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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.