Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through D-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study
D
Non-RDBPC human or In-vivo animal trials
 

Introduction

Whole person care is a person-centered approach to medicine. It goes beyond treating symptoms or isolated conditions, focusing on the interconnectedness of bodily systems and addressing a wide range of factors. These include biological makeup, behavioral habits, environmental factors, and a patient’s personal beliefs, values, and goals. By tailoring care to align with these unique aspects, healthcare providers can create highly personalized treatment plans that address not only physical health but also emotional and mental well-being.

This template, developed in partnership with OvationLab, aims to provide healthcare providers with practical suggestions for labs, supplements, and lifestyle strategies, helping them design personalized, whole person care plans for patients looking to support a healthy pregnancy during the first trimester. 

Advanced lab testing during the first trimester of pregnancy establishes a baseline of maternal health, screens for pre-existing health conditions, and identifies potential risks that may impact the pregnancy and fetal development. Early identification facilitates timely interventions, which can reduce the risk of complications and contribute to better pregnancy outcomes. (Ramírez 2023)

Tests like human chorionic gonadotropin (hCG) and progesterone can be ordered to confirm and date a pregnancy and assess its viability in early stages. (Friis Petersen 2019) Once pregnancy has been confirmed, a first-trimester lab panel typically includes tests that assess maternal blood health and immune status, while also screening for infections and health conditions that may pose risks to the pregnancy. (AAFP 2014) This typically includes a complete blood count (CBC), blood type, Rh factor, thyroid-stimulating hormone (TSH), vitamin D, and an infectious disease panel. (ACOG 2011)(Nazarpour 2015)(ACOG 2023)(Ramírez 2023)(Bi 2024)

Evidence-based supplements address the increased nutritional demands of pregnancy, as dietary intake alone often fails to meet these needs. (Sauder 2023) Foundational nutritional supplements, including a prenatal multivitamin, choline, and docosahexaenoic acid (DHA), support key aspects of fetal development while also preventing nutrient deficiencies in the mother. (Cetin 2025) Additionally, natural supplements have demonstrated efficacy in managing common pregnancy-related symptoms like nausea and vomiting. (Rondanelli 2025)

Lifestyle modifications span multiple domains, including nutrition, physical activity, stress management, sleep, and environmental factors. According to one study, women who adhered to six healthy lifestyle factors before pregnancy (maintaining a healthy body weight, engaging in regular exercise, eating a nutritious diet, avoiding smoking and excessive alcohol intake, and taking multivitamins) had a 37% lower risk of adverse pregnancy outcomes. (Wang 2023) Pregnancy can be a powerful motivator for women to implement these habits into their daily lives.

Lab Testing

Antibodies

Quest Diagnostics Thyroid Peroxidase Antibodies (TPO)

Quest Diagnostics Thyroid Peroxidase Antibodies (TPO) in the Fullscript catalog

Quest Diagnostics Thyroglobulin Panel

Quest Diagnostics Thyroglobulin Panel in the Fullscript catalog

Hormones

Quest Diagnostics Total Quantitative hCG

Quest Diagnostics Total Quantitative hCG in the Fullscript catalog

Quest Diagnostics Progesterone

Quest Diagnostics Progesterone in the Fullscript catalog

Quest Diagnostics TSH

Quest Diagnostics TSH in the Fullscript catalog

Quest Diagnostics T3, Free

Quest Diagnostics T3, Free in the Fullscript catalog

Quest Diagnostics T4 Free (FT4)

Quest Diagnostics T4 Free (FT4) in the Fullscript catalog

Hematology

Quest Diagnostics ABO Group and Rh Type

Quest Diagnostics ABO Group and Rh Type in the Fullscript catalog

Quest Diagnostics CBC with Differential and Platelets

Quest Diagnostics CBC with Differential and Platelets in the Fullscript catalog

Infectious Diseases

Quest Diagnostics Hepatitis B Surface Antibody Immunity, Quantitative

Quest Diagnostics Hepatitis B Surface Antibody Immunity, Quantitative in the Fullscript catalog

Quest Diagnostics Herpes Simplex Virus 1 and 2 (IgG), Type-Specific Antibodies

Quest Diagnostics Herpes Simplex Virus 1 and 2 (IgG), Type-Specific Antibodies in the Fullscript catalog

Quest Diagnostics Rubella Antibody (IgG)

Quest Diagnostics Rubella Antibody (IgG) in the Fullscript catalog

Micronutrients

Quest Diagnostics 25-Hydroxyvitamin D

Quest Diagnostics 25-Hydroxyvitamin D in the Fullscript catalog

Quest Diagnostics Iron, TIBC, and Ferritin Panel

Quest Diagnostics Iron, TIBC, and Ferritin Panel in the Fullscript catalog

Ingredients

Prenatal Multivitamin

Dosing: Dose per label instructions from preconception through lactation. A prenatal multivitamin should contain at least 400 mcg of folic acid and 30 mg of elemental iron. (Chanarin 1971)(Greenberg 2011)

Supporting evidence:

    •  Prenatal multivitamins are formulated to meet increased nutritional demands during pregnancy. These supplements contain higher levels of certain nutrients, particularly folic acid and iron, to support fetal neurological and musculoskeletal development. (Adams 2022)
    • Approximately 50% of the general population has genetic mutations that impair the conversion of supplemental folic acid to its metabolically active form, 5-methyltetrahydrofolate (5-MTHF). (Graydon 2019) Multivitamins with methylated folate (5-MTHF) are preferred over those with folic acid because they bypass this enzymatic bottleneck, avoid accumulation of unmetabolized folic acid, raise circulating folate levels, and may further reduce the risk of neural tube defects (NTDs). (Obeid 2013)(Henderson 2018)(Miraglia 2022)
    • A systematic review and meta-analysis including 35 studies and 98,926 women found that multivitamin use during pregnancy in high-income countries is associated with a decreased risk of small for gestational age (SGA) infants, NTDs, cardiovascular defects, urinary tract defects, and limb deficiencies. (Wolf 2017)
    • The Camden Study examined prenatal vitamin use in 1,430 low-income, urban women and its impact on preterm delivery (<37 weeks) and low birth weight (<2,500 g). The study found that taking prenatal supplements in the first or second trimester was associated with a twofold lower risk of preterm birth. First-trimester supplementation cut the risk of very preterm delivery (<33 weeks) by more than fourfold. It also led to a sevenfold decrease in risk for very low birth weight. (Scholl 1997)
    • According to this meta-analysis, prenatal multivitamin supplementation improves birth weight outcomes compared to placebo and iron-folic acid supplementation. (Shah 2009)
    • The Baby VIP study was an observational cohort study of 362 mother-infant pairs in the UK, examining first-trimester iron status using serum ferritin and transferrin receptor levels. Iron depletion was associated with an increased risk of SGA infants, though this appeared to be mediated by low hemoglobin, suggesting hemoglobin is more directly linked to poor birth outcomes. Each 10 g/L increase in hemoglobin reduced the risk of SGA by 30%, while levels below 110 g/L tripled the risk. These findings support early assessment of iron status, including CBC and ferritin, to guide timely supplementation when needed. (Nisreen A. Alwan 2015)
Prenatal Multivitamins in the Fullscript catalog

Iron

Optional: Recommend based on CBC and ferritin results

Iron in the Fullscript catalog

Docosahexaenoic Acid (DHA)

Dosing: 450–800 mg per day; begin taking no later than 20 weeks’ gestation and continue until at least 37 weeks’ gestation, or until childbirth if before 37 weeks’ gestation (Bilgundi 2024)(Cetin 2024)

Supporting evidence:

  • DHA is a long-chain omega-3 fatty acid and a key structural component of brain and retinal tissues. Because fetuses cannot synthesize DHA, they rely on maternal dietary intake to support early neurological, cognitive, and visual development. (Jiang 2023)
  • Approximately 95% of pregnant women and women of childbearing age do not consume adequate amounts of omega-3 fatty acids, necessitating additional supplementation to meet fetal nutritional requirements. (Devarshi 2019)
  • Pregnant women with a low DHA intake and low DHA blood levels have an increased risk of preterm birth. (Cetin 2024) According to a Cochrane systematic review, omega-3 (particularly DHA) supplementation during pregnancy reduces the relative risk for early preterm birth (<34 weeks) by 42% and preterm birth (<37 weeks) by 11%. (Middleton 2018)
  • A prospective study of racially diverse and low-risk pregnant women found that first-trimester DHA and eicosapentaenoic acid (EPA) supplementation was associated with significant increases in fetal growth trajectories, including larger estimated fetal weight and abdominal circumference, particularly evident from weeks 19–41 of pregnancy. (Vafai 2023)
  • In this RCT, 350 pregnant women were assigned to take DHA or a placebo from <20 weeks of gestation to birth. Compared to placebo, DHA supplementation resulted in longer gestation duration, decreased preterm birth rates, and higher infant birth weight, length, and head circumference. (Carlson 2013)
Docosahexaenoic Acid (DHA) in the Fullscript catalog

Choline

Dosing: 450 mg per day during the first 12 weeks of pregnancy (Jaiswal 2023)

Supporting evidence:

  • Choline is an essential nutrient that plays a role in cell membrane structure, brain function, and lipid metabolism. Choline nutritional demands increase in pregnancy to support fetal neural tube formation and brain development, while also supporting maternal cardiometabolic health. (Jaiswal 2023)
  • 88.76% of pregnant women do not achieve the optimal choline intake through diet. (Nguyen 2025)
  • This systematic review and meta-analysis, which included over 5,000 mothers, demonstrated that low maternal choline intake during pregnancy was associated with a higher risk of NTDs, with the odds increasing by more than double in some populations. (Obeid 2022)
  • Conversely, a 2025 systematic review and meta-analysis concluded that the likelihood of experiencing adverse pregnancy outcomes (i.e., preterm birth, low birth weight, SGA, and preeclampsia) is approximately half that for women with adequate choline intake compared to those with lower levels. (Nguyen 2025)
Choline in the Fullscript catalog

Vitamin B6 (Pyridoxine)

Dosing: 10–25 mg every eight hours (Herrell 2014)

Supporting evidence:

  • Vitamin B6 is believed to exert antiemetic effects by acting as a coenzyme that modulates lysine reactivity, which can reduce nausea and vomiting caused by increased estrogen levels during pregnancy. It also acts as a cofactor in the production of neurotransmitters like serotonin and dopamine, which contribute to nausea and vomiting when deficient. (Wibowo 2011)
  • A systematic review and meta-analysis of 18 studies demonstrated that pyridoxine supplementation significantly improves the symptoms of nausea and vomiting in pregnancy (NVP), as measured by the Pregnancy-Unique Quantification of Emesis (PUQE) and Rhodes scores. (Jayawardena 2023)
  • This cohort study involving 160 pregnant women demonstrated that the combination of vitamin B6 and doxylamine is more effective than mono-pyridoxine therapy, leading to up to a 75% reduction in nausea and vomiting. (Pope 2015)
  • Based on the large pool of evidence that supports clinical efficacy and safety during the first trimester, the American College of Obstetricians and Gynecologists (ACOG) recommends vitamin B6, with or without doxylamine, as a first-line treatment for managing NVP. (McKeigue 1994)(ACOG 2018)
Vitamin B6 (Pyridoxine) in the Fullscript catalog

Ginger (Zingiber officinale)

Dosing: 1 g per day in divided doses, typically 250 mg four times daily or 500 mg twice daily (Smith 2004)(Sharifzadeh 2017)

Supporting evidence:

  • A three-week RCT of 291 women less than 16 weeks pregnant compared the use of ginger and vitamin B6 to reduce nausea, retching, and vomiting. The results demonstrated that ginger can be an effective alternative to vitamin B6 for managing nausea and vomiting in the first trimester. (Smith 2004)
  • A systematic review and meta-analysis including 12 RCTs with 1,278 pregnant women concluded that ginger significantly improved nausea symptoms compared to placebo, with subgroup analyses favoring a lower daily dosage of <1,500 mg daily. While ginger did not significantly reduce the number of vomiting episodes, there was a trend towards improvement. The authors also found no significant risk of adverse effects from ginger during pregnancy. (Viljoen 2014)
  • Another more recent meta-analysis, including 13 RCTs and 1,174 participants, found that ginger significantly improved the general symptoms of NVP compared to placebo. However, it was not significantly more effective than vitamin B6. (Hu 2020)
Ginger (Zingiber officinale) in the Fullscript catalog

Lifestyle Recommendations

Nutrition

Eat a well-balanced and diverse diet that replaces nutrient-poor, energy-dense (processed) foods with whole fruits, vegetables, legumes, nuts, seeds, and fish to meet increased nutritional demands. (Marshall 2021) Examples of foods rich in key nutrients for pregnancy include:

  • Folate: Green leafy vegetables, broccoli, Brussels sprouts, beans (Chan 2013)
  • Iodine: Seafood, dairy products, eggs, iodized salt (Pehrsson 2022)
  • Iron: Oysters, sardines, beef, spinach, lentils, soybeans (USDA 2024)
  • Vitamin D: Fatty fish, eggs, sun-exposed mushrooms, liver (Dominguez 2021) 

 

  • To meet the adequate intake of omega-3 fatty acids, eat 2–3 servings (8–12 oz) of low-mercury fish (e.g., sardines, anchovies, salmon, skipjack tuna) weekly. (Cetin 2024)
  • Fluid requirements are higher during early pregnancy to support blood volume, amniotic fluid, and fetal circulation. Drink 8–10 glasses (64–80 oz) of water to stay hydrated and prevent dehydration. (Montgomery 2002)
  • Limit caffeine to 200 mg per day (equivalent to two small cups of coffee). (Qian 2019)
  • Avoid eating unpasteurized dairy, soft cheeses, deli meats, smoked fish, raw seafood, and raw or undercooked eggs due to the risk of foodborne illness. (Taylor 2010)
  • Abstain from drinking any alcohol due to the risk of fetal alcohol spectrum disorder. (Dejong 2019)

Movement/Exercise

  • Moderate-intensity physical activity in the first trimester is inversely correlated with mid-pregnancy anxiety and depression, cesarean section, excessive weight gain, gestational diabetes, preeclampsia, low infant birth weight, and preterm birth. (Piercy 2018)(Rodriguez-Ayllon 2019)(ACOG 2020)
  • Patients with uncomplicated pregnancies are encouraged to engage in moderate-intensity aerobic exercise for at least 20–30 minutes most days of the week, totaling at least 150 minutes weekly. (​​Brown 2018)
  • Individuals can continue their pre-pregnancy level of exertion as long as it does not involve activities with a higher risk of injury and trauma (e.g., outdoor cycling, gymnastics, horseback riding, downhill skiing). Examples of pregnancy-safe exercises include pilates, resistance training, stationary biking, swimming, walking, and yoga. (ACOG 2020)
  • Exercise modifications should be individualized as needed for any obstetric complications or pre-existing medical conditions.

Stress/Relationships

  • Systematic screening, coupled with appropriate follow-up and treatment, can significantly increase the detection and timely treatment of perinatal mood and anxiety disorders. (Johnson 2021) Obstetric care providers should screen for depression and anxiety symptoms with a standardized, validated tool (e.g., Edinburgh Postnatal Depression Scale or Patient Health Questionnaire-9) at least once during the first trimester. (ACOG 2018)
  • Mind-body interventions, such as mindfulness, cognitive behavioral therapy, relaxation techniques, and yoga, have been shown to significantly reduce stress, anxiety, and depression in pregnant women, with most noticeable results observed after 4–8 weeks of continued practice. (Guo 2021)
  • Higher levels of partner and family support are associated with subsequent decreases in stress and anxiety during pregnancy and the postpartum period. (Racine 2019)

Sleep

  • Compared to pre-pregnancy, many women sleep longer, feel more tired during the day, and experience poorer sleep quality during the first trimester. (Zhao 2022)(Manconi 2024)
  • Sleep disturbances during pregnancy may predict adverse maternal and fetal outcomes, including preeclampsia, gestational hypertension, gestational diabetes, cesarean section, preterm birth, and stillbirth. (Lu 2021)
  • Women should be encouraged to sleep 7–9 hours per night and use safe non-pharmacological strategies, such as listening to music, relaxation exercises, acupressure, and sleep hygiene practices, to improve sleep quality. (Paulino 2022)(Cannon 2023)

Environment

  • Environmental toxins are linked to adverse reproductive and developmental outcomes, such as infertility, miscarriage, preterm birth, low birth weight, and neurodevelopmental delays. (ACOG 2021)
  • Avoid Cannabis sativa (marijuana) use during pregnancy. (ACOG 2017)
  • Minimize exposure to:

Patient Resources

 

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

View protocol on Fullscript
References
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