What are the recommended prenatal care and lifestyle modifications at 5 weeks pregnant?

Prenatal Care at 5 Weeks Gestation

At 5 weeks pregnant, immediately begin taking 400-800 mcg of folic acid daily (if not already started), schedule your first prenatal visit as soon as possible, completely avoid alcohol and tobacco, and maintain a healthy diet with regular moderate exercise. 1, 2

Immediate Actions Required

Folic Acid Supplementation

• Start folic acid 400-800 mcg daily immediately if not already taking it. This is critical because neural tube closure occurs at 6 weeks (28 days after conception), and supplementation after this point provides no benefit for preventing neural tube defects. 3, 1
• Prenatal vitamins should also contain 150 mg of potassium iodide. 1

Schedule First Prenatal Visit

• Initiate prenatal care before 10 weeks gestation, as care started at 10 weeks or earlier significantly improves outcomes. 2
• At 5 weeks, you are in the critical window where organogenesis is beginning and placental development is already underway (starting at implantation, 7 days after conception). 3

Lifestyle Modifications to Implement Now

Substance Avoidance (Non-Negotiable)

• Complete abstinence from alcohol - there is no safe amount during pregnancy, and fetal alcohol syndrome risk begins immediately. 3, 4
• Stop smoking immediately using the five A's approach (Ask, Advise, Assess, Assist, Arrange) if needed, as tobacco increases risks of miscarriage, preterm birth, and low birth weight. 3, 4
• Avoid all recreational drugs and review all current medications (including over-the-counter drugs, herbs, and supplements) with your healthcare provider to identify teratogenic agents. 3, 1

Nutrition

• Consume "five-a-day": two servings of fruit and three servings of vegetables daily. 3, 1
• Maintain adequate hydration and balanced nutrition. 1
• Achieve or maintain a healthy pre-pregnancy BMI of 19.8-26.0 kg/m², as BMI >25 kg/m² increases risks of gestational diabetes, hypertension, miscarriage, and stillbirth. 3, 2

Physical Activity

• Engage in regular moderate exercise appropriate for pregnancy (at least 30 minutes for 5 days per week). 1, 4

Sleep and Environmental Safety

• Ensure 7-9 hours of quality sleep nightly. 4
• Avoid hyperthermia from hot tubs. 1
• Always wear seatbelts. 3
• Assess and minimize exposure to workplace and household toxins (heavy metals, solvents, pesticides, endocrine disruptors). 3, 1

What to Expect at Your First Prenatal Visit

Medical History Review

Your provider will assess: 3, 1

• Reproductive history, including previous pregnancy complications (preterm birth, fetal loss, birth defects, low birth weight)
• Chronic medical conditions (hypertension, diabetes, thyroid disease, autoimmune diseases, thromboembolism, rheumatic heart disease)
• Current medications requiring adjustment
• Family history for genetic risk assessment based on ethnic background and age

Physical Examination

Focused examination of: 3, 1

• Periodontal health (periodontal disease increases preterm delivery risk) 2
• Thyroid
• Heart
• Breast
• Pelvic examination

Laboratory Testing

Initial screening includes: 3, 1

• Complete blood count (screen for anemia, which increases risks of preterm delivery, intrauterine growth restriction, and perinatal depression) 2, 5
• Urinalysis
• Blood type and screen (critical for Rho(D) immune globulin administration if you are RhD-negative) 2, 5
• Rubella immunity
• Syphilis screening
• Hepatitis B screening
• HIV screening
• Gonorrhea and chlamydia screening
• Cervical cytology as indicated

Genetic Screening Discussion

Based on: 3, 6

• Maternal age (≥35 years increases chromosomal anomaly risk)
• Ethnic background (cystic fibrosis and other carrier screening)
• Family history of genetic disorders

Immunization Updates

Ensure current on: 3, 1

• Hepatitis B (if not immune)
• Rubella (if not immune, must be given before pregnancy)
• Varicella (if not immune, must be given before pregnancy)
• Influenza vaccine (safe during pregnancy)
• Tdap vaccine (typically given between 27-36 weeks)

Psychosocial Screening

Your provider should screen for: 3, 6

• Depression and anxiety
• Intimate partner violence/domestic violence
• Major psychosocial stressors
• Substance abuse using validated questionnaires (CAGE or T-ACE)
• Food insecurity 2

Common Pitfalls to Avoid

• Do not delay prenatal care - waiting until later in the first trimester means missing the critical window for preventing some birth defects and placental development problems. 3
• Do not assume over-the-counter medications and supplements are safe - review everything with your provider, as many are FDA pregnancy category X or D. 3, 4
• Do not continue risky behaviors "just a little longer" - alcohol, tobacco, and teratogenic exposures cause harm from the moment of conception. 3, 4

Special Considerations for High-Risk Conditions

If you have pre-existing diabetes: 1

• Aim for A1C <6.5% to reduce risks of congenital anomalies, preeclampsia, and preterm birth
• Establish care with a multidisciplinary team (endocrinologist, maternal-fetal medicine specialist, registered dietitian, diabetes educator)

If you have chronic hypertension: 2

• Ensure blood pressure is controlled to <140/90 mm Hg with pregnancy-safe medications