What advice should an antenatal (before birth) mother follow for a healthy pregnancy?

Antenatal Care Recommendations for a Healthy Pregnancy

All pregnant women should begin prenatal care before 12 weeks gestation, take daily folic acid supplementation (400-800 mcg), maintain a balanced folate-rich diet, achieve optimal control of any chronic diseases, avoid all alcohol and tobacco, update immunizations as needed, and undergo comprehensive risk assessment and screening. 1, 2, 3

Preconception and Early Pregnancy Nutrition

Folic Acid Supplementation

• Take 400-800 mcg of folic acid daily starting at least 2-3 months before conception and continuing through the first 12 weeks of pregnancy to reduce neural tube defects by nearly 75%. 1, 2, 4
• Women with high-risk factors (previous neural tube defect, epilepsy, insulin-dependent diabetes, obesity with BMI >35 kg/m², family history of neural tube defects) should take 4-5 mg of folic acid daily starting 3 months before conception until 12 weeks gestation. 1, 4, 5
• After 12 weeks gestation, continue with 400-1000 mcg daily throughout pregnancy and 4-6 weeks postpartum or while breastfeeding. 4, 5
• Take folic acid in a multivitamin that includes 2.6 mcg/day of vitamin B12 to prevent any theoretical concerns about masking B12 deficiency. 4

Dietary Recommendations

• Consume a balanced diet rich in folate-containing foods (leafy greens, fortified cereals, legumes) in addition to supplementation, as diet alone cannot achieve protective red blood cell folate levels. 1, 4
• Avoid consuming large fish (shark, swordfish, tilefish, king mackerel) and limit other fish intake to prevent mercury exposure. 1, 2
• If dietary calcium intake is low (<1200 mg/day), take calcium supplements 1200 mg daily. 1

Weight and Metabolic Health Management

Weight Optimization

• Achieve a healthy pre-pregnancy BMI, as both underweight and obesity (BMI ≥30 kg/m²) increase risks of gestational diabetes, hypertension, macrosomia, congenital anomalies, preeclampsia, and stillbirth. 1, 2
• Women with obesity should receive higher dose folic acid (5 mg daily) and vitamin D supplementation. 3
• Engage in at least 30 minutes of moderate physical activity for 5 days per week before and during pregnancy. 2

Chronic Disease Control

• Women with pregestational diabetes must achieve optimal glycemic control (A1C <6.5-7%) before conception to reduce congenital malformation rates, which are directly related to first-trimester glucose levels. 1, 3, 6
• Establish multidisciplinary care including endocrinology, maternal-fetal medicine, dietitian, and diabetes educator for diabetic women. 3
• Women with chronic hypertension require blood pressure control using pregnancy-safe medications before conception. 1, 3, 6
• Hypothyroidism requires careful management with appropriate levothyroxine dosage adjustments. 6

Medication and Substance Use Review

Medication Assessment

• Review all current medications, including over-the-counter drugs and supplements, with your healthcare provider to identify teratogenic agents (isotretinoin, warfarin, certain antiseizure medications). 1, 2, 3
• Switch to safer medications when possible for chronic conditions, using the fewest medications at the lowest effective dosages. 1
• Women taking folic acid antagonists (methotrexate) or anticonvulsants (phenytoin, primidone, barbiturates) require higher folic acid doses. 7, 4

Substance Avoidance

• Completely abstain from alcohol before and during pregnancy to prevent fetal alcohol syndrome and pregnancy complications. 1, 2, 6
• Quit smoking and avoid secondhand smoke exposure, as tobacco increases risks of miscarriage, preterm birth, low birth weight, and stillbirth. 1, 2, 6
• Screen for and address illicit drug use with brief behavioral interventions and referral for substance dependence. 1

Infection Screening and Immunizations

Laboratory Testing

• Obtain complete blood count, urinalysis, blood type and screen, rubella immunity, syphilis, hepatitis B, HIV, gonorrhea, chlamydia screening, and cervical cytology as indicated. 1, 3
• Screen for periodontal and urogenital infections as clinically indicated. 1, 3

Immunization Updates

• Update immunizations before pregnancy, including hepatitis B, rubella, varicella (if no immunity documented), Tdap, HPV, and influenza vaccines as needed. 1, 3, 6
• Rubella and varicella vaccines should be given before conception if seronegativity is identified, as these are live vaccines contraindicated during pregnancy. 1, 6

Psychosocial and Environmental Assessment

Mental Health Screening

• Screen for depression, anxiety disorders, and major psychosocial stressors at the initial visit and throughout pregnancy. 1, 3
• Counsel about risks of untreated depression during pregnancy versus treatment risks, and individualize treatment decisions. 1
• Develop stress management techniques and build support systems. 2

Safety Assessment

• Screen for intimate partner violence using validated tools, evaluate safety, and provide referral to appropriate resources. 1, 6

Environmental Exposures

• Assess workplace exposures to toxicants in industries using toxic chemicals (healthcare laboratories, dry cleaning, printing, manufacturing, agriculture). 1, 2
• Evaluate household exposures to heavy metals, solvents, pesticides, and endocrine disruptors. 1, 2
• Review Material Safety Data Sheets for workplace chemicals and consult teratology specialists as needed. 1

Genetic and Family History Assessment

Risk Stratification

• Screen for personal or family history of congenital anomalies, genetic disorders, or chromosomal abnormalities based on family history, ethnic background, and maternal age. 1, 6
• Refer for genetic counseling when risk factors are identified and provide carrier testing (cystic fibrosis, others) as appropriate. 1, 6

Preeclampsia Prevention for High-Risk Women

Aspirin Prophylaxis

• Women with one or more major risk factors (previous preeclampsia, chronic hypertension, pregestational diabetes, BMI >30 kg/m², chronic kidney disease, antiphospholipid syndrome) should take low-dose aspirin 100-150 mg daily starting before 16 weeks gestation until 37 weeks. 1, 3
• Women with two or more minor risk factors (advanced maternal age, family history of preeclampsia, primiparity, connective tissue disorders) should also receive aspirin prophylaxis. 1

Timing and Frequency of Antenatal Care

Initial Visit Timing

• Begin antenatal care as early as possible in the first trimester, ideally before 12 weeks gestation. 3
• The 2016 WHO guidelines recommend a minimum of 8 antenatal contacts throughout pregnancy. 1

Sleep and Lifestyle

• Obtain 7-9 hours of quality sleep per night, which is especially important during pregnancy planning. 2

Common Pitfalls to Avoid

• Do not delay preconception care until just before attempting pregnancy, as many critical interventions (folic acid, chronic disease optimization, medication changes) require 2-3 months before conception to be effective. 2, 6
• Do not assume dietary folate alone is sufficient—supplementation is necessary to achieve protective red blood cell folate levels. 4, 5
• Do not continue teratogenic medications during pregnancy planning—review all medications including over-the-counter drugs and herbal supplements. 2, 3, 6
• Do not use general questioning for substance abuse screening—use validated questionnaires (CAGE or T-ACE) for accurate assessment. 3
• Do not exceed one daily dose of multivitamin supplements when taking high-dose folic acid; use additional folic acid-only tablets to reach the desired dose. 4
• Do not neglect mental health screening, as mood and anxiety disorders are highly prevalent in women of reproductive age with high relapse rates during pregnancy. 1, 3