What are the recommended knowledge, attitude, and practices for a healthy pregnancy?

Knowledge, Attitude, and Practices for a Healthy Pregnancy

All women of childbearing age should engage in comprehensive preconception care that includes daily folic acid supplementation (400-800 mcg), achieving a healthy pre-pregnancy BMI (19.8-26.0 kg/m²), physical activity throughout pregnancy, complete avoidance of alcohol and tobacco, optimization of chronic medical conditions, and development of a reproductive life plan. 1, 2

Essential Knowledge Components

Preconception Health Understanding

• Women must understand that preconception health directly impacts maternal and fetal outcomes, making the period before pregnancy a critical "window of opportunity" for intervention 1, 3
• Recognize that many pregnancy complications can be prevented through preconception optimization, including neural tube defects, gestational diabetes, preeclampsia, and adverse birth outcomes 1, 4
• Understand that approximately 50% of pregnancies are unintended, making every primary care visit an opportunity for preconception counseling for all women of reproductive age 1

Nutritional Knowledge

• Daily folic acid supplementation (400-800 mcg) reduces neural tube defects by up to 70% and should begin at least one month before conception 1, 2, 4
• Achieve optimal pre-pregnancy weight, as underweight (BMI <19.8) and overweight/obesity (BMI ≥25) significantly increase risks of gestational diabetes, hypertension, miscarriage, and stillbirth 1, 2
• Women with previous bariatric surgery must avoid pregnancy during rapid weight loss phases and ensure adequate micronutrient supplementation (protein, albumin, iron, B12, folate, vitamin D, calcium) checked every trimester 1

Physical Activity Knowledge

• All pregnant women without contraindication should accumulate at least 150 minutes of moderate-intensity physical activity weekly throughout pregnancy 1
• Resistance training combined with aerobic exercise provides greater benefits than aerobic activity alone, including reduced gestational diabetes, improved glucose control, decreased macrosomia risk, and increased likelihood of vaginal delivery 1, 5
• Previously inactive women can safely begin exercise programs during pregnancy with appropriate progression and monitoring 1

Substance Use Knowledge

• Complete alcohol abstinence is mandatory before and during pregnancy to prevent fetal alcohol syndrome, as no safe level of alcohol consumption exists 1, 2
• Tobacco cessation is critical, as smoking increases risks of miscarriage, preterm birth, low birth weight, and stillbirth 1, 2
• Review all medications, including over-the-counter drugs and supplements, as many are teratogenic and require discontinuation or substitution before conception 1, 2

Medical Condition Knowledge

• Women with diabetes must achieve optimal glycemic control before conception (A1C <7%, ideally <6% if achievable without hypoglycemia) to reduce congenital anomaly risk 6, 2
• Chronic hypertension requires blood pressure control to <140/90 mmHg, and women at high risk for preeclampsia should receive low-dose aspirin (60-150 mg daily) starting at 12-16 weeks 6, 4
• All chronic conditions (thyroid disorders, seizure disorders, autoimmune diseases) must be optimally controlled before conception 1, 2

Screening and Immunization Knowledge

• Required preconception/early pregnancy screening includes: complete blood count, urinalysis, blood type and Rh status, rubella immunity, syphilis, hepatitis B, HIV, gonorrhea, chlamydia, diabetes screening, and cervical cytology as indicated 1
• Tdap vaccine is required between 27-36 weeks during each pregnancy, and inactivated influenza vaccine should be given in any trimester 6, 4
• MMR and varicella vaccines must be given preconceptionally or postpartum if non-immune, as they are live vaccines contraindicated during pregnancy 6

Recommended Attitudes

Proactive Health Engagement

• Develop a reproductive life plan that reflects personal intentions regarding number and timing of pregnancies in context of values and life goals 1
• View every healthcare encounter as an opportunity for preconception optimization, not just dedicated preconception visits 1
• Recognize pregnancy planning as a shared responsibility between women, partners, and healthcare providers 1

Risk Awareness Without Fear

• Understand that prenatal physical activity reduces pregnancy complications rather than causing harm, contrary to common misconceptions 1
• Recognize that most women can safely exercise throughout pregnancy, with modifications as needed for comfort and safety 1
• Seek immediate medical attention for concerning symptoms (severe abdominal pain, vaginal bleeding, decreased fetal movement, signs of preeclampsia) rather than delaying care 1, 4

Mental Health Prioritization

• Screen for and address depression, anxiety, and psychosocial stressors before conception, as mental health significantly impacts pregnancy outcomes 1, 2
• Develop stress management techniques and build support systems before pregnancy 2
• Recognize that intimate partner violence screening is essential, as abuse often escalates during pregnancy 1, 4

Evidence-Based Practices

Preconception Practices

• Schedule a dedicated preconception visit at least 3-6 months before attempting pregnancy to identify and address risk factors 1, 2
• Implement long-acting reversible contraception (IUD) until ready for pregnancy, particularly after bariatric surgery when oral contraceptives may have reduced efficacy 1
• Assess and remediate environmental exposures to toxins and teratogens at home and workplace (heavy metals, solvents, pesticides) 1, 2

Prenatal Care Practices

• Initiate prenatal care at 10 weeks or earlier, as early care initiation improves outcomes 4
• Follow standard visit schedule for low-risk pregnancies: monthly visits until 28 weeks, every 2 weeks from 28-36 weeks, then weekly until delivery (approximately 13 total visits) 6
• High-risk pregnancies require more frequent visits with intervals determined by specific maternal or fetal conditions, often weekly or twice-weekly in the third trimester 6

Nutrition Practices During Pregnancy

• Consume frequent, smaller meals with emphasis on protein and low glycemic index carbohydrates while reducing quick-absorbing carbohydrates 1
• Avoid caffeine and alcohol completely throughout pregnancy 1, 2
• For women with bariatric surgery, monitor serum micronutrients, protein, albumin, complete blood count, and INR every trimester and supplement as necessary 1

Physical Activity Practices During Pregnancy

• Engage in at least 150 minutes weekly of moderate-intensity aerobic activity (brisk walking, swimming, stationary cycling, water aerobics) 1
• Include resistance training 2-3 times weekly with appropriate modifications, avoiding supine positions after first trimester, Valsalva maneuvers, and exercises with high fall risk 1, 5
• Avoid activities with high trauma risk (contact sports, activities with fall risk), prolonged supine exercise, hot yoga, and exercise in excessive heat with high humidity 1
• Stay well-hydrated and avoid vigorous activity at altitudes above 2500 meters without appropriate acclimatization 1

Monitoring Practices

• Monitor gestational weight gain according to IOM guidelines based on pre-pregnancy BMI 1
• Screen for gestational diabetes between 24-28 weeks in all pregnant women 6, 4
• Group B Streptococcus screening at 36-37 weeks with intrapartum antibiotic prophylaxis if positive 4
• For women with bariatric surgery, monitor fetal growth every trimester and assess for congenital anomalies 1

Dental Care Practices

• Obtain dental evaluation and treatment before pregnancy, as periodontal disease increases preterm delivery risk 1, 4
• Continue routine dental care during pregnancy with appropriate precautions 1

Critical Pitfalls to Avoid

Timing Errors

• Never delay preconception care until immediately before attempting pregnancy, as many interventions require months for optimization 2
• Do not postpone addressing chronic medical conditions, as uncontrolled disease significantly worsens maternal and fetal outcomes 6, 2
• For bariatric surgery patients, avoid pregnancy until weight has stabilized (typically 12-18 months post-surgery) 1

Medication Errors

• Never assume over-the-counter medications and supplements are safe in pregnancy without specific review 1, 2
• Avoid FDA pregnancy category X medications and most category D medications unless maternal benefits clearly outweigh fetal risks 1
• Do not use aspirin in the last 3 months of pregnancy unless specifically directed by a physician, as it may cause problems in the unborn child or complications during delivery 7

Screening Omissions

• Never skip universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity early in pregnancy, as social determinants profoundly impact outcomes 4
• Do not neglect genetic screening based on family history, ethnic background, and maternal age, including cystic fibrosis carrier screening when indicated 1

Exercise Misconceptions

• Do not advise pregnant women to avoid physical activity due to unfounded fears of miscarriage or fetal harm, as evidence demonstrates safety and substantial benefits 1
• Avoid recommending "exercise as tolerated" without specific guidance, as this vague advice leads to inadequate activity levels 1

Nutritional Errors

• Never neglect micronutrient supplementation in bariatric surgery patients, as deficiencies can cause severe maternal and fetal complications including intracranial hemorrhage 1
• Do not recommend restrictive dieting during pregnancy even for women with obesity, as appropriate gestational weight gain is essential 1