Healthy Woman: The 12 Months of Pregnancy

Most women are careful about leading a healthy and safe lifestyle during pregnancy, but it usually takes at least a few weeks for a woman to realize that she's pregnant. Because so much development occurs in those first few weeks, experts say that women who are planning a pregnancy should begin preparing for it at least three months prior to actively trying to conceive.

"The greatest risk to the fetus for congenital anomalies and birth defects happens between the first two and eight weeks of pregnancy," says Ginger Breedlove, the program director of the Nurse Midwifery Education Program at the University of Kansas School of Nursing and a board member of the American College of Nurse Midwives.

"If most of the risk is happening before health professionals see or even talk to the women on the phone, by and large, we've lost the window of opportunity for education," explains Breedlove.

Below, Breedlove discusses how preconception medical visits and lifestyle adjustments can help women prepare for pregnancy to help ensure they have the healthiest possible pregnancy and baby.

Why is it important to prepare for pregnancy? I think the most important thing that we can do in America is reframe the duration of pregnancy and not think of it as nine months but as 12 months. Many of the risks that women have are relevant before they ever conceive.

For example, research that was primarily funded by the March of Dimes has shown that women who took appropriate levels of folic acid prior to conception significantly reduced the rate of neural tube defects, primarily spina bifida.

One of the things that we want women to continue to understand is that taking at least 0.4 mg of folic acid in a daily multivitamin anytime during the childbearing years is important because about 70 percent of pregnancies are unplanned.

Why are preconception visits important? I think it's important that women and families understand that a preconception visit, in my opinion, is probably more important than a routine obstetric appointment. So many things happen before you ever get to that first prenatal visit. An average woman, even with private health-care insurance, isn't in that obstetric office until about 10 weeks of pregnancy.

What sort of vaccinations should women have prior to conception? Oftentimes, after we get out of the secondary school system, people don't pay attention to vaccinations. But a tetanus/diphtheria booster every 10 years is important.

Women who are in high-risk groups — women with asthma, cardiac problems, HIV or other conditions that might increase their risk of bacterial or viral infections —should probably have a hepatitis B vaccine, an influenza vaccine and maybe even a pneumonia vaccine annually.

Whenever possible, preconception immunizations are preferred to vaccinations of pregnant women. For example, women should have their rubella status identified prior to conception and, if necessary, have an MMR vaccination three months prior to conception.

When is genetic testing appropriate? Screening is considered in people with a family history of certain conditions, such as a neural tube or congenital heart defects.

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