What are the key recommendations for a pregnant female or a female planning to conceive, particularly regarding prenatal care, diet, and substance avoidance, considering potential pre-existing medical conditions such as diabetes or hypertension?

Pregnancy Teachings: Essential Preconception and Prenatal Care

Preconception Care for All Women Planning Pregnancy

All women of reproductive age should begin taking 400-800 mcg of folic acid daily starting at least one month before conception and continuing through the first 12 weeks of pregnancy to prevent neural tube defects. 1, 2

Reproductive Life Planning

• Discuss pregnancy intentions at every healthcare visit, asking directly: "Would you like to become pregnant in the next year?" 1, 3
• Women not planning immediate pregnancy should receive effective contraception counseling, including emergency contraception options 1
• Develop a reproductive life plan based on individual values, resources, and timing preferences 1

Essential Lifestyle Modifications

Substance Avoidance (Absolute Requirements):

• Complete cessation of alcohol, tobacco, and all recreational drugs before conception - these substances cause preterm birth, low birthweight, and fetal abnormalities 1, 4
• Stop smoking using the "5 A's" approach (Ask, Advise, Assess, Assist, Arrange) - only 20% of women successfully quit during pregnancy, making preconception cessation critical 1
• Avoid hot tubs and hyperthermia exposure throughout pregnancy 5

Weight and Nutrition:

• Achieve healthy prepregnancy BMI of 19.8-26.0 kg/m² through diet and exercise - obesity increases risks of neural tube defects, preterm delivery, gestational diabetes, cesarean section, and hypertensive disease 1
• Consume "five-a-day" (two fruit servings, three vegetable servings) with balanced folate-rich foods 1, 5
• Engage in regular moderate exercise appropriate for pregnancy 5, 4

Critical Medical Screening and Optimization

Chronic Disease Management (Must Be Controlled Before Conception):

• Diabetes: Achieve HbA1c <6.5% before conception - uncontrolled diabetes causes a three-fold increase in birth defects 1, 5
• Hypertension: Target blood pressure <140/90 mmHg with pregnancy-safe medications; switch from ACE inhibitors/ARBs to nifedipine or methyldopa 1, 6
• Thyroid disease: Optimize thyroid function with TSH <2.5 mIU/L before conception - levothyroxine requirements increase during early pregnancy 1, 6
• Epilepsy: Reduce anti-epileptic drug dosages to lowest effective dose, particularly avoiding valproic acid which is highly teratogenic 1
• Phenylketonuria (PKU): Adhere to low-phenylalanine diet before and throughout pregnancy to prevent fetal mental retardation 1

Medication Review:

• Discontinue all FDA pregnancy category X medications and most category D medications unless maternal benefits outweigh fetal risks 1
• Stop statins immediately - they cause severe CNS and other fetal malformations 6
• Switch warfarin to non-teratogenic anticoagulants before conception 1
• Review all over-the-counter medications, herbs, and supplements for safety 1

Infectious Disease Screening and Immunization

Required Screening:

• HIV, syphilis, hepatitis B and C, gonorrhea, chlamydia - early detection and treatment prevent fetal death, developmental disabilities, mental retardation, and blindness 1, 7
• Screen for periodontal disease and urogenital infections 1

Immunizations (Complete Before Conception):

• Rubella, varicella, hepatitis B vaccines if not immune - these prevent congenital rubella syndrome and neonatal infections 1
• Tdap vaccine should be administered at 27-36 weeks gestation during pregnancy 5, 7
• Influenza vaccine if pregnant during flu season 7

Genetic Screening

• Offer carrier screening for cystic fibrosis and other conditions based on family history, ethnic background, and maternal age ≥35 years 1, 3
• Discuss management of known genetic disorders before pregnancy 1

Psychosocial Assessment

• Screen for depression, anxiety, domestic violence, and major psychosocial stressors at every visit - mood disorders are highly prevalent in reproductive-aged women with high relapse rates during pregnancy 1, 3
• Assess housing security and social support systems 5

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Prenatal Care Once Pregnant

Initial Prenatal Visit (By 10 Weeks Gestation)

Comprehensive Laboratory Testing:

• Complete blood count, comprehensive metabolic panel, urinalysis 5, 7
• Blood type and Rh screen (critical for RhoGAM administration if Rh-negative) 7
• Infectious disease panel: HIV, syphilis, hepatitis B and C, gonorrhea, chlamydia, rubella immunity 5, 7
• Thyroid panel with TSH, hemoglobin A1c 7
• Quantitative beta-hCG to confirm pregnancy 7

Physical Examination:

• Focused assessment including periodontal, thyroid, cardiac, breast, and pelvic examinations 5, 7
• Blood pressure measurement at every visit 5

Ongoing Prenatal Supplementation

Daily Requirements Throughout Pregnancy:

• Prenatal vitamin containing 400-800 mcg folic acid (continue through first trimester) 1, 5, 7
• 150 mcg potassium iodide 5, 7
• Vitamin B12, vitamin D, iron, choline, and DHA 7

Visit Schedule

• Low-risk pregnancies: 8-14 visits at weeks 10,16,22,28,32,36,38,39, and 40 5
• High-risk pregnancies (diabetes, hypertension, previous complications): individualized more frequent visits with multidisciplinary team including maternal-fetal medicine, endocrinology, and cardiology 6, 5

Critical Timing-Specific Interventions

24-28 Weeks:

• Gestational diabetes screening with 1-hour glucose challenge test or 2-hour oral glucose tolerance test 5, 7

27-36 Weeks:

• Tdap vaccine administration to provide infant pertussis protection 5, 7

32-34 Weeks (High-Risk Pregnancies):

• Begin antepartum fetal surveillance 5
• Ultrasound for fetal growth assessment 5

Special Considerations for Pre-existing Conditions

Diabetes Management:

• Multidisciplinary team: endocrinologist, maternal-fetal medicine specialist, registered dietitian, diabetes educator 5
• Fasting glucose <95 mg/dL; 1-hour postprandial <140 mg/dL or 2-hour postprandial <120 mg/dL 5
• Dilated eye examinations every trimester and for 1 year postpartum 5
• Delivery timing: 39 0/7-39 6/7 weeks with good control; 36 0/7-38 6/7 weeks with poor control or vascular complications 5

Hypertension/Preeclampsia Prevention:

• Start low-dose aspirin 81-150 mg daily at 12-16 weeks gestation for women with history of gestational hypertension or other high-risk factors - this reduces preeclampsia risk by 25% 6, 5
• Monitor blood pressure and proteinuria throughout pregnancy 5

Critical Pitfalls to Avoid

• Failing to achieve optimal chronic disease control before conception increases maternal and fetal complications substantially 5, 7
• Delaying Tdap vaccine beyond 36 weeks leaves infants vulnerable to pertussis 7
• Administering folic acid doses >0.1 mg daily may obscure pernicious anemia diagnosis while neurologic damage progresses - ensure vitamin B12 adequacy 2
• Missing domestic violence screening during preconception and prenatal visits 1, 3