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Prenatal care helps prevent complications of pregnancy and childbirth and provides both the pregnant woman and the fetus with any necessary medical care before birth. Because fetal development is affected by environmental factors inside the uterus and by the woman’s state of health (especially during the crucial first 3 months), a woman’s doctor may make some lifestyle recommendations. For example, doctors usually recommend that pregnant women not smoke cigarettes (smoking increases the risk of having a baby with a low birth weight or of having a preterm delivery) and avoid alcohol because it can cause a number of serious problems in the fetus, including mental retardation (fetal alcohol syndrome; see page 409). Also avoid taking any unnecessary drugs or exposing yourself to radiation or environmental substances such as lead, mercury, pesticides, or solvents, which can cause complications during pregnancy and delivery. Stay away from saunas, steam baths, hot tubs, and extremely hot baths, which can raise your body temperature to a level that could be harmful to the fetus.

At your first visit, your doctor will perform a physical examination (including measuring your blood pressure and weight) and establish your due date (which usually is set 40 weeks from the first day of your last menstrual period, but may be adjusted based on the size of the fetus shown on an ultrasound or the size of your uterus felt on a pelvic examination). The doctor will examine your cervix to make sure it can support a pregnancy. He or she will take your medical history and ask if there is a possibility that you could have a sexually transmitted disease (all pregnant women are tested for gonorrhea and syphilis).

At your initial visit or during subsequent visits, you will have blood tests for blood type (see page 145), Rh factor (see next page), and anemia (see page 610); for infections (see next page) such as rubella, hepatitis B (see page 786), and toxoplasmosis; and for excess levels of protein (which can indicate preeclampsia; see page 526) and glucose (a sign of gestational diabetes; see page 521).

Smoking and Pregnancy

Smoking is especially harmful during pregnancy. Seriously consider quitting if you are pregnant because:

• Smoking increases your risk of having an ectopic pregnancy or miscarriage.

• Smoking doubles your risk of having serious pregnancy complications involving the placenta.

• Smoking makes you twice as likely as a nonsmoking woman to have a baby with a low birth weight, and more likely to have a preterm delivery.

• Smoking may increase your baby’s risk of having birth defects such as clubfoot, cleft lip, or cleft palate.

• Smoking triples your baby’s risk of dying of sudden infant death syndrome (SIDS) compared with children of mothers who did not smoke during pregnancy.

• Smoking increases your child’s risk of having an attention deficit disorder or learning disability.

Ask your doctor about a quit-smoking strategy (see page 29) that would be safe and effective for you.

Infectious Diseases and Pregnancy

Some infections that a woman develops during pregnancy can cause birth defects or can be fatal to the fetus. It is best to talk to your doctor about infections before you get pregnant, but if you are already pregnant, ask your doctor about any precautions you should take during your pregnancy to avoid infections.

Childhood infections

If you are pregnant and have not had common childhood diseases such as chickenpox (see page 439) or fifth disease (see page 439) or have not had or been vaccinated against measles (see page 437) or German measles (rubella; see page 438), talk to your doctor. Having these infections during pregnancy can harm the fetus. Most adults have been vaccinated against measles (or had it during childhood) or have had chickenpox (and are therefore immune), and about half are immune to fifth disease. In the United States, all children are required to have vaccinations against rubella and chickenpox. Because there is no vaccination against