High levels of alcohol consumption during pregnancy results in fetal alcohol syndrome (FAS). There are various components including growth restriction, intellectual impairment, facial anomalies and behavioral problems.
Refrain from taking alcohol during the first trimester, as there appears to be a small increased risk of miscarriage associated with drinking alcohol.
Lose weight before becoming pregnant. A healthy weight reduces the risk of NTD, preterm delivery, gestational diabetes, caesarean delivery, hypertension and thromboembolic disease and is also more likely to promote conception. Similarly, women who are underweight may find getting pregnant difficult and be at risk of more pregnancy-related complications.
Whilst it is often impractical to achieve ideal body weight, women should be advised as to their increased risk of adverse pregnancy outcomes associated with their weight, particularly at BMIs >40. Consultation with a dietitian may be helpful.
Supplementation with folic acid is one of the most significant preventative interventions available in the preconceptual/antenatal period:
All women should take at least 400 micrograms/day whilst trying to become pregnant and for at least the first three months of pregnancy to reduce the risk of neural tube defects (NTDs).
Women at high risk of NTD should take a higher dose of 5 mg/day until 12 weeks of pregnancy.
In healthy women on a normal diet, advice on eating five portions of fruit and vegetables per day and consuming dairy products to raise stores of vitamins, iron and calcium is reasonable.
Because of the dangers of toxoplasmosis and listeriosis, women should avoid:
1) Uncooked meat, fish and eggs
2) Unpasteurised milk
3) Unripened soft cheeses, such as Brie, Camembert or blue-veined cheese
4) Unwashed fruit and vegetables
Vegetarians, and especially vegans, are at risk of various nutritional deficiencies and may need to be referred to a dietitian.
Vitamin D deficiency causes impaired fetal growth. All women should be informed about the importance of maintaining adequate vitamin D stores during pregnancy and breast-feeding.
Caffeine during pregnancy may cause fetal growth restriction. One cohort study found an odds ratio of 1.2 for 100-199 mg of caffeine/day (1-2 cups of coffee, 2-4 cups of tea) and 1.6 for >300 mg caffeine/day (more than 3 cups of coffee or 6 cups of tea). A sensible approach would be to reduce caffeine consumption prior to pregnancy in heavy users.
Women should be cautioned, however, against substituting caffeinated drinks with herbal preparations and teas, as their use and safety in pregnancy have not been studied.
Women who exercise regularly should be advised to continue to do so.
Those who are inactive should start a gentle program of regular exercise.
Saunas and hot tubs should be avoided because of possible risk of hyperthermia to the fetus.
Women should be advised of the potential dangers of certain activities during pregnancy - eg, contact or high-impact sports, vigorous racquet sports and scuba diving.
Identify women who are due or nearly due a cervical smear and encourage women to have their screen before becoming pregnant.
Smears are not routinely taken during pregnancy, as pregnancy-related inflammatory changes make them difficult to interpret.
Many treatments cannot be carried out during pregnancy should an abnormality be detected.