Ideally, a couple who is thinking of having a baby should see a doctor or other health care practitioner to discuss whether pregnancy is advisable. Usually, pregnancy is very safe. However, some disorders can become severe during pregnancy. Also, for some couples, the risk of having a baby with a hereditary disorder is increased.
As soon as a couple is thinking of having a baby, the woman should start taking a multivitamin that contains folate Folate Deficiency Folate deficiency is common. Because the body stores only a small amount of folate, a diet lacking in folate leads to a deficiency within a few months. Not eating enough raw leafy vegetables... read more (folic acid) once a day. The lowest amount recommended for women of childbearing age is 400 micrograms, but some experts recommend taking slightly higher amounts, such as 600 or 800 micrograms. Such doses are often available in over-the-counter products, such as multivitamins. Folate reduces the risk of having a baby with a birth defect of the spinal cord or brain (neural tube defect Neural Tube Defects and Spina Bifida Neural tube defects are a certain type of birth defect of the brain, spine, and/or spinal cord. Neural tube defects can result in nerve damage, learning disabilities, paralysis, and death. The... read more ). Women who have had a baby with a neural tube defect should start taking a much larger amount than usually recommended: 4,000 micrograms as soon as they start thinking of having another baby. Doses of 1,000 micrograms or higher are available only with a prescription.
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If the couple decides to try to have a baby, they and the doctor discuss ways to make the pregnancy as healthy as possible. The woman should ask the doctor about factors that could impair her health or the health of the developing fetus.
Factors or situations to avoid include the following:
Using tobacco or alcohol
Being exposed to secondhand smoke, which may harm the fetus
Having contact with cat litter or cat feces unless the cats are strictly confined to the home and are not exposed to other cats (such contact can transmit toxoplasmosis Toxoplasmosis Toxoplasmosis is infection caused by the single-celled protozoan parasite Toxoplasma gondii. Infection occurs when people unknowingly ingest toxoplasma cysts from cat feces or eat contaminated... read more , an infection by a protozoan that can damage the fetus’s brain)
Being exposed to hot temperatures for a long time
Being exposed to chemicals or paint fumes
Having contact with people who have rubella Rubella Rubella is a contagious viral infection that typically causes mild symptoms, such as joint pain and a rash, but can cause severe birth defects if the mother becomes infected with rubella during... read more (German measles) or other infections that can cause birth defects
Having contact with people who have chickenpox Chickenpox Chickenpox is a highly contagious viral infection with the varicella-zoster virus that causes a characteristic itchy rash, consisting of small, raised, blistered, or crusted spots. Chickenpox... read more or shingles Shingles Shingles is a painful skin rash caused by a viral infection that results from reactivation of the varicella-zoster virus, the virus that causes chickenpox. What causes the virus to reactive... read more unless the woman has had a test that shows she has had chickenpox and is immune to it
Chickenpox and shingles are caused by herpes viruses. During delivery, these viruses can be spread to the fetus and cause severe illness. The virus can also cause pneumonia, which is occasionally severe, in the woman.
Knowing about and dealing with such factors before pregnancy may help reduce the risk of problems during pregnancy (see High-Risk Pregnancy Risk Factors for High-Risk Pregnancy Some risk factors are present before women become pregnant. These risk factors include Certain physical characteristics, such as age, and social characteristics of women Problems in a previous... read more ). In addition, the woman can discuss her diet and her social, emotional, and medical concerns with the doctor.
When a woman sees a doctor or another health care practitioner before she is pregnant, she can be given any needed vaccines, such as the rubella vaccine Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more . If she is not already taking folate, doctors can prescribe prenatal multivitamins that contain the recommended daily amount (RDA) of folate or a larger amount of folate if the woman has had a baby with a neural tube defect. If needed, genetic screening Genetic Screening Genetic screening is used to determine whether a couple is at increased risk of having a baby with a hereditary genetic disorder. Hereditary genetic disorders are disorders of chromosomes or... read more can be done to determine whether the woman and her partner are at increased risk of having a baby with a hereditary genetic disorder.
After pregnancy is confirmed, the woman should have a physical examination, preferably between 6 and 8 weeks of pregnancy. At this time, the length of the pregnancy can be estimated and the date of delivery can be predicted as accurately as possible.
Doctors ask about disorders the woman has and has had, drugs she taken, and details about previous pregnancies, including problems that occurred such as diabetes Diabetes During Pregnancy For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such... read more , miscarriages Miscarriage A miscarriage is the loss of a fetus due to natural causes before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect)... read more , and birth defects Overview of Birth Defects Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. They are usually obvious within the first year of life. The cause of many birth... read more . Many doctors routinely ask women about domestic violence Domestic Violence Domestic violence is physical, sexual, or psychologic abuse between people who live together. It includes intimate partner violence, which refers to physical, sexual, or psychologic abuse by... read more —whether she is being mentally, physically, or sexually abused by someone she lives with.
The first physical examination during pregnancy is very thorough. It includes the following:
Measurement of weight, height, and blood pressure
Examination of the ankles for swelling
Pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more : During this examination, the doctor notes the size and position of the uterus.
Blood tests: A sample of blood is taken and analyzed. Analysis includes a complete blood cell count, tests for infectious diseases (such as syphilis, hepatitis, and human immunodeficiency virus [HIV]), and tests for evidence of immunity to rubella and chickenpox (varicella). Blood type, including Rh factor status (positive or negative), is determined.
Urine tests: A sample of urine is taken and analyzed.
Papanicolaou (Pap) test Screening for Cervical Cancer Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more or a variation of it: Samples of tissue from the cervix are taken to check for cancer of the cervix.
Test for sexually transmitted infections Screening for Sexually Transmitted Infections Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more : Immediately after the Pap test, another sample of tissue from the cervix is taken to test for sexually transmitted infections, such as gonorrhea and chlamydial infection.
Other tests may be done, depending on the woman’s situation. Thyroid hormone levels may be measured in some women (such as those with who have had a thyroid disorder, diabetes, infertility, or miscarriage).
If the woman has Rh-negative blood, it is tested for antibodies to the Rh factor (see Rh Incompatibility Rh Incompatibility Rh incompatibility occurs when a pregnant woman has Rh-negative blood and the fetus has Rh-positive blood. Rh incompatibility can result in destruction of the fetus’s red blood cells, sometimes... read more ). The woman's immune system produces these antibodies when her Rh-negative blood comes in contact with Rh-positive blood—for example, in a previous pregnancy with a fetus who has Rh-positive blood. The antibodies (called Rh antibodies) may destroy blood cells in a fetus with Rh-positive blood, causing severe problems (even death) for the fetus. If antibodies in a pregnant woman’s blood are detected early, the doctor can take measures to protect the fetus. All women with Rh-negative blood are given Rh(D) immune globulin, injected into a muscle, at 28 weeks of pregnancy. They are also given an injection after any possible contact between their blood and the fetus's blood—for example, after an episode of vaginal bleeding or amniocentesis and after delivery. Rh(D) immune globulin reduces the risk that the fetus's blood cells will be destroyed.
Did You Know...
Women of African descent are tested for sickle cell trait or disease Sickle Cell Disease Sickle cell disease is an inherited genetic abnormality of hemoglobin (the oxygen-carrying protein found in red blood cells) characterized by sickle (crescent)-shaped red blood cells and chronic... read more if they have not been tested previously. Skin tests for tuberculosis Diagnosis Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs. Tuberculosis is spread mainly when people breathe... read more are advisable for all women.
After the first examination, a pregnant woman should see her doctor as follows:
Every 4 weeks until 28 weeks of pregnancy
Then every 2 weeks until 36 weeks
Then once a week until delivery
At each examination, the woman’s weight and blood pressure are usually recorded, and the size of the uterus is noted to determine whether the fetus is growing normally. The woman’s ankles are examined for swelling.
Doctors check the heartbeat of the fetus. It can usually be detected at about 10 to 11 weeks with a handheld Doppler ultrasound Doppler ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more device. Once a heartbeat has been detected, doctors check it at each visit to determine whether it is normal.
At each visit, urine is tested for sugar. Sugar in the urine may indicate diabetes. If the urine contains sugar, a blood test to check for diabetes is done as soon as possible. Even if the urine does not contain sugar, doctors usually test all women for the type of diabetes that develops during pregnancy (gestational diabetes Gestational diabetes For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such... read more ). This blood test is done at 24 to 28 weeks. It measures the level of sugar (glucose) in the blood 1 hour after women drink a liquid that contains a certain amount of glucose—called a glucose tolerance test. If women have risk factors for gestational diabetes, this test is done early in the pregnancy, preferably before 12 weeks.
Risk factors for gestational diabetes include the following:
Severe overweight (weighing more than 250 pounds)
Gestational diabetes or a large baby (weighing 10 pounds or more) in a previous pregnancy
An unexplained miscarriage in a previous pregnancy
First-degree relatives (such as mothers or sisters) with diabetes
A history of having sugar in the urine over a long period of time
If results of the initial test are normal, these at-risk women are retested at 24 to 28 weeks.
At each visit, the urine is also tested for protein. Protein in urine may indicate preeclampsia Preeclampsia and Eclampsia Preeclampsia is new high blood pressure or worsening of existing high blood pressure that is accompanied by excess protein in the urine and that develops after the 20th week of pregnancy. Eclampsia... read more (a type of high blood pressure that develops during pregnancy).
Blood tests to check for thyroid disorders is done if women
Have symptoms of a thyroid disorder
Come from an area where moderate to severe iodine insufficiency occurs
Have relatives who have had a thyroid disorder
Have had a thyroid disorder
Have type 1 diabetes
Have had infertility problems, early delivery of a baby, or a miscarriage
Have had head or neck radiation therapy
Are severely obese
Are over 30 years old
If women have a high risk of conceiving a baby with a genetic disorder, prenatal diagnostic testing Prenatal Diagnostic Testing Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more can be done.
Most doctors believe that ultrasonography Ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more , the safest imaging procedure, should be done at least once during a pregnancy to make sure the fetus is normally formed and to verify the expected date of delivery. It is usually done between 16 and 20 weeks of pregnancy.
For the procedure, a device that produces sound waves (transducer) is placed on the woman’s abdomen. The sound waves are processed to form an image that is displayed on a monitor. Sometimes, particularly during early pregnancy, the doctor uses an ultrasound device that can be inserted in the vagina. Ultrasonography produces high-quality images, including live-action images that show the fetus in motion. These images provide the doctor with useful information and can reassure a pregnant woman.
Ultrasonography can also be used to do the following:
Show the fetus’s beating heart and thus confirm that the fetus is alive, as early as 5 weeks of pregnancy
Identify the sex of the fetus, as early as 14 weeks of pregnancy
See whether a woman is carrying more than one fetus
Identify abnormalities, such as a mislocated placenta (placenta previa Placenta Previa Placenta previa is attachment (implantation) of the placenta over the opening of the cervix, in the lower rather than the upper part of the uterus. Women may have painless, sometimes profuse... read more ), too much fluid in the sac that contains the fetus (polyhydramnios Too much amniotic fluid Amniotic fluid is the fluid that surrounds the fetus in the uterus. The fluid and fetus are contained in membranes called the amniotic sac. Problems with amniotic fluid include Too much amniotic... read more ), or an abnormal position of the fetus Abnormal Position and Presentation of the Fetus Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). It’s important to check the baby’s... read more
Date the pregnancy and thus help determine whether the pregnancy is progressing normally
Identify birth defects (sometimes)
Check for evidence of Down syndrome Down Syndrome (Trisomy 21) Down syndrome is a chromosome disorder caused by an extra chromosome 21 that results in intellectual disability and physical abnormalities. Down syndrome is caused by an extra chromosome 21... read more (and some other disorders) by measuring the fluid-filled space near the back of the fetus’s neck (called nuchal translucency)
Guide the placement of instruments during certain procedures, such as prenatal diagnostic testing
Toward the end of pregnancy, ultrasonography may be used to identify premature rupture of the fluid-filled membranes containing the fetus. Ultrasonography can provide information that helps doctors decide whether cesarean delivery is needed.
X-rays are not routinely taken during pregnancy, but they can be taken safely when necessary. If an x-ray is required, the fetus is shielded by placing a lead-filled garment over the woman’s lower abdomen to cover the uterus.
Experts recommend that all pregnant women be vaccinated against the influenza Influenza Vaccine The influenza virus vaccine helps protect against influenza. Two types of influenza virus, type A and type B, regularly cause seasonal epidemics of influenza in the United States. There are... read more virus during the influenza (flu) season.
Pregnant women can be given the hepatitis B vaccine Hepatitis B Vaccine The hepatitis B vaccine helps protect against hepatitis B and its complications (chronic hepatitis, cirrhosis, and liver cancer). Generally, hepatitis B is more serious than hepatitis A and... read more if needed.
Experts recommend a booster shot for tetanus, diphtheria, and pertussis (Tdap Diphtheria-Tetanus-Pertussis Vaccine The diphtheria, tetanus, and pertussis vaccine is a combination vaccine that protects against these three diseases: Diphtheria usually causes inflammation of the throat and mucous membranes... read more ) after 20 weeks of pregnancy (preferably at 27 to 36 weeks) or after delivery, even if the shots are up-to-date.
Although the COVID-19 vaccine Vaccination COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more has not been specifically evaluated in pregnant women, experts recommend that the COVID-19 vaccine can be given to pregnant women who are eligible for vaccination and who have no contraindications to the vaccine, such as allergy to a component of the vaccine. No vaccines have been fully approved by the U.S. Food and Drug Administration (FDA), but some have been authorized for emergency use. (See also the Centers for Disease Control and Prevention: COVID-19 Vaccination.)
The measles, mumps, and rubella vaccine Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more and varicella vaccine Varicella Vaccine The varicella vaccine helps protect against chickenpox (varicella), a very contagious infection caused by the varicella-zoster virus. It causes an itchy rash that looks like small blisters with... read more should not be given during pregnancy.