal and fetal blood could complicate future pregnancies.
Full blood count
A complete or full blood count is done periodically to monitor red and white cells, platelets and iron. Your blood is checked at the start of pregnancy. If haemoglobin is deemed low (under 11 g/dl) you will be advised to take iron supplements and retested at 28 and 36 weeks. The baby takes most of its iron from you in utero for the first six months of life, so healthy iron levels matter: low levels mean tiredness, breathlessness and a higher chance of bleeding at birth.
Sickle cell and thalassaemia
These tests look at the size, structure and shape of your red blood cells, to rule out sickle-cell anaemia and thalassaemia. If both parents carry these inherited conditions, they can be passed to the baby and can cause serious health complications.
Gestational diabetes
Everyone is offered testing for gestational diabetes, irrespective of risk or lifestyle. Women of Southeast Asian, Afro-Caribbean and Middle Eastern origin are genetically more predisposed. A previous baby over 4.5 kg, a family history of gestational diabetes or type 2 diabetes, or a BMI over 30 also raises the chance. In Bangkok, non-fasting glucose screening is offered to all pregnant women between 24 and 28 weeks. If results are high, a fasting oral glucose-tolerance test (OGTT) follows. Discuss your risks and options with your doctor.
Group B strep
Group B strep is a normal, transient colonisation of bacteria, thought to be present in around 25% of women’s vaginas. It is tested with a low vaginal swab at the 36-week appointment; results are usually shared before 37 weeks. GBS poses no risk to the mother, but carries a small risk of infection for newborns born vaginally. A positive result does not mean you need a caesarean. Women who are GBS-positive are offered IV antibiotics in labour, which cuts the risk of newborn GBS infection from about one in two hundred to one in four thousand.
Vaccines
As well as screening tests, you may be offered vaccines in pregnancy to protect you and your baby.
Flu
Usually advised between 12 and 20 weeks for best protection. Some strains (especially H1N1) pose more risk in pregnancy, with cases often more serious and more likely to need hospital care, which in turn can raise the risk of preterm labour, low birth weight, and in the most serious cases stillbirth or miscarriage.
COVID-19
Thailand routinely offers COVID vaccines from the second trimester onwards. Cases in pregnancy have higher rates of hospitalisation and increased risk of pre-eclampsia, gestational diabetes, blood clots (thrombosis) and preterm labour.
Tdap
A combined vaccine for tetanus, diphtheria and pertussis (whooping cough). It is offered between 27 and 36 weeks, to protect the newborn in the first two months of life — especially from pertussis — until they can have their own vaccine. Maternal antibodies cross the placenta and protect the baby from birth.
RSV
An RSV vaccine, offered between 32 and 36 weeks, mounts a maternal immune response so antibodies can cross the placenta. Those antibodies provide protection for up to six months. Newborn RSV infection carries the highest risk of serious illness because of small airways and an underdeveloped immune system. Longer-term complications can include asthma and recurrent bronchiolitis.
Medications and supplements
Prenatal vitamins
Along with a varied and healthy diet, pregnancy multivitamins provide micronutrients that support fetal development. Folic acid is the synthetic form of vitamin B9 (folate in its natural form). Taking B9 before pregnancy and through the first trimester helps prevent neural-tube defects such as spina bifida and anencephaly. Vitamin D (600 IU a day) helps build strong bones and teeth. Calcium (1000 mg a day) supports skeletal development. Iron (27 mg a day) helps support oxygen-carrying capacity as blood volume increases. Take a pregnancy-specific multivitamin: high levels of vitamin A are dangerous in pregnancy.
Anti-emetics, for nausea
Hormonal changes, especially in the first trimester, can cause nausea and vomiting. Vitamin B6 and ginger, along with a high-protein diet, can help in mild cases. In moderate cases your doctor may prescribe Dramamine, an antihistamine with anti-nausea properties. In severe cases, when you struggle to keep even liquids down and risk dehydration, a potent anti-emetic such as ondansetron may be prescribed under strict medical supervision.
Progesterone
If you have bleeding in early pregnancy, or a history of miscarriage or preterm birth, your doctor may prescribe vaginal progesterone pessaries. In some cases of assisted fertility or IVF, progesterone supplementation may also be advised.
Aspirin
In high-risk pregnancies, low-dose aspirin helps reduce inflammation in blood vessels and improve blood flow, which supports placental function. This can help prevent or delay the onset of pre-eclampsia, gestational diabetes and hypertension.
Low-molecular-weight heparin
If you have a history of blood clots, a pre-existing clotting disorder, a history of recurrent miscarriage, or an autoimmune condition that causes the blood to clot (antiphospholipid syndrome), you may be advised to take a blood-thinning medication by daily injection. In those cases your haematologist will plan care with you and your obstetrician.
RhoGAM (anti-D)
If you are rhesus-negative you may be offered RhoGAM (anti-D) at 28 weeks, to protect you from mounting an immune response to potential micro-mixing of your blood with the baby’s. Your doctor can give you the relevant information. Any fall or trauma, especially to the abdomen, may be a sensitising event — report it so they can assess whether you need more RhoGAM.
Steroid injections
If you have an identified risk of preterm birth — preterm labour, premature rupture of membranes, or severe pre-eclampsia — you may be offered corticosteroids to help mature the baby’s lungs and reduce other newborn complications if birth comes early.
For most women pregnancy is uncomplicated. Screening and monitoring help identify risks so they can be managed swiftly. Tests can and should be offered, but it should be your choice to accept or decline them. If you are unclear what any test is for, ask. A prenatal consult at Bumpsy Daisy can also help you feel reassured.
Consult your doctor before taking any medication in pregnancy. When buying over-the-counter medicines, check with the pharmacist that they are safe for you and your baby. Antenatal care is not included in the hospital birth package: blood tests, scans and prenatal appointments are billed separately and can be costly, especially if tests are repeated without a medical reason. Being informed and proactive is how you stay in partnership with your doctor for the best care for you and your baby.