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Health Care in Pregnancy

doctor with ultrasound picture and pregnant motherdoctor with ultrasound picture and pregnant mother
Health care during pregnancy is a multifaceted program involving medical visits, prenatal testing, nutrition, exercise, screening for infections and certain genetic diseases where appropriate, getting any maternal illnesses under control, and taking any other special considerations. The first step to receiving good health care during pregnancy is to choose the health care provider.

These days, most women in the developed world can choose an obstetrician, family doctor, or midwife to see them through pregnancy, childbirth and the first few weeks after birth. Your choice of health care provider will need to take into consideration whether you are low- or high-risk, how much of a role you want to play in decision-making, and your thoughts about 'natural' deliveries and pain medication.

Good nutrition and healthy eating practices can help ensure a healthy pregnancy. Pregnant woman need to maintain a healthy diet with food choices from the four major food groups: milk and milk products, meat and meat alternatives, fruits and vegetables, and grain products. A vitamin called folic acid is also important to protect against the development of birth defects called neural tube defects.

Regular moderate exercise is very helpful during pregnancy. Women who do not exercise are at higher risk of excessive weight gain, gestational diabetes, pregnancy-induced hypertension, varicose veins, and low back pain in pregnancy.

If you or your partner have a family history of certain diseases, you should both undergo screening to determine if you carry the traits for those diseases. Carrier screening is done for couples with a family history of cystic fibrosis, congenital hearing loss, or who are high-risk for genetically determined diseases such as sickle cell anemia or thalassemia.

Some infections put the unborn baby at risk during pregnancy. All pregnant women should consider screening for HIV, because if the disease is diagnosed early, transmission to the unborn baby can be reduced. High-risk women should consider screening for syphilis and hepatitis B, and there is a vaccine for hepatitis B that can be given during pregnancy if needed. Screening can also be done to determine if you have had fifth disease (parvovirus) before, in which case you would be immune. Also, if you have not had rubella or chickenpox, stay away from people who are infected with these illnesses, as they can seriously hurt your developing baby. While there are vaccines available for rubella and chickenpox, they can only be given before or after, not during, pregnancy.

Try to remove or reduce your exposure to any potentially harmful substances, called teratogens. These substances can cause problems in the development of your unborn baby, usually in the first couple of months of pregnancy. Potential teratogens include certain drugs, hazardous substances at work, pesticides, paint thinners, smoking, alcohol, cocaine, marijuana, and heroin.

Additionally, some chronic illnesses in the mother can complicate pregnancy and pose a threat to the unborn baby and/or the mother. It is important to get these conditions under control, preferably before becoming pregnant, or as soon as you find out you are pregnant. In some cases, a change in treatment may be needed, because some medications are harmful to the fetus.

Considerations for the woman over age 35

Many women are postponing having children until after age 35, which poses a higher risk to both mother and baby. If you are over age 35, you may want to consult a geneticist to go over any risks to your unborn baby. Today, these risks are quite small, but they do increase somewhat with age. Some of these risks are as follows:

  • Infertility: The risk of infertility increases with age, and reaches about 20% in couples who are over age 35.
  • Maternal conditions: High blood pressure, diabetes, and cardiovascular disease are all more common in women over 35.
  • Pregnancy complications: The risks of miscarriage, preterm labour, and postpartum hemorrhage are slightly higher in older women.
  • Down syndrome and other chromosomal abnormalities: The risk of giving birth to a baby with Down syndrome is about one in 10,000 for a 20-year-old, three in 1000 for a 35-year-old, and one in 100 for a 40-year-old. Prenatal screening can help assess the risk of these abnormalities in a given pregnancy. If the risk is significant, certain tests such as ultrasound, amniocentesis, and chorionic villus sampling are available.