EARLY PRENATAL CARE
Probably the most important step you can take is to obtain early prenatal care. If you suspect you might be pregnant, get a pregnancy test right away and arrange for a healthcare visit. The earlier you start prenatal care, the earlier you and your provider can start you on a healthy routine for you and your baby. In fact, having a preconception visit is an even better idea (see preconception health). Women who start prenatal visits during the first 3 months of pregnancy have fewer problems with their pregnancy and have healthier babies.

THE FIRST PRENATAL VISIT
During your first prenatal visit, your provider, usually a physician or nurse midwife, will be taking a complete medical and famly history. Medical conditions will be evaluated and medications adjusted if necessary. Family history (for you and your partner) of genetic disorders, mental retardation, and birth defects, as well as ethnic origin may make genetic counseling desirable. Knowing the date of the last normal menstrual period is the basis for estimating your date of delivery. Of course no due date is absolute. Most women deliver within two weeks of their estimated date of delivery. A complete physical exam is also done at the first visit. The pelvic exam, if done early enough in pregnancy can also help confirm the due date.

Usually, many lab tests are done during the first prenatal visit. Blood tests are drawn to check for anemia, syphilis, history of German Measles, blood type, RH factor, hepatitis, and other conditions as indicated by your history or exam. Testing for HIV is now recommended for all women since early treatment during pregnancy can significantly lower the transmission rate of HIV to the fetus. A glucose screening test will be taken at some point during pregnancy to see if you show any signs of diabetes. During the pelvic exam, a Pap smear is done to check for cervical cancer, and cultures are taken to check for gonorrhea and chlamydia infections. Other tests may be done if they are warranted. All these tests help your provider chart a healthy course for you and your future baby.

PRENATAL VISITS

Checkups are usually about once a month. Starting at about the 28th week, you may need to be seen every 2 - 3 weeks. After 36 weeks, you are usually seen every week until delivery. This routine may vary considerably depending on your individual circumstances. At each visit you will be weighed and have your blood pressure taken. The baby's heartbeat can be heard usually by the 12th week and you may feel the baby moving about the 20th week.

Your provider may decide to do an ultrasound during pregnancy. This is a test which uses sound waves to take a picture of the baby and the area around the baby. It can help tell the date when the baby is due. It also may help show if the baby is develping properly.

Other tests done are genetic screening test such as a blood test called alpha-fetoprotein to help detect neural tube defects (brain and spinal cord problems), amniocentesis and chorionic villus sampling (CVS). The latter 2 tests take fluid from around the baby or cells from the sac around the baby to see if the baby has certain problems. Amniocentesis is done at around 16 weeks; CVS is done at around 10-12 weeks.

NUTRITION
Women should gain 25-35 pounds during pregnancy. Pregnancy is not the time to diet. Eating right is now more important than ever. The Food Pyramid is a good model to follow every day and consists essentially of: 6 servings of grain (bread, rice, pasta); 5 servings of fruits/vegetables; 4 servings of milk/milk products (cheese, yogurt, pudding); and 2 servings of protein (meat, chicken, fish, dried peas, beans, peanut butter).

FOLIC ACID, a B-vitamin, is especialy important in early pregnancy. Every women should take 400 mcg. of folic acid beginning 1 month before conception and at least through the first 3 months of pregnancy. This will reduce the risk of delivering a baby with a neural tube defect such as spina bifida (open spine). These babies have lower body paralysis and loss of bowel and bladder function. Neural tube defects are one of the most common birth defects and occur about 1 out of every 1000 births. Good sources of folic acid are green leafy vegetables, liver, citrus juices, lentils, and chickpeas. Fortified cereals or multivitamins will insure you get adequate amounts of folic acid daily.

EXERCISE
Most women can maintain their usual exercise routine during pregnancy. A combination aerobic, flexibility, and muscle strenghthening routine works well. Intervals of 30 minutes, 3 times a week are recommended. Even women who have not exercised before may benefit from a daily walk or swim. Activites which involve possible trauma to the abdomen (vigorous contact sports, falling from a high place) or severe changes in hyperbaric pressure (scuba diving) should be avoided.

Strenuous exercisers must remain well hydrated and possibly modifiy their level of activity in hot, humid weather. Becoming overheated (hyperthermia) can result in a rise of your core temperature to 102 F - which in animals has been shown to be associated with birth defects. Even sauna, hot tubs, and steamy baths can raise your temperature. So either take your temperature and make sure it is below 102 F. or limit your hot tub sessions to 15 minutes.

HABITS TO BREAK
Substance abusers should ideally quit before pregnancy. Feeding a baby cocaine or alcohol is shocking but that is what you are doing if you continue your habit during pregnancy.

Cigarettes - Every time a puff of smoke is taken, 4000 chemicals are inhaled by you and your baby. Cigarette smoke can lead to miscarriages, prematurity, and low birthweights - factors which can increase the risk of newborn sickness and even death.

Alcohol - Alcohol use during pregnancy is the most common known cause of mental retardation in babies. We know that the more you drink, the more dangerous it is for the future baby. We don't know how many drinks, if any, are safe.

Cocaine, Heroin - babies of mothers who abuse these substance tend to be premature and born too small. They can have horrible withdrawal symptoms after delivery.

WORKING
Working outside the home is usually not a problem during pregnancy. There is no set time in pregnancy when you should stop. A good rule of thumb is to keep working if you feel up to it. Avoid prolonged standing by taking breaks. If you find it difficult or fatiguing to continue your level of work, ask for a reassignment and/or cut down your hours.

Under the Communication Standards of the Occupational Safety and Health Administration (OSHA), employers are required to post a 'Material Safety Data Sheet' that lists all possible hazardous chemicals at your work site. Women in jobs that may expose them to these agents need to use special precautions. General safety measures such as wearing goggles, protective clothing, and gloves, and working in a well-ventilated area are important precautions to take when working with chemicals.

COMMON COMPLAINTS
Nausea and vomiting, leg cramps, bladder pressure,hemorrhoids, constipation, headaches, heartburn, and tiredness are common problems during pregnancy. Talk to your health provider about ways to lessen these symptoms.

Depression during pregnancy and after delivery (postpartum depression) are also very common. It critical that new mothers discuss their emotional concerns with friends, family and health professionals.

SIGNS OF POSSIBLE SERIOUS PROBLEMS
Call your provider if any of the following symptoms occur:

•  vaginal bleeding
• pain with urination
• severe headaches,
• blurry vision, spots before eyes,
• dizziness severe abdominal pain
• stopping or slowing down of the baby's movements
• fever and chills
• leakage or gush of water/fluid from the vagina

When in doubt, it's always best to call and check it out.

COMMUNICATE!
It's important to talk to your partner and health care provider about any concerns you may have. No question is silly. Pregnancy is an exciting but anxiety- filled time. An honest discussion of your worries and fears will help you make good decisions about your health. Being informed and going to all your checkups is the best thing you can do for your baby.

REMEMBER, ABOVE ALL, SEEK EARLY PRENATAL CARE.
While you're waiting to see your health care provider...

• Eat Healthy  4 glasses of milk per day (or its equivalent) 
         folic acid 400 mcg per day  
• Avoid Hyperthermia (getting too hot)
• Keep your core temperature below 102 F.

Only Take Medications That Are Abosolutely Necessary