What can a woman do to promote a healthy pregnancy before she gets pregnant?

For women who are considering getting pregnant, following a health care provider’s advice can reduce the risk of problems during pregnancy or after the child’s birth. A health care provider can recommend ways to get the proper nutrition and avoid habits whose lasting effects could harm a fetus. For example, exposure to alcohol and tobacco early in pregnancy can increase the risk of Sudden Infant Death Syndrome (SIDS). Taking a supplement containing at least 400 micrograms of folic acid before getting pregnant can reduce the risk of complications such as neural tube defects (NTDs)—abnormalities that can occur in the brain, spine, or spinal column of a developing fetus and are present at birth.^1, 2

Scheduling a preconception care visit with your health care provider can improve the chances of a healthy pregnancy. A health care provider will likely recommend the following steps:

Develop a plan for your reproductive life.

This plan includes your and your partner’s plans for the number and timing of pregnancies based on your values and life goals. Sharing your life plan with your health care provider can help address any potential problems before you conceive.²

Increase your intake of folic acid.

Folic acid is a B vitamin (B9). It helps produce and maintain new cells.³ This is especially important during times when the cells are dividing and growing rapidly such as infancy and pregnancy.⁴ The United States Public Health Service recommends that all pregnant women and “women of childbearing age [15 to 44 years] in the United States who are capable of becoming pregnant should consume [a supplement containing] 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs.”⁵ Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.⁶Studies show that taking folic acid for 3 months before getting pregnant and 3 months after conceiving can reduce the risk of NTDs, such as spina bifida⁷,⁸ by up to 70%.⁹

Get up to date on vaccines.

Ask your health care provider if you need a booster for any vaccines. Some vaccines can be given during pregnancy, but the rubella (German measles) and varicella (chicken pox) vaccines are recommended before you get pregnant.

Talk to your health care provider about your diabetes or other medical conditions.

Getting health problems such as diabetes, hypertension (high blood pressure), asthma, seizure disorders, maternal phenylketonuria (a condition in which the pregnant woman’s blood level of a certain amino acid—phenylalanine—is too high) under control before and during pregnancy reduces the risk of miscarriage and stillbirth as well as other health problems for the infant.⁷

Avoid smoking, drinking alcohol, or taking drugs.

These substances can increase the risk for SIDS, preterm birth, fetal alcohol spectrum disorders, and NTDs.¹⁰ If you are trying to quit smoking, drinking, or doing drugs and you need help, talk to your health care provider about support groups or about medications to help quit smoking.

Strive to reach a healthy weight.

Obesity may make it more difficult to become pregnant.¹¹ Being overweight or obese also puts you at risk for complications during pregnancy, such as high blood pressure, preeclampsia, gestationaldiabetes, stillbirth, and increases the chances of cesarean delivery. NICHD researchers have found that obesity can increase your child’s risk of a congenital (pronounced kon-JEN-ih-tal) heart defect (a problem with the heart that is present at birth) by 15%.¹² Research has also uncovered a link between obesity and NTDs.12 Talk to your health care provider about what a healthy weight is for you and about a plan to help you achieve it.

Learn your family's health history.

Your health care provider will ask for information about your family’s genetic and health history. You may be referred for genetic counseling if certain conditions run in your family or if a family member was born with a physical abnormality.⁹

Get mentally healthy.

Good mental health means you feel good about your life and value yourself. It’s natural to worry or feel sad, anxious, or stressed at times. However, if these feelings do not go away and they interfere with your daily life, it’s important to seek help before you get pregnant.¹⁰ The hormonal changes during pregnancy can contribute to depression. Women who are depressed may have trouble eating or sleeping or may turn to tobacco, alcohol, or drugs, all of which can harm the fetus.¹³

NICHD. (2010). Healthy native babies: Workbook and toolkit. Retrieved May 23, 2012, fromhttp://www.nichd.nih.gov/publications/pubs/Documents/healthy_native_babies_workbook.pdf (PDF – 3.59 MB) [top]
Centers for Disease Control and Prevention. (2006). A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. Retrieved May 18, 2012, fromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm [top]
Kamen, B. (1997). Folate and antifolate pharmacology. Seminars in Oncology, 24, S18-30–S18-39. PMID: 9420019 [top]
NIH Office of Dietary Supplements. (Reviewed April 15, 2009). Dietary Supplement Fact Sheet: Folate. Retrieved July 10, 2012, from http://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ [top]
Centers for Disease Control. (1992). Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR, 41(No. RR-14), 1–7. PMID: 1522835. Retrieved July 31, 2013, from http://www.cdc.gov/mmwr/preview/mmwrhtml/00019479.htm [top]
Institute of Medicine. (1998) Food and Nutrition Board. Dietary Reference Intakes: Thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. National Academy Press. Washington, DC. [top]
American College of Obstetricians and Gynecologists (ACOG). (2005). The importance of preconception care in the continuum of women's health care [ACOG Committee Opinion]. Retrieved April 12, 2012, fromhttp://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Gynecologic_Practice/The_Importance_of_Preconception_Care_in_the_Continuum_of_Womens_Health_Care [top]
American College of Obstetricians and Gynecologists (ACOG). (2012). Good Health Before Pregnancy: Preconception Care [ACOG Committee Opinion]. Retrieved May 3, 2013, fromhttp://www.acog.org/~/media/For%20Patients/faq056.pdf?dmc=1&ts=20130422T1153356227 [top]
MRC Vitamin Study Research Group. (1991). Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet, 338(8760), 131–137. PMID: 1677062 and see Centers for Disease Control and Prevention. (2011, February). National Center on Birth Defects and Developmental Disabilities strategic plan 2011–2015. Retrieved June 26, 2012, fromhttp://www.cdc.gov/NCBDDD/AboutUs/documents/NCBDDD_StrategicPlan_2-10-11.pdf (PDF - 1.24 MB)[top]
Centers for Disease Control and Prevention. (2012, May 1). Preconception care and health care: Planning for pregnancy. Retrieved April 12, 2012, from http://www.cdc.gov/preconception/planning.html [top]
Pasquali, R., Patton, L., & Gambineri, A. (2007). Obesity and infertility. Current Opinion in Endocrinology, Diabetes and Obesity, 14, 482–487. PMID: 17982356 [top]
NIH. (2010, April 7). Risk of newborn heart defects increases with maternal obesity [news release]. Retrieved May 19, 2012, from http://www.nichd.nih.gov/news/releases/pages/040710-newborn-heart-defects.aspx [top]
Womenshealth.gov. (2009, March 6). Publications: Depression during and after pregnancy fact sheet.Retrieved June 12, 2012, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.html [top]