• Consider other causes of anemia if it has not improved after 1 month.

  • When the anemia has resolved, discontinue the high-dose iron. If a low-dose of iron is needed because a chronic condition (such as heavy menstrual periods) originally caused the anemia, the iron can be provided with an iron-containing multivitamin/ mineral preparation or the iron can be given alone.

Use of Harmful Substances
  • Provide reinforcement for any constructive steps that have already been taken, provide assistance with quitting, and refer the woman for further evaluation or enrollment in an intensive treatment program as needed.

  • If a pregnancy is planned, encourage the woman to view stopping or cutting down on substance use as a gift to her unborn child.

  • Assist women in recovery to develop a sense of reasonable amounts of food to eat, especially if they are concerned about weight fluctuations.

History of Delivering an Infant with a Neural Tube Defect

The Centers for Disease Control recommends that if a woman has had a pregnancy involving a fetus or infant affected with a neural tube defect, she should consult her physician as soon as she plans a pregnancy “Unless contraindicated, they should be advised to take 4 mg per day of folic acid starting at the time they plan to become pregnant. Women should take the supplement from at least 4 weeks before conception through the first 3 months of pregnancy The dose should be taken only under a physician's supervision."15 Folate supplementation after the third month of pregnancy does not protect against neural tube defects.

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