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 third trimester of pregnancy.

Advanced lab testing is utilized during the final trimester of pregnancy to continue to monitor the mother for anemia and screen for gestational diabetes (if a glucose tolerance test was not performed in the second trimester). (Tran 2019)(Pillay 2021) Screening for Group B Streptococcus (GBS) colonization is also performed at 36–37 weeks’ gestation. Prophylactic antibiotic therapy will be given to mothers who are carriers to prevent the transmission of the infection to their newborns and neonatal GBS early-onset disease. (ACOG 2020)

Evidence-based supplements, including a prenatal multivitamin, choline, and docosahexaenoic acid (DHA), continue to support the rapidly growing fetus and the final stages of fetal development during the third trimester, as dietary intake alone often falls short of meeting nutritional requirements. They also help to prevent nutrient deficiency conditions like iron deficiency anemia in the mother and help her body prepare for labor and delivery. (Sauder 2023)(Cetin 2025)

Lifestyle modifications encompassing nutrition, physical activity, stress management, sleep, and environmental exposures can lower the risk of adverse pregnancy outcomes. (Wang 2023) The integration of healthy habits emphasized throughout the pregnancy should be continued for the final months as the mother prepares to welcome her baby into the world.

Lab Testing

Quest Diagnostics CBC with Differential and Platelets

Quest Diagnostics CBC with Differential and Platelets in the Fullscript catalog

Quest Diagnostics Glucose Tolerance Test

Quest Diagnostics Glucose Tolerance Test in the Fullscript catalog

Quest Diagnostics Iron, TIBC, and Ferritin Panel

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

Group B Streptococcus (GBS)

Screening for GBS colonization in the vagina and rectum is typically performed between 36 and 37 weeks of gestation. If the mother is GBS positive, intrapartum antibiotic prophylaxis is administered to prevent neonatal GBS infection. (CDC 2025)

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:

  • Based on evidence that prenatal multivitamins can decrease the risk of low birth weight (LBW) compared to iron or folic acid alone, the American Association of Clinical Endocrinologists, the American College of Endocrinology, and The Obesity Society recommend that all women take a prenatal multivitamin to meet increased gestational nutritional needs during pregnancy. (Gonzalez-Campoy 2013)
  • A Cochrane review involving 141,849 women from low- and middle-income countries found that multiple-micronutrient (MMN) supplementation (including iron and folic acid) during the entirety of pregnancy reduced the risk of LBW and small-for-gestational-age (SGA) infants. (Keats 2019)
  • A systematic review and meta-analysis of 35 studies, including 98,926 women in high-income countries, showed that prenatal multivitamins decreased the risk of SGA infants and neural tube defects (NTDs). (Wolf 2017)
  • An RCT with 1,729 women ages 18–38 from the United Kingdom, Singapore, and New Zealand demonstrated that enhanced vitamin supplementation starting preconception and continuing through pregnancy reduces vitamin insufficiencies, including vitamin D and B vitamins, during late pregnancy. (Godfrey 2023)
Prenatal Multivitamins in the Fullscript catalog

Docosahexaenoic Acid (DHA)

Dosing: At least 200 mg per day starting no later than 20 weeks’ gestation; women with omega-3 deficiency may require 600–1,000 mg per day of omega-3 fatty acids (DHA+EPA) daily (Koletzko 2007)(Best 2022)

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 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)
  • A phase III, double-blind RCT with 350 women showed that daily DHA supplementation from <20 weeks’ gestation to birth increased gestation duration by 2.9 days, infant birth weight by 172 g, and head circumference by 0.5 cm, and reduced early preterm births and neonatal intensive care unit (NICU) stay duration. (Carlson 2013)
  • In a multicenter, parallel RCT, women who supplemented with a daily multivitamin and DHA had significantly increased DHA and vitamin D status during the second and third trimesters. Their babies also had improved subscapular skinfold thickness (an anthropometric parameter for assessing body composition) at birth. (Massari 2020)
  • A systematic review and meta-analysis of nine RCTs involving 5,710 individuals found that DHA supplementation during the latter half of pregnancy was associated with significantly higher birth weights and fewer LBW infants. (Bilgundi 2024)
  • In this randomized double-blind trial, 301 mothers were administered either daily DHA or a placebo from 14.5 weeks’ gestation to delivery. Children from those pregnancies were followed from ten months through six years of age. Approximately 200 infants completed the longitudinal follow-up. Results demonstrated that daily DHA supplementation during pregnancy reduced early preterm birth rates and improved visual attention in infancy, although no long-term cognitive benefits were consistently observed into childhood. (Colombo 2019)
Docosahexaenoic Acid (DHA) in the Fullscript catalog

Choline

Dosing: 550 mg per day during the third trimester 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)
  • A 2025 systematic review and meta-analysis of 27 studies concluded that 88.76% of pregnant women do not achieve the optimal choline intake through diet. Women with insufficient choline levels may have up to double the risk of adverse pregnancy outcomes, including maternal and fetal fatty liver, preterm birth, LBW, SGA, and preeclampsia. (Obeid 2024)(Nguyen 2025)
  • Two small studies indicate that infants of mothers who consumed higher levels of choline during their third trimester exhibit better cognitive performance, based on faster reaction times and sustained attention, at birth and into childhood. (Caudill 2018)(Bahnfleth 2022)
  • A systematic review and meta-analysis of human studies found that higher maternal choline intake during the second half of pregnancy and the early postpartum period was associated with better child neurocognitive outcomes, such as memory, attention, and visuospatial learning. (Obeid 2022)
Choline in the Fullscript catalog

Iron

Dosing: 60–120 mg of elemental iron per day, in addition to the iron included in prenatal multivitamins, to treat maternal anemia until it resolves (Gonzalez-Campoy 2013)

Supporting evidence:

  • Iron deficiency is the leading cause of anemia during pregnancy, with prevalence rates increasing across the trimesters (from 6.9% in the first trimester to 28.4% in the third trimester). Iron deficiency anemia affects about 5% of pregnant individuals. (USPSTF 2024)
  • A prospective cohort study in Ireland reported that the prevalence of iron deficiency (ferritin <15 μg/L) increased from 4.5% at 15 weeks to 51.2% at 33 weeks’ gestation. Using a ferritin threshold of <30 μg/L, deficiency rates were even higher, reaching 83.8% in the third trimester. (McCarthy 2024)
  • A Cochrane review of 57 clinical trials involving 48,971 women found that daily oral iron supplementation during pregnancy reduced the rates of maternal anemia (7.4% to 4%) and iron deficiency (66% to 44%) at term. (Finkelstein 2024)
  • A study involving 60 pregnant women receiving 27 mg per day of elemental iron found that 81% of participants had probable iron deficiency (ferritin <30 μg/L) at endline, suggesting that additional supplementation on top of what is included in the prenatal multivitamin may be necessary to meet increased iron requirements in late pregnancy. (Cochrane 2022)
  • The American College of Obstetricians and Gynecologists (ACOG) recommends screening for anemia at 24–28 weeks of gestation and treating confirmed iron deficiency anemia with oral iron supplementation. (James 2021)
Iron in the Fullscript catalog

Lifestyle Recommendations

Nutrition

    • Continue eating a well-balanced, nutrient-rich diet emphasizing a diverse range of unprocessed fruits, vegetables, whole grains, legumes, nuts, seeds, and lean animal proteins to ensure a broad intake of essential vitamins and minerals. (Marshall 2021)
    • Eat foods rich in the pregnancy-essential nutrients highlighted by the American Association of Clinical Endocrinologists, the American College of Endocrinology, and The Obesity Society. (Gonzalez-Campoy 2013) Examples include: 
            • Folate: Green leafy vegetables, broccoli, Brussels sprouts, beans (Chan 2013)
            • Iron: Oysters, sardines, beef, spinach, lentils, soybeans (USDA 2024)
            • Calcium: Dairy, tofu, dark leafy greens, sardines (USDA 2024)
            • Zinc: Oysters, beef, crab, pumpkin seeds (NIH 2022)
  • Eat 2–3 servings (8–12 oz) of low-mercury fish (e.g., sardines, anchovies, salmon, skipjack tuna) weekly to meet the adequate intake of omega-3 fatty acids. (Cetin 2024)
  • Continue to monitor weight gain according to pre-pregnancy body mass index (BMI) guidelines. In general, the Centers for Disease Control and Prevention (CDC) recommends that women eat an additional 450 calories daily during the third trimester. (CDC 2024)
  • 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

  • Regular physical activity during pregnancy is associated with numerous benefits, including a reduced risk of gestational diabetes, preeclampsia, excessive weight gain, and cesarean delivery, as well as improved mood and shorter labor and postpartum recovery. (Piercy 2018)(Dipietro 2019)
  • Continue moderate-intensity exercise for at least 150 minutes per week. Modify exercise type, duration, and intensity for physical limitations, obstetric complications, or pre-existing medical conditions. (Piercy 2018)
  • The ACOG supports the continuation of physically demanding occupations during pregnancy with appropriate guidance from a physician. (ACOG 2020)
  • Including pelvic floor muscle training (PFMT) helps prepare the body for labor and postpartum recovery, reduces the risk of third- or fourth-degree perineal tears during labor, and prevents/treats urinary incontinence that can arise in the later stages of pregnancy. (Zhang 2024)

Stress/Relationships

  • According to a recent meta-analysis, women experience the highest prevalence of stress symptoms in the third trimester (52%), underscoring the importance of continued medical screening for perinatal mood disorders and stress management in the third trimester of pregnancy. (Aziz 2025)
  • Mindfulness-based interventions, including yoga, progressive muscle relaxation, deep breathing, meditation, and guided imagery, are low-cost, easy to implement, and safe for pregnant women. They improve stress resilience and have been associated with reductions in maternal stress, anxiety, and depression, increased birth weight, and reduced duration of labor. (Oyarzabal 2021)(Pan 2023)(Abera 2024)
  • Cognitive behavioral therapy (CBT) provides structured approaches to modify negative thought patterns and behaviors to manage antenatal stress and anxiety. (Yu 2022) Group-based interventions that integrate mindfulness and skills-building with behavioral therapy show promise in improving mood and reducing stress among pregnant women. (Moore 2023)
  • Discuss birth and postpartum plans, expectations, and support systems with healthcare providers, partners, family, and friends. (Racine 2019)(McCarthy 2021)

Sleep

  • Insomnia affects approximately 42% of women during the third trimester. (Salari 2021)
  • Oxytocin may promote wakefulness, leading to sleep fragmentation. (Raymond 2021) 
  • Physical discomforts, such as back pain, leg cramps, frequent urination, and increased abdominal size, can contribute to sleep disturbances. Using strategies, such as using pillows for support, can mitigate this discomfort. (Mindell 2015)(Kiyoko 2024)  
  • Side sleeping, particularly on the left side, is recommended in the later stages of pregnancy to optimize maternal and fetal blood flow and reduce the risk of stillbirth. (Couper 2021)
  • Continue non-pharmacological strategies to improve sleep quality:
          • Listening to music
          • Physical exercise
          • Relaxation exercises
          • Sleep hygiene
          • Acupressure (Paulino 2022)

Environment

  • Continue maintaining a toxin-free environment by avoiding Cannabis sativa (marijuana) use and exposure to tobacco smoke, heavy metals, and air pollution. (ACOG 2017)(Gould 2020)(Rani 2023)(Zinia 2023)
  • Prepare a safe and healthy home for the newborn by considering air quality, checking baby item recalls, and ensuring that smoke and carbon monoxide detectors work. (OWH 2021)

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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