The outcome of a pregnancy depends greatly on your state of health and lifestyle before you ever become pregnant. Proper pre-conceptual and prenatal care go hand in hand with having a healthy baby.

Your Pre-conceptual Care
Start taking care of yourself even before you try to become pregnant. The fertilized egg (embryo) draws all its nutrients from the endometrium -- the thick, blood-filled lining of the uterus.

It is on this that the embryo implants itself and begins to develop into a baby that will be ready for birth 40 weeks later. The nutrient supply in the endometrium comes directly from what you put into your own body.

Fertilization as sperm enters egg.

Many birth defects occur during the first two weeks of pregnancy, at a time when the woman does not even know she is pregnant.

Birth defects can be hereditary, but are also caused by toxic substances, viral infections, nutritional deficiencies, x-ray radiation, medicines, drugs and alcohol. While the mother's health and activities can help to prevent many birth defects, some are beyond the mother's or anyone's control.

Before becoming pregnant, have your dentist take care of any cavities, since the body reroutes minerals used for tooth maintenance to the unborn child.

Hopefully, you already have a good relationship with the health-care provider who will take care of you while you're pregnant. Discuss your respective views on childbirth and see if they agree. If not, it may be time to seek another care provider.

If you have any medical problem, now is the time to get it resolved or under control. Don't wait until you're pregnant.

Good pre-conceptual health includes being within five pounds of your estimated weight, as does being in good physical condition.

Dieting is not recommended during pregnancy, since losing weight at that time could harm the unborn child.

Stop taking all over-the-counter medication, except folic acid found in Vitamin B-complex or multivitamin supplements. The U.S. Public Health Service recommends that all women of childbearing age consume at least 0.4 mg of folic acid a day.

Taking a multivitamin with folic acid has been shown to reduce the risk of having a child with neural-tube defects among women who used it for three months before becoming pregnant.

If you must take prescribed medications, make sure they do not cause birth defects. If necessary, consult your health-care provider for safer alternatives.

Avoid all toxic substances like alcohol and other drugs. If you smoke, this is a good time to quit.

Make sure you are immune to rubella (German measles). If a woman contracts rubella during pregnancy, especially during the first three months, it could cause serious birth defects.

If you are taking the Pill, switch to a barrier method of birth control (such as condoms together with foam) for at least three cycles before trying to become pregnant. It may take up to six to eight weeks for some women who have been on the Pill to start having a regular cycle.

Once your cycle is regular, it will be much easier to determine when you become pregnant.

Because of potential risk to the developing fetus, appropriate vaccines should be administered as part of the pre-conception evaluation.

Live vaccines such as oral polio, yellow fever, measles, mumps or rubella should not be given to pregnant women or those actively trying to conceive. Influenza vaccine should only be given (preferably after the third trimester) to pregnant mothers who have other medical conditions that increase their risk of complication from influenza.

The Father's Role in a Healthy Pregnancy
Just like the female egg, sperm are vulnerable to genetic and environmental influences, and the seminal fluid may contain harmful materials.

If the father abuses drugs or alcohol, if he smokes tobacco, and if he is exposed to toxic agents in the environment, he can negatively affect the health of his offspring.

More studies are needed to know the exact possible harm from any of these substances.

• Many small studies have already shown a direct correlation between 60 industrial compounds that cause defects in sperm and possible risks to the baby.
• Some studies have shown that the pregnant wives of men who are occupationally exposed to materials like latex, plastics, benzine and toluene have an increased risk of spontaneous abortion (miscarriage).
• A study in British Columbia recently showed that children born of fireman fathers had a higher risk of congenital heart defects, possibly due to toxic chemicals the men were exposed to in their line of duty.

Prospective fathers should follow the same advice given to women who are trying to become pregnant. Do not drink, use drugs, or smoke before, during and after pregnancy, and do not become exposed to toxic substances in the environment.

The healthy development of children and the family as a whole is all the more enhanced by a husband who is supportive of his wife and promotes healthy habits and a stable home.

Prenatal Care
Study after study has shown that the earlier the start of prenatal care, the better the pregnancy outcome. As soon as you have missed your period, you should confirm your being pregnant with your doctor.

Urine pregnancy tests are very sensitive and if you are pregnant, you could test positive even before your expected menstrual period.

The prenatal medical care you receive gives your health-care provider the chance to recognize any developing problems and provide treatment.

At the first visit, she/he will take a menstrual history, including the date of your last menstrual period (referred to as the LMP) and whether the period was normal or abnormal.

The health-care provider will examine you physically and provide an estimated date of confinement (EDC). The regular term of a pregnancy is about 40 weeks (or 10 lunar months), and medical professionals usually refer to the pregnancy in terms of weeks rather than months.

An unborn baby is mature (ready to be born) plus or minus two weeks of the due date. An ultrasound scan may be ordered during the pregnancy to confirm the due date.

Medical History
Other information the health-care provider needs to evaluate the state of the pregnancy includes any drugs you take and whether you have had any infection or bleeding since the LMP.

If you have had other pregnancies, you will be asked if they were at term, premature or post-term, the progress of the labor, and whether the delivery was vaginal or cesarean. If you had a cesarean, the health-care provider will want to know the type of incision used on the uterus.

For a previous vaginal delivery, you should know which types of instruments, if any, were used or whether the delivery was spontaneous, as well as any anesthesia used. You will also be asked whether there were complications during labor or afterward.

• Your family's medical history is also important.
• How is the health of any living children?
• What kinds of diseases have you had?
• What medicines or drugs have you taken?
• Do you smoke, or did you in the past?
• Do you have any allergies?
• Have you had blood transfusions?
• What type of birth control did you use prior to the pregnancy?
• Have you had any pelvic surgery?
• Any trauma to the pelvis?

You should also tell the health-care provider about any hereditary diseases in both your and your husband's families.  You will also be asked about your type of work, and whether it would affect the pregnancy in any way.

Physical Exam
Much of the physical exam at this time is like any annual exam.  

• The health-care provider will routinely check you for high blood pressure, diabetes, kidney function, and other common and possibly symptomless problems.
• In addition, your pelvic bones will be evaluated for their adequacy for natural childbirth.
• A Pap smear and cervical cultures to rule out any STDs will be taken.
• The health-care provider will evaluate the size of your uterus to confirm the EDC (estimated date of confinement) -- the date the baby is expected to be born.
• A blood work-up will be performed, to determine your blood count (to rule out anemia), your Rh blood factor and your blood type.
• The blood test will also screen for syphilis, immunity against rubella, hepatitis B, HIV and unusual antibodies.
• Your urine will be tested for glucose and protein levels, as well as infection.

At this time, you and the health-care provider will also discuss which hospital you want to use for the delivery. (You -- and your husband -- might want to visit various hospitals and evaluate the types of birthing environments they provide before making a choice.)

You can also ask the health-care provider about diet, exercise and any other questions you may have.

Return Visits
Up to the 32nd week, you will see the health-care provider every four weeks. Then you will return every two weeks until the 36th week, and after that weekly until birth. Of course, if there are any problems you should be able to see your health care provider at any time.

During the return visits, the progress of the pregnancy, including your weight, blood pressure and fundal height (measured from the top of the pubic bone to the top of the rounded uterus), will be recorded.

Your urine is tested for sugar and protein. The presence of sugar could signal a possibility of diabetes. Protein could be a sign of toxemia of the pregnancy.

Special Studies
During the pregnancy, the health-care provider may want to perform some special tests. One is the alpha-fetoprotein, to rule out defects of the unborn baby's nervous system from 15 to 20 weeks.

Amniocentesis involves sampling fluid from the bag of water that surrounds the baby, to test for abnormalities. CVS (chorionic villus sampling) takes a tissue sample from the placenta, also to test for abnormalities.

A pregnant mother is also checked for Group B Strep. Group B Strep has been associated with severe neonatal infection. Secretion is taken with from the outer vagina and the rectum between 34 to 36 weeks and sent for a culture. If the culture is positive, the mother will be treated during labor with antibiotics.

Amniocentesis procedure: A- bag of water, B - amniotic fluid.

Most pregnant women in the United States have an ultrasound test, in which sound waves take a picture of the unborn child that can be seen on a special television screen.

The test helps the health-care provider examine the baby's external features. It also depicts the baby's position, age, weight presentation, the placental site and the amount of amniotic fluid.

Pregnant mothers are also checked for Group B streptococcus. Group B strep has been associated with severe neonatal infection.

A secretion from the outer vagina and the rectum is taken between the 34th to 36th week of pregnancy and sent for a culture. If the culture is positive, the mother will be treated during labor with antibiotics.

Nutrition and Exercise
A pregnant woman should consume a certain number of calories per day to assure the normal growth of the unborn child, as well as to maintain her own health. A woman should gain about 25 pounds during a healthy pregnancy.

Your health-care provider will help you determine an appropriate diet, which should be rich in vegetables, fruits, cereals, bread, beans, cheese, fish and meat. You should also consume one quart of whole, low-fat or fat-free milk a day.

A pregnant woman should drink at least eight glasses of water a day as an aid against constipation. The diet should include extra iron, which is also being used by the baby. Red meat and green vegetables are rich in iron. The greener the vegetable, the richer it is in iron.

A woman should not have to stop her routine during pregnancy, except when she feels tired or if strict bed rest has been recommended by her health-care provider.

In fact, a recent release from the American College of Obstetricians and Gynecologists advises that it is perfectly safe for a pregnant woman who has not been exercising to begin an exercise program during pregnancy, providing the exercise is moderate and her pregnancy is normal, and she pays heed to her body's pregnancy-related limits.

It is important to remember that, when pregnant, part of your oxygen intake is being diverted to your baby. While moderate aerobic exercise is fine, contact sports and exhaustive aerobic exercise should be avoided as they increase your need for oxygen at the expense of the your unborn child.

STOP EXERCISING WHEN YOU BECOME TIRED.

A pregnant woman should not exercise if she has any of the following:

• High blood pressure related to pregnancy.
• Premature rupture of the amniotic sac (bag of water).
• Premature labor during prior or current pregnancy.
• A cervical cerclage (a weak cervix that has caused premature labor or prior miscarriage and is consequently surgically tied).
• Persistent bleeding in the second or third trimesters.
• Signs of lack of growth of the fetus.

Smoking, Drugs and Alcohol
The majority of drugs used by the mother reach the baby by way of the placenta, the organ responsible for the baby's nutrition.

When a pregnant woman abuses drugs like cocaine and crystal methamphetamine, the infant is at risk to be born addicted and suffer from brain, heart, kidney and intestinal problems.

There is also an increased risk that the baby will have a stroke or be stillborn.

Alcohol should be avoided during pregnancy. It is the most common cause of mental retardation in children.

When a pregnant woman abuses alcohol, she is at higher risk of having a spontaneous abortion. Or she may cause irreparable damage to her growing child in the form of fetal alcohol syndrome, which includes mental retardation and physical abnormalities.

When a pregnant woman smokes, her growing baby is also smoking. The woman is at higher risk of having an ectopic pregnancy (in which the fetus is growing outside of the uterus), spontaneous abortion (a miscarriage), and placental separation (detachment of the placenta, or afterbirth, from the uterine wall) before the normal time.

The child risks being born with low birth weight, a low IQ, and greater-than-normal chance of having upper respiratory infections during childhood, cancer and SIDS (sudden infant death syndrome).

Behavior During Pregnancy
A pregnant woman is likely to suffer discomfort during her pregnancy, such as nausea and vomiting, heartburn, back pain, general malaise, constipation, leg cramps, varicose veins, hemorrhoids and/or pelvic discomfort.

All these symptoms should be discussed with the health-care provider. No over-the-counter drugs should be taken without prior consultation.

You can have sexual intercourse throughout pregnancy, unless you have a history of premature labor, abnormal bleeding or a broken bag of water (amniotic sac).

Some women work until their babies are due, especially if their jobs are sedentary. You should try to take frequent short breaks during the work day.

If there are any signs of complications, you should follow your health-care provider's advice and, if necessary, stop working.

Avoid any vaccines consisting of live viruses.

Car and pressurized airplane travel need not be given up during pregnancy, but especially during the last weeks it's safer to stay close to home. If need be, during a long trip, try to walk around or change position every half hour or so.

Childbirth classes with the baby's father are a must. These classes are a way to have the father involved even more and make him feel better about the pregnancy.

Together you can learn about labor, childbirth, breathing and relaxation techniques, and muscle control in order to cope with the pain and stress of childbirth.

Danger Signals
If any of these occur, you should immediately contact your health-care provider:

• Excessive vomiting.
• Vaginal bleeding. During an early stage of pregnancy it could mean a miscarriage or an ectopic pregnancy, and later on an abnormal separation of the placenta.
• Excessive weight gain in a short period of time, or excessive swelling of the hands, feet or face.
• Contractions close together when it's not yet time to give birth.
• Fluid from the vagina.
• Constant headaches.
• Blurred vision.
• Fever and chills.
• If you feel the baby is not as active as it should be.