Use of Harmful Substances
  • Provide reinforcement for any constructive steps that have already been taken, provide assistance with quitting, and refer the woman to evaluation or treatment programs as needed.

  • 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 high weight gain.

History of Delivering an Infant with a Neural Tube Defect

If the first prenatal visit occurs in the first trimester of pregnancy, the Centers for Disease Control recommends: "Unless contraindicated, they [women who have had a pregnancy involving a fetus or infant affected with a neural tube defect] should be advised to take 4 mg per day of folic acid . . . through the first 3 months of pregnancy The dose should be taken only under a physician's supervision."15Folate supplementation after the third month of pregnancy does not protect against neural tube defects.



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