Before you begin

A handful of habits and a few phone numbers do more for a healthy pregnancy than anything you can buy. This chapter gathers them in one place; the daily entries explain each one when it comes up.

The habits that matter most

Take folic acid. 400 micrograms a day, ideally from before conception until the end of week 12, lowers the risk of spina bifida and other neural tube defects. Some people are advised to take a higher dose, so ask your care provider if you have diabetes, epilepsy, a high body weight, or a family history of neural tube defects. A prenatal vitamin with iodine and vitamin D is a sensible base for the whole pregnancy.

Stop alcohol, smoking, vaping and cannabis. No amount of alcohol is known to be safe in pregnancy. Stopping at any point helps, and your care provider can connect you with support that roughly doubles your chance of quitting.

Check every medication. Many medicines are safe, some need switching, and a few should never be stopped suddenly. Before you start, stop or change anything, including herbal remedies and supplements, talk to your care provider or pharmacist.

Keep caffeine under 200 mg a day. That is about two small cups of brewed coffee, or four cups of tea.

Eat safely. Avoid unpasteurized milk and cheese, raw or undercooked meat, fish and eggs, chilled smoked fish, pâté, and high-mercury fish such as shark, swordfish, king mackerel and bigeye tuna. Wash fruit and vegetables, and wear gloves for gardening and cat litter.

Keep moving. About 150 minutes a week of moderate activity, such as brisk walking or swimming, is safe and helpful for most pregnancies. Stay up to date on vaccines. Flu and COVID-19 vaccines are recommended during pregnancy, and a whooping cough (pertussis) vaccine is offered in the second or third trimester to protect your newborn. Live vaccines, such as MMR and chickenpox, wait until after the birth.

Your care and appointments

You will see a midwife, a family doctor, an obstetrician, or a combination, depending on where you live and your health. The first appointment usually takes place between 8 and 12 weeks. A typical pattern after that is a visit every four weeks until 28 weeks, every two weeks until 36 weeks, and then every week until birth. You may be seen more often if you are expecting twins, have a health condition, or something needs watching. At most visits your blood pressure is checked, your urine may be tested, and from about 24 weeks your bump is measured to track growth. It is a good time to ask anything. Writing questions down between visits helps, because they tend to vanish the moment you sit down.

Tests you are likely to be offered

Every test is your choice. Your care provider should explain what each one looks for and what would happen next with any result.

Timing Test What it is for

First visit Blood tests Blood group and Rh factor, iron levels, immunity to rubella, and infections such as HIV, hepatitis B and syphilis