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According to the Centers for Disease Control and Prevention (CDC), almost 4 million American women give birth every year. Nearly one third of them will have some kind of pregnancy-related complication. Those who don't get adequate prenatal care run the risk that such complications will go undetected or won't be dealt with soon enough. That, in turn, can lead to potentially serious consequences for both the mother and her baby.

These statistics aren't meant to alarm you, but rather to convey the importance of starting prenatal care as early as possible — ideally, before you even become pregnant. Of course, this isn't always possible or practical. But the sooner in your pregnancy you begin, the better your chances of ensuring your own health and that of your baby.

Prenatal Care Before Getting Pregnant

Ideally, prenatal care should start before you get pregnant. If you're planning a pregnancy, see your health care provider for a complete checkup. He or she can do routine testing to make sure you're in good health and that you don't have any illnesses or other conditions that could affect your pregnancy. If you've been experiencing any unusual symptoms, this is a good time to report them.

If you're already being treated for a chronic condition, such as diabetes, hypertension (high blood pressure), a heart problem, depression, or some other condition, you should talk to your doctor about how it could affect your pregnancy. In some cases, you may need to change or eliminate medications — especially during the first trimester (12 weeks) — to reduce risk to the fetus. Or, you may need to be even more vigilant about managing your condition.

For example, women with diabetes must be especially careful about keeping their blood glucose levels under control, both before they begin trying to conceive and during their pregnancy. Abnormal levels increase the risk of birth defects and other complications.

This is also a good time to talk with your health care provider about other habits that can pose a risk to your baby, such as drinking alcohol or smoking. Ask about starting a prenatal vitamin that contains folic acid, calcium, and iron.

It's especially important for women who are planning to become pregnant to take vitamins with folic acid beforehand, because neural tube defects (problems with the normal development of the spine and nervous system) happen in the first 28 days of pregnancy, often before a woman even knows she's pregnant.

If you have or your partner has a family history of a significant genetic disorder and you suspect either of you may be a carrier, then certified nurse-midwife (an advanced practice nurse specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for pregnancies without complications)

Any of these care providers is a good choice if you're healthy and there's no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case a cesarean section has to be performed.

Your health care provider may refer you to a doctor with expertise in high-risk pregnancies if you:

• have a chronic condition like diabetes or heart problems
• have an increased risk of sexually transmitted diseases (STDs), including chickenpox (varicella), mumps, or cystic fibrosis (health care providers have just recently started to routinely offer this to individuals even if there's no family history of the disorder)

Women of African or Mediterranean descent are usually tested for sickle cell trait or disease because they're at higher risk for having prenatal tests, which can help predict the likelihood, or even detect the presence, of certain developmental or chromosomal abnormalities in the fetus:

Alpha-fetoprotein screening (AFP): Between 16 and 18 weeks, the level of alpha-fetoprotein, a protein produced by the fetus, can be measured in the woman's blood. If the level is high, she may be carrying more than one fetus or a fetus with Down syndrome. It's important to keep in mind that low or high results don't automatically indicate a problem; rather, they indicate the need for further testing, which yields normal results in many cases.

Multiple marker screening (also called a maternal serum screening, triple screen, triple marker, quadruple screen, quad screen, quadruple marker, or quad marker): Also between 16 and 18 weeks, your health care provider may measure the levels of certain hormones in your blood, along with AFP. For this screening, a sample of blood is drawn from the mother to measure the level of AFP, as well as the levels of hCG (human chorionic gonadotropin) and estriol, which are produced by the placenta. The levels of these three substances (which is why the test is often called the triple screen or triple marker) in the blood can help doctors identify a fetus at risk for certain

Ultrasound scanning is used to:

There are ultrasounds available at shopping malls as a way to have a "

Common Concerns

• gestational diabetes: Up to 8% of pregnant women develop this condition, usually after the first trimester. During pregnancy, the placenta, which provides the fetus with nutrients and oxygen, also produces hormones that change the way insulin works. Insulin is a substance that's made by the pancreas. It helps the body store the sugar in food so that later it can be converted to energy. When someone has gestational diabetes, the problem with the insulin leads to a high blood sugar level as well.
• preeclampsia (also called toxemia of pregnancy): An abnormal condition that develops after the sixth month, it causes high blood pressure, edema (accumulation of fluid in body tissues resulting in swelling of the hands, feet, or face), and protein in the urine.
• Rh-negative mother/Rh-positive fetus (also called Rh incompatibility): diet, however, it can be a great time to start eating healthy food if you didn't before. It's also a good time to get regular, low-impact folic acid, iron, and calcium.

  Over-the-counter medications are generally considered off-limits because of their potential effects on the fetus. Most doctors will recommend that you don't take any over-the-counter medications at all, but they might offer a list of those they think are safe to take. Be sure to discuss any questions about medications, including natural remedies, supplements, and vitamins, with your health care provider.

  When you're pregnant, it's also important to avoid food-borne illnesses, such as toxoplasmosis, which can be life threatening to an unborn baby and may cause birth defects or Foods you'll want to steer clear of include:

  • soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
  • unpasteurized milk, juices, and apple cider
  • raw eggs or foods containing raw eggs, including mousse and tiramisu
  • raw or undercooked meats, fish, or shellfish
  • processed meats such as hot dogs and deli meats (these should be well cooked)

  You should also avoid eating shark, swordfish, king mackerel, or tilefish. Although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), these types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus.

  Pregnancy also can cause a number of uncomfortable, although not necessarily serious, sleep loss

If you experience one or more of these side effects, keep in mind that you're not alone! Talk to your doctor about strategies for alleviating any discomfort.

Talking to Your Health Care Provider

When your body is going through physical changes that may be completely new to you, it isn't always easy to talk to your health care provider. Maybe you're wondering whether you can have delivery.

You might feel embarrassed to ask these or other questions, but it's important to do so — your health care provider has probably heard them all before. Keep a running list of questions between your appointments, and take that list with you to each visit.

It's also strongly recommended that you call your health care provider immediately if you experience:

• heavy bleeding
• a sudden loss of fluid
• a marked absence of movement by the baby once he or she has begun moving
• more than three contractions in an hour

Reviewed by: George Macones, MD