Updated 15/08/2006
Preparing for pregnancy
Folic acid
Folic acid supplementation during pregnancy reduces the risk of neural tube defect (spina bifida).
All women who are planning a pregnancy should take folic acid supplements (folic acid 400 micrograms daily) and, once pregnant, continue this for the first 12 weeks of pregnancy.
Women who have not been taking folic acid supplements and suspect or know that they are pregnant should start taking folic acid at once and continue for 12 weeks into the pregnancy
Remind all women to eat a folate-rich diet and advise them how to achieve this (e.g. eating breakfast cereals, bread, and leafy green vegetables).
(All women at higher risk of having a baby with a neural tube defect should take folic acid 5 mg daily preconceptually and for 12 weeks into the pregnancy. A woman is at higher risk if:
She has had a previously affected pregnancy (approximately a ten times greater risk of neural tube defect compared to women without a previously affected pregnancy)
She, her partner, or a first-degree relative has a neural tube defect
She has coeliac disease (when dietary intake of folate is likely to be compromised due to inability to digest wheat products)
She is taking antiepileptic drugs
Women with sickle cell anaemia should take 5 mg folic acid daily for life and continue to do so during pregnancy)
Stopping smoking
All women who smoke should quit smoking before becoming pregnant.
Smoking in pregnancy increases the risk of miscarriage, preterm delivery, reduced birthweight, and perinatal death
Quitting before or early in pregnancy is strongly recommended, but the baby will benefit from quitting at any stage during the pregnancy.
Women who quit before pregnancy are less likely to relapse
Women who smoke and wish to become pregnant should receive clear, accurate, and specific information on the risks of smoking to themselves and the baby, and be advised to stop smoking.
There is a lack of data on the use and relative risks of nicotine replacement therapy (NRT) in pregnancy. Cigarette smoking, in general, delivers more nicotine than NRT, and exposes the mother and baby to many other toxins. NRT is likely to be appreciably safer than continued smoking and theoretically can be justified in pregnant women in whom non‑pharmacological interventions have failed
Reducing alcohol intake
Women should reduce their alcohol intake if they are planning a pregnancy. Once pregnant, current advice is that light occasional drinking (one or two drinks once or twice a week) is unlikely to harm the baby
Heavy drinking is associated with miscarriage and sometimes has serious effects on the baby's development:
Maternal consumption of 15 units/week or more is associated with a reduction in birthweight.
Maternal consumption in excess of 20 units/week is associated with intellectual impairment in the child.
Fetal alcohol syndrome (brain damage, prenatal and postnatal growth retardation, and facial malformations) is relatively uncommon even amongst heavily drinking pregnant women. It occurs in approximately a third of children born to women who drink about 18 units/day
Up-to-date cervical smear
Opportunity should be taken to identify women who need a cervical smear. Cervical smears are not routinely taken during pregnancy as pregnancy‑related inflammatory changes make them difficult to interpret. If an abnormality is detected many interventional treatments cannot be carried out during pregnancy.
Checking rubella status
Primary rubella infection can have a devastating effect on the baby. Fetal defects include mental handicap, cataract, deafness, cardiac abnormalities, intrauterine growth retardation, and inflammatory lesions of the brain, liver, lungs, and bone marrow
Infection in the first 8-10 weeks of pregnancy results in damage in up to 90% of infants. The risk declines to about 10-20% by 16 weeks, and damage is rare after this.
Check rubella immunity status in all women who are not clearly documented as being immune. Testing is not required if any of below apply: At least two previous rubella antibody screening tests have detected antibodies or At least two documented doses of rubella vaccine have been given or One documented dose of vaccine has been followed by a rubella antibody screening test which has detected antibodies
Offer vaccination against rubella to all women who are found not to have antibodies against rubella on preconception screening. Women should be advised to avoid becoming pregnant for 1 month after receiving rubella-containing vaccine, although extensive studies have failed to identify fetal damage as a consequence of immunizing with rubella vaccine in early pregnancy. The measles, mumps, and rubella (MMR) combined vaccine is now used for immunization of unprotected women of childbearing age due to the non-availability of single rubella vaccine.
Other immunization status to consider
Hepatitis B should be strongly recommended if the woman is considered to be at high risk. In the UK high risk groups include:
Parenteral drug abusers
People who change sexual partners frequently
Close family contacts of a case of hepatitis B or a carrier of hepatitis B
Health-care personnel and other occupational risk groups, e.g. staff at day care or residential centres
Assessing risks from the environment
This is a complex area involving potential hazards:
At work
In the home (e.g. pets)
Farm animals
Advise any woman who thinks that her occupation may pose a risk to a pregnancy to discuss this with her employer or occupational health department, if available, before becoming pregnant
Information guides for employers and expectant mothers can be downloaded from the Health and Safety Executive website at www.hse.gov.uk.
Review of medication (including over-the-counter drugs)
It is important to minimize exposure to all drugs whenever conception is possible. All non‑essential drug treatment should be discouraged, including self‑medication with over‑the‑counter products.
Herbal remedies are unlicensed products and there is little or no information on their safety immediately before or during pregnancy.
How long does it take to become pregnant?
A Norwich Union survey of pregnant women looked at the time it took to become pregnant.
The Minster Practice, Lichfield
