Medical care during pregnancy

[Zipporah Schumaker]

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 (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). 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.
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, an infection by a protozoan that can damage the fetus’s brain)
Having contact with people who have rubella (German measles) or other infections that can cause birth defects
Having contact with people who have chickenpox or shingles 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). 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. 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 can be done to determine whether the woman and her partner are at increased risk of having a baby with a hereditary genetic disorder.