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Preconception

Introduction

The term preconception refers to the period leading up to a pregnancy, from the decision to have a baby, to becoming pregnant (conceiving).

A healthy pregnancy

Preconception care involves taking good care of yourself before you become pregnant, by ensuring that you eat healthily and exercise regularly.

Make sure that you are up-to-date with vaccinations, such as rubella (the virus that causes German measles) and varicella (the virus that causes chickenpox and shingles).

If you are trying to conceive, your GP can provide you with further advice and information to ensure the best possible health for you and your baby.

Because not all pregnancies are planned, some women will only start to monitor their health, in relation to their baby, once they are already pregnant. However, for couples who plan their pregnancies, preconception care can help them to make the necessary changes well in advance.

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Facts

How long will it take to become pregnant?

The length of time it takes to become pregnant (conceive) is different for everyone but, on average, for every 100 couples who have sex two to three times a week:

  • around 30 will conceive within one month 
  • around 60 will conceive within six months
  • around 85 will conceive within one year

The remaining couples take longer, and some may need medical help to conceive. A small number of couples (about 5%) may not be able to conceive at all if one, or both, of them is infertile.

The type of contraception you have been using does not usually affect your ability to conceive, or how long it takes to happen.

However, women who have been having the progestogen-only injection may find that their normal fertility is delayed and that they cannot conceive for up to a year after their last injection. Other methods of contraception should have no effect on your fertility once you stop using them.

If you have had a miscarriage in the past, you still have a good chance of having a healthy pregnancy and baby. If you have had three, or more, miscarriages in a row,  your GP may refer you to a gynaecologist (a specialist in reproductive healthcare). They will be able to determine whether or not your miscarriages are being caused by an underlying health problem.

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Definition

Lifestyle assessment

Preconception care involves an assessment of lifestyle, health and fitness by a healthcare professional, in order to identify areas for improvement. 

Areas that the assessment may focus on:

  • include an unhealthy diet
  • lack of exercise
  • other factors such as smoking and illegal drug use which can harm an unborn baby.

Preconception care focuses mainly on the mother's health, but there are also changes that the father can make as well. For example, men are advised to cut down on the amount of alcohol that they drink, and to avoid smoking.

This is because drinking and smoking have been shown to decrease the quality of a man’s sperm, which could reduce the chances of their partner conceiving.

Controlling pre-existing conditions

Another important part of preconception care is to ensure that any chronic (long-term) health problems that you have are controlled as effectively possible before you become pregnant.

Chronic health problems, such as diabetes, epilepsy, and asthma, can cause an increased risk of complications developing for both mother and baby during pregnancy and labour (when the baby is being born). For example, having diabetes that is poorly controlled can mean that you have a higher risk of miscarriage (loss of the pregnancy during the first 23 weeks).

Risk assessment

During the preconception assessment, genetically inherited conditions (those that are passed on from the parents) can be identified. Couples with a high risk of having a baby with a genetic condition can be given support and advice.

Conditions that can be passed on to a baby from its parents include:

  • cystic fibrosis, where internal bodily secretions become thicker and hinder the function of organs, such as the lungs and digestive system
  • sickle-cell anaemia, a condition that affects the ability of red blood cells to carry oxygen around the body
  • Huntingdon's disease, a condition that causes the nerve cells in the brain to deteriorate

Being aware of the risks will enable couples to make informed choices when planning their pregnancy.  

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Recommendations

Depending on how healthy your lifestyle normally is, when you become pregnant you may need to make changes to your diet, drinking habits and the amount of exercise that you do. You will also need to ensure that you are up-to-date with all of your required vaccinations and screening tests.

To ensure that your pregnancy goes as smoothly as possible, and that your baby is as healthy as possible, it is important that you take good care of yourself while you are pregnant, and follow the self-care guidelines outlined below.

Diet

While you are pregnant it is important that you maintain a healthy, balanced diet that includes food from all of the main food groups. This will help both you and your baby to stay healthy during your pregnancy. You should aim to eat:

  • at least five portions of fruit and vegetables a day
  • four to six portions of carbohydrates each day, such as rice, pasta, potatoes, cereals and bread
  • at least one portion of pasteurised dairy products a day, such as cheese, milk and yoghurt
  • three portions of protein from foods such as meat, fish, eggs, poultry and pulses

You should also make sure that you drink plenty of fluids each day (at least two litres) because this will help your body to get rid of toxins, as well as preventing nausea and constipation. Water and fruit juices are good choices.

When trying to get pregnant, you should avoid eating swordfish, shark and marlin. It is also advisable to limit how much tuna fish you eat to two tuna steaks or four medium-sized cans of tuna a week. This is because these types of fish contain high levels of mercury, which can potentially harm the development of a baby's nervous system.

See the encyclopaedia topic on Diet for more information and advice about eating a healthy, balanced diet.

Food hygiene

Your GP and midwife can give you information about food hygiene and how to avoid bacterial food infections that could harm you or your baby. Salmonella and listeriosis are two common bacterial food infections. You should avoid eating:

  • soft cheeses, such as brie and blue-veined cheese (there is no risk with processed cheese, cottage cheese or hard cheeses such as cheddar)
  • vegetable or meat pâté
  • any food that could contain raw or partially cooked eggs, such as mayonnaise
  • raw or partially cooked meat, particularly poultry

Toxoplasmosis is an infection that is caused by undercooked or uncooked cured meats, such as salami, from contaminated soil or water, and from the faeces of infected cats. It is an infection that could potentially cause problems for your unborn baby.

Folic acid

Taking folic acid supplements before and during pregnancy can reduce the risk of your baby being born with a neural tube defect (NTD). Neural tube defects, such as spina bifida, adversely affect the growth and development of your baby's brain and spinal cord.

You should take 0.4mg (400 micrograms) of folic acid daily if you are trying to conceive, and you should continue to take it until your 12th week of pregnancy, while your baby's spine develops.

Folic acid supplements are available over the counter at pharmacies. As well as taking folic acid supplements, you can also add foods that are high in folic acid to your diet, such as green leafy vegetables and breads and cereals.

You have a higher risk of having a baby affected by a NTD if:

  • either you, or your partner, has a NTD
  • you have had a previous pregnancy affected by a NTD
  • you have coeliac disease (a condition that is caused by a sensitivity to gluten)
  • you are diabetic
  • you are taking antiepileptic medication

If you have a high risk of having a baby with a NTD, a higher daily dose of folic acid may be recommended. In this case, your GP or midwife will be able to recommend an appropriate dose of folic acid for you.

Alcohol

Drinking alcohol while you are pregnant can harm your unborn baby. Binge drinking during early pregnancy is thought to be particularly harmful. Heavy drinking during pregnancy is associated with low birthweight and many other serious birth defects, such as heart problems and delayed development.

It is best to avoid drinking any alcohol if you are planning a pregnancy. You should also avoid drinking alcohol while you are pregnant. If you are trying to conceive, you may be unaware that you are pregnant until several weeks into the pregnancy, so you should stop drinking alcohol before any damage can be done.

If you want to drink alcohol while pregnant, to minimise your baby's risk do not have more than one or two units, once or twice a week. One unit of alcohol is approximately equal to one small glass of wine, half a pint of ordinary-strength bitter or lager, or a pub measure (25ml) of spirits.

It is important never to get drunk while you are pregnant. If you feel you are unable to reduce your levels of drinking on your own, you should visit your GP who will be able to refer you to a specialist for help.

Caffeine

Consuming too much caffeine during pregnancy can lead to your baby having a lower than normal birth weight. It can also increase your baby’s risk of developing health problems later in life and may also increase the chances of miscarriage (losing the baby during the first 23 weeks of pregnancy).

The Food Standards Agency (FSA) recommends a maximum daily intake of 200mg of caffeine during pregnancy. As a guide, 200mg is equivalent to:

  • two mugs of instant coffee
  • one mug of filter coffee
  • two mugs of tea
  • five cans of cola
  • four (50g) bars of plain chocolate (caffeine in milk chocolate is roughly half of that in plain chocolate)

You should check with your pharmacist before taking any cold-and-flu remedies because some of them contain caffeine.

Exercise

Regular, moderate exercise is highly recommended for most pregnant woman. Exercise can help boost your energy levels, and keeping in shape will help to prepare for labour by increasing stamina and muscle strength.

Thirty minutes of moderate exercise a day – for example, swimming or walking – is recommended for most pregnant women. Your GP or midwife can advise you further about specific types of exercise that are appropriate for you.

Sports such as scuba-diving and any activities that put you at risk of falling, such as horse-riding, are not recommended while you are pregnant because they may put the baby’s development at risk.

Body weight

Before becoming pregnant, you should try to get as close as possible to the ideal weight for your height and build.

If you are overweight or obese you should try to lose weight before trying to conceive. Women who are overweight or obese are more likely to need a Caesarean section (where the baby is removed through an incision in the abdomen), and they are at higher risk of having a stillborn baby.

Overweight or obese women also have a higher risk of developing pre-eclampsia, a condition where pregnant women develop high blood pressure (hypertension), as well as protein in their urine and fluid retention. Pre-eclampsia is usually mild, but in rare cases it can cause serious harm to the mother and growth problems in the unborn baby.

You are overweight if your body mass index (BMI) is between 25 and 29.9. You are obese if your BMI is 30 or more.

Visit your GP if you are overweight or obese and you are planning to become pregnant. They will be able to advise you about the most effective and safest way to lose weight.

Vitamin A

Avoid taking vitamin A supplements while you are pregnant because they may cause abnormalities to develop in your unborn baby. Also avoid eating liver because it is high in vitamin A.

Over-the-counter medications

Wherever possible, avoid using over-the-counter (OTC) medicines while you are pregnant. This is because not all OTC medicines have been proven safe for pregnant women to use. Check with your GP or pharmacist if you are unsure.

If you need pain relief while you are pregnant, or if you have a high temperature, paracetamol is usually recommended at the lowest possible effective dose. Depending on the stage of your pregnancy, ibuprofen may also be recommended.

Complementary medicines

It is not advisable to take complementary medicines while you are trying to conceive, or while you are pregnant. Many complementary medicines are unlicensed, and there is not enough evidence to confirm that they are safe for both you and your baby.

Advice for men

Many of the recommendations above also apply to men.

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Vaccinations and screening

Vaccinations and screening tests

If you are planning a pregnancy, make sure that you are up-to-date with vaccinations, such as rubella (German measles) and varicllea (chickenpox).

Vaccinations

All women who wish to become pregnant should be vaccinated against  the rubella virus. You may already be immune to rubella if you had the necessary jabs when you were younger. However, your GP may want to carry out a test to make sure that you are immune to the condition.

If you are not immune, you may have to wait up to a month after being vaccinated before trying to conceive.

If you have never had chickenpox or shingles, you may need to be vaccinated against the varicella virus before you can become pregnant.

However, it is unlikely that you will need vaccinating unless there is a possibility that you may come into contact with carriers of the virus, such as healthcare workers.

If you do need to be vaccinated, you may have to wait up to six weeks after the vaccine before trying to conceive.

Similarly, women who are likely to contract hepatitis B may need to be vaccinated against the condition before they can conceive. You may need a hepatitis B vaccination if:

  • you are a healthcare worker
  • you have a chronic (long-term) condition, such as kidney or liver disease
  • you come into close contact with someone who has hepatitis B
  • you have many different sexual partners
  • you use intravenous drugs (injected into a vein)

Cervical screening

If you are planning a pregnancy and you are due to have a cervical screening test, you will need to have it before you conceive. This is because pregnancy can make the results of a cervical screening test more difficult to interpret.

See the topic Cervical screening test to find out more.

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Risks

There are several factors that can pose a risk to your health during pregnancy. It is therefore best to be aware of these risks before you conceive.

In some cases, you will need to change your own habits to ensure that you have a smooth, trouble-free pregnancy, and your baby is as healthy as possible.

In other cases, the risks to your baby are less easy to control, for example, health conditions that are passed on through the parents’ genes. Preconception assessments can help identify couples with a high risk of having a baby with an inherited condition, such as cystic fibrosis, or sickle-cell anaemia.

Smoking

Smoking while pregnant can cause numerous health problems for your unborn baby, including an increased risk of miscarriage, early birth, and a reduced birth weight. There is also evidence that women who smoke while they are pregnant are more likely to have babies that die of sudden infant death syndrome (SIDs), a condition that is also known as cot death.

If you want to have a baby and you smoke, it is very important that you stop smoking before you become pregnant. Do not wait until after you have conceived before giving up because you may not know that you are pregnant until you are several weeks into the pregnancy and, by smoking, you will have already harmed your baby.

If you find it difficult to stop smoking, or you are already pregnant and still smoking, see your GP. They will be able to refer you to a smoking cessation service, who can advise you on the best ways to quit. The topic about Smoking, quitting also provides information and advice.

You can also call the confidential Stop Smoking Wales helpline on 0800 085 2219 to speak to an trained advisor who can provide you with further advice and information. The line is open Monday to Friday from 9.00am to 5.00pm.

If you are already pregnant and you want to stop smoking, it is best to try to give up without using nicotine replacement therapy (NRT), such as patches and chewing gum. This is because these methods still expose your baby to nicotine, which may have similar, harmful effects to smoking.

However, if you have tried unsuccessfully to stop smoking without using NRT, your GP may advise you to try using it. The exposure to nicotine will harm you and your baby less than the exposure to tobacco smoke, which contains higher levels of nicotine, as well as many other harmful toxins.

Illegal drugs

Women who are planning a pregnancy should not take illegal drugs. If you have been taking drugs, carry on using contraception until you are able to stop.

Women who use illegal drugs while they are pregnant seriously endanger their baby's health, and increase the risks of miscarriage and low birth weight. Studies have shown that women who use cocaine, or heroin, during pregnancy, are twice as likely to have a premature baby compared with women who do not use these drugs.

It has also been shown that woman who use cocaine during pregnancy are more likely to have a child with behavioural problems. Premature and low birth weight babies have an increased risk of lasting health problems, such as mental health problems, cerebral palsy (where brain damage affects movement and coordination), and even death. In some cases, using illegal drugs can cause your baby to have a brain haemorrhage (bleeding in the brain).

See your GP if you need help and support to give up using illegal drugs. If you have been using intravenous drugs (drugs injected through a vein), you will be offered testing for hepatitis B, hepatitis C and HIV.

Hazardous substances or radiation

If you are trying to conceive, you should make it a habit to check the warning labels of any products containing chemicals, such as cleaning products. If you are unsure about any product, ask your GP.

If you have a job which involves working closely with hazardous substances, infections, or radiation, it is a good idea to tell your employer that you are planning to become pregnant. By law, your employer is obliged to minimise the risk to you and your baby of any potentially harmful substances.

However, if you would rather not tell your employer that you want to become pregnant, you can obtain information about the risks of specific substances by visiting the Health and Safety Executive website.

Inherited disorders

Some health problems and conditions are inherited, which means that they are passed down to a baby from its parent's genes. Inherited disorders include:

  • sickle-cell anaemia, in which red blood cells cannot carry oxygen around your body properly
  • cystic fibrosis, which stops the lungs and digestive system from working effectively
  • Huntingdon's disease, a condition which causes the brain to gradually deteriorate.

See the topics about sickle-cell anaemia, cystic fibrosis and Huntingdon’s disease for more information about these conditions.

If you want to become pregnant, you should be offered screening for blood conditions to find out if you carry any blood diseases which could be passed on to your baby. Your GP will take a blood sample, and you will need to fill out a family of origin questionnaire which identifies people from high risk populations.

Couples with a personal, or family history of an inherited genetic condition, or those who have had a previously affected pregnancy, can be referred for genetic screening and counselling. This should ideally be done before you become pregnant, so it is important to see your GP before you begin trying to conceive your baby.

Older women

A woman's risk of having a baby with a chromosomal condition, such as Down's syndrome, increases as she becomes older. If you are between 35-40 years of age, your chances of having a baby with Down's syndrome are 1 in 270, compared with 1 in 1,500 if you are aged between 20-30.

The risk increases to one in 100 for women over 40 and 1 in 50 if you are aged over 45. The risk also increases if you have had a previous pregnancy affected by Down's syndrome.

There is no test that can show whether or not you will have a baby with a chromosomal condition before you become pregnant. However, antenatal testing can be done during your pregnancy to estimate the likelihood of your baby being affected.

This may be carried out using an alpha-fetoprotein test, which measures the levels of alpha-fetoprotein (AFP) in your blood. If your AFP levels are low, it could indicate that your baby has Down's syndrome.

If you have a particularly high risk of having a baby affected by a chromosomal condition, or you have had an AFP test which shows that your levels of AFP are low, you may be able to have a diagnostic test that can definitely show whether or not your baby has a chromosomal condition.

Diagnostic testing can be carried out using amniocentesis, chorionic villus sampling (CVS), or by testing a sample of your baby's blood, which is collected from a vein in the umbilical cord using a thin needle passed through your abdomen.

Amniocentesis testing and chorionic villus sampling (CVS) are carried out in the same way, but amniocentesis takes samples of amniotic fluid (the fluid that surrounds and protects your baby in the womb), and CVS takes a sample of placenta, for testing. These tests carry a small risk of harming your baby, but this is very rare and only occurs in around 1-2% of cases.  

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Chronic health conditions

If you have a long-lasting (chronic) health problem, it is very important that  it is effectively treated and controlled before you become pregnant. Chronic health problems that can affect pregnancy include:

  • epilepsy
  • heart disease
  • high blood pressure (hypertension)
  • blood clots
  • kidney disease
  • sickle-cell anaemia
  • thalassaemia
  • diabetes
  • thyroid disease
  • rheumatoid arthritis
  • asthma
  • depression
  • bipolar disorder and schizophrenia

If you have a chronic health problem, you should visit your GP after you have decided to have a baby. They will be able to refer you for a full assessment of your condition and any medication that you are taking. Never stop taking any medication unless you are told to do so by a health professional.

You should carry on using contraception at least until your assessment is complete, as some medications can be harmful to an unborn baby. You may need to carry on using contraception until your condition is under control, or until your medication has been changed to one that will not harm your baby.

See below for further information about the chronic health problems listed above, and the preconception care for each one:

Epilepsy

If you have epilepsy, there is an increased risk that you will experience complications during pregnancy and labour (when the baby is born). However, even if you are taking antiepileptic medication, you have a 90% chance of having a normal pregnancy and labour.

Your GP can refer you to a specialist, who will assess your condition and medication, and change it if necessary. Some antiepileptic medications can be harmful to an unborn baby, and may cause heart abnormalities or facial defects. It is important to continue to use effective methods of contraception until a full assessment has been carried out by a specialist.

Women who are taking anti-epileptic medication are more at risk of having a baby with a neural tube defect (NTD), such as spina bifida (a condition where your baby's brain and spinal cord do not develop properly). You will need to take 5mg of folic acid supplements daily before you become pregnant, until your 12th week of pregnancy.

Heart disease

Having a heart condition can make pregnancy unsafe for both mother and baby. The more severe your heart condition is, the more likely it is that you will experience complications.

If your heart condition is mild and you have few, or no, symptoms, you will have a relatively low risk of developing complications during your pregnancy. However, if your heart condition is severe, and your symptoms are continuous, it may not be safe for you to conceive unless your heart function can be improved. Before beginning to try to conceive, your GP should refer you to a cardiologist (a heart specialist) to assess the level of risk to you and your unborn baby.

It is important to use effective methods of contraception until a specialist says it is safe not to.

High blood pressure (hypertension)

Women with high blood pressure (hypertension) are more likely to develop pre-eclampsia during pregnancy.

Pre-eclampsia is a condition in which pregnant women develop high blood pressure, as well as protein in their urine, and fluid retention. It is usually mild but, in rare cases, it can cause serious harm to the mother and growth problems to the unborn baby. If you have high blood pressure, your pregnancy will need to be closely monitored to ensure that pre-eclampsia can be controlled, should it occur.

Your GP can refer you to a cardiologist (a heart specialist) for an assessment of your condition. They may decide to change the medication you are taking.

Blood clots in the veins

If you have had a blood clot in a vein (venous thromboembolism), or if someone in your family has had one, your GP may recommend that you are screened to determine the likelihood that you will develop blood clots before you become pregnant.

If the blood test reveals that you have an increased risk of developing a blood clot because you have a family history of thrombophilia, or if you have previously had deep vein thrombosis (DVT) (a condition that causes a blood clot to develop in a deep vein),  or a pulmonary embolism (a blood clot in the lung),  you will need to be referred for specialist advice. A pulmonary embolism can be very dangerous for the mother during pregnancy.

If you are taking warfarin to help thin your blood, you will need to change to a different medication, such as heparin, because warfarin can be very harmful to your unborn baby.

Kidney disease

Having kidney disease can increase your chances of having a premature baby. If you have kidney disease, your GP may refer you to a specialist for an assessment. You should carry on using contraception until this is complete. If you have had a kidney transplant, you may have to wait to conceive for up to two years after your operation.

Sickle-cell anaemia

If you have sickle-cell anaemia, you are more at risk of having a baby with a neural tube defect (NTD). An example of an NTD is spina bifida. If you have sickle-cell anaemia, you should already be taking 5mg of folic acid supplements every day as part of your treatment, and it is important to keep this up during your pregnancy.

Your GP can refer you to a haematologist (a specialist in blood diseases), who can assess your condition and monitor your pregnancy. You should carry on using contraception until your assessment is complete.

Thalassaemia

If you have thalassaemia, a condition which can cause anaemia (where the blood is unable to carry enough oxygen due to a low red blood cell count), you will need to take 5mg of folic acid supplements every day throughout your pregnancy.

However, women who have the condition without symptoms only need to take the recommended 400 micrograms of folic acid daily. If you are a carrier of thalassaemia, your partner will need to be tested to see if they are also a carrier.

If you have thalassaemia, before becoming pregnant, you should be referred to a haematologist (a specialist in blood diseases) for an assessment.

Diabetes

If you have diabetes, your condition needs to be controlled as well as possible before you become pregnant. If your diabetes is poorly controlled, you have a higher risk of miscarriage, or of having a baby with serious health problems. You should therefore continue to use contraception until your condition is under control.

Your GP may refer you to a preconception diabetes clinic, or to your diabetes care team (a team of diabetes specialists who you should have been assigned when you were diagnosed with the condition), for an assessment.

Having diabetes also means you have a higher risk of having a baby with a neural tube defect (NTD), such as spina bifida. You will need to take 5mg of folic acid supplements daily starting before you become pregnant if possible, up until your 12th week of pregnancy.

Thyroid disease

If you have a thyroid disease (either an under-active, or an over-active thyroid), your condition needs to be as closely controlled as possible before you become pregnant. You will also need to be closely monitored during your pregnancy.

If you have an under-active thyroid (hypothyroidism), you should inform your GP as soon as you think that you may be pregnant because your medication dosage may need to be altered.

If you have an over-active thyroid (hyperthyroidism), you may have to complete a course of treatment before you can conceive. For women with hyperthyroidism who want to conceive in the next few years, surgery to remove all, or part, of the thyroid may be the best option.

Rheumatoid arthritis

Women who have rheumatoid arthritis should be referred to a rheumatologist (a specialist in arthritis) for an assessment of their condition and medication. Your medication will need to be changed if you have been taking disease-modifying anti-rheumatic drugs (DMARDs), as these can harm your unborn baby. You will need to continue using contraception until the DMARDs have completely left your system, which may take up to several months.

Asthma

If you have asthma, your condition must be well controlled before you become pregnant, and you must continue to use your medication as prescribed throughout your pregnancy. If your asthma is severe, your GP may refer you to a specialist chest physician, who can assess and monitor your condition.

Depression

Having depression need only affect your pregnancy if you are taking medication for your condition. This is because some anti-depressants can harm an unborn baby. You should see your GP who can review your medication and change it if necessary.

If your depression is mild, your GP may recommend a break from your medication while you are pregnant. However, do not stop taking anti-depressants unless you are advised to do so by a healthcare professional.

If your depression is severe, your GP can refer you to a psychiatrist (a mental health specialist) who can assess your condition and medication.

Bi-polar disorder and schizophrenia

If you have bi-polar disorder or schizophrenia, your GP will refer you to a psychiatrist who can assess your condition and any medication you are taking. You should continue to use contraception until this assessment is complete, and do not stop taking your medication unless you are advised to do so.

Some women with bi-polar disorder may be taking antiepileptic medication for their condition. If this is the case, you have a higher risk of having a baby with a neural tube defect (NTD), such as spina bifida, and you will need to take 5mg of folic acid supplements daily, until the 12th week of pregnancy.

Certain medications that are used to treat bipolar disorder can affect whether a woman is able to breastfeed her baby.

It is important to seek advice from your GP, who can assess your condition and medication throughout your pregnancy and postnatal period.

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