Use of Harmful Substances

Cigarette smoking is a major cause of low birth weight, other perinatal health problems, and many health problems unrelated to pregnancy and lactation. A safe lower limit for alcohol consumption during pregnancy is not known. Therefore, the only surely safe level of alcohol consumption for pregnant women is none. See box, page 26.

Infant Feeding

Breastfeeding is recommended for all infants in the United States under ordinary circumstances.2 Many women make their infant feeding decisions before pregnancy or early in pregnancy—often without having contact with breastfeeding women or encouragement from health care providers.

Physical Examination
General Appearance

Signs of an eating disorder include dental enamel erosion, little subcutaneous fat, and (rarely) swollen parotid glands and callouses on the knuckles. Untreated dental disease, depression, battering, and other problems may interfere with adequate nutrient intake. Poor hygiene may be suggestive of life circumstances that interfere with adequate nutrient intake.

Breast Examination

Intervention for inverted nipples is recommended in the third trimester, but early in pregnancy women may need reassurance about their ability to breastfeed.

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