When it comes to having a healthy pregnancy, it’s never too soon to start planning.

“A significant number of pregnancies—an estimated 40-50%—are unplanned,” says Yan Yu Chen, D.O., a Piedmont obstetrician and gynecologist. “All reproductive-age women should be on a reliable form of birth control so that when they’re ready to start family planning, they have the option to discontinue the contraceptive and make lifestyle changes to support a healthy pregnancy.”

1. Plan ahead for pregnancy

Dr. Chen says the most crucial time for organogenesis—when the fetus forms organs—occurs very early in the pregnancy. If the pregnancy is unexpected, there is a higher chance of fetal exposure to modifiable risks like medications/drugs or alcohol.

Planning for a pregnancy can also help you and your physician ensure any chronic health conditions you have (such as high blood pressure) are well-managed. If needed, your doctor can help you switch to medications that are safer during pregnancy.

2. Take your daily prenatal vitamins

Dr. Chen also recommends starting a daily prenatal vitamin with 400mcg of folic acid before you start trying to conceive so the risk of neural tube defects or malformations of the brain and spine can be reduced. Prenatal vitamins should also be continued throughout your pregnancy and extended to the postpartum period as well. If you have trouble swallowing prenatal vitamins, there are also gummy versions available over the counter. An early start can also reduce morning sickness symptoms.

3. Get up to date on your immunizations before pregnancy

Before trying to conceive, Dr. Chen recommends ensuring you’re up-to-date on your vaccinations, since there are some live vaccinations like MMR (measles, mumps, rubella) and varicella that are not given in pregnancy. Recommended vaccinations include Tdap, influenza, COVID-19 and even monkeypox to help decrease the risk of infections and complications. Tdap (tetanus-diphtheria-pertussis) is usually given between 27 and 36 weeks and will help protect your baby against whooping cough at birth.

4. Establish prenatal care

An important part of a healthy pregnancy is regular prenatal care.

“While the majority of pregnancies are normal, up to 25% of women will, unfortunately, miscarry in the first trimester,” she says. “Routine prenatal care allows us to coordinate care so the harmful risks to mother and baby can both be reduced.”

This includes screening for and treating infections that could lead to miscarriage or preterm labor and delivery.

“Even at the first visit, we can also confirm the dates of your pregnancy and make sure it is in the right location with an early ultrasound,” Dr. Chen says.

She recommends establishing early care, especially if you have any vaginal bleeding, since ectopic pregnancies can be life-threatening.

5. Stay active during pregnancy

If you already exercise and get the OK from your doctor, it’s likely safe to continue that form of exercise during pregnancy with appropriate modifications. If you’re not participating in regular exercise, talk to your doctor about the safest ways to start exercising.

“Exercise during pregnancy is encouraged,” Dr. Chen says. “It is an essential part of a healthy lifestyle and has many positive benefits in pregnancy. Routine exercise has been shown to reduce the risk of gestational diabetes and operative deliveries, and shorten postpartum recovery time. Examples of safe exercise include walking, aerobic exercises, dancing, stretching/yoga and stationary cycling.”

6. Gain a healthy amount of weight during pregnancy

Dr. Chen says the adage “eating for two” isn’t the best approach. Most women only need about 300 extra calories per day while pregnant.

It’s also important to gain weight in a healthy way during pregnancy.

“Obstetricians recommend different ranges of weight gain based on your starting BMI,” she says. “If you fall into the obese BMI range (BMI >30), it’s recommended to gain no more than 11 to 20 pounds during your pregnancy. If you’re overweight (BMI 25-29.9), gestational weight gain of 15 to 25 pounds is adequate. If you’re in the normal BMI range, it’s recommended to gain 25 to 45 pounds. And if you’re underweight, you can gain up to 40 pounds.”

Gaining less weight does not appear to have a negative effect on fetal growth or outcomes as long as your baby is growing adequately.

“Additionally, obesity, diabetes and high blood pressure are all risk factors for preterm labor and delivery,” she says.

Meeting with a dietitian or nutritionist before or during pregnancy can help ensure you’re eating the right foods to support your health and your baby’s well-being.

7. Take care of your mental health

“If you have a history of anxiety or depression, these medical conditions should also be addressed,” Dr. Chen says. “I will refer patients to a therapist or recommend starting medication, depending on the severity of the symptoms.”

8. Talk to your provider about drug or alcohol use

If you think you may be addicted to tobacco, alcohol or drugs, it can be scary to bring this up with your provider, but it’s essential for the health and well-being of you and your baby.

“There are many safe ways we can help you manage addiction during pregnancy if we know about it,” Dr. Chen says. “The earlier you bring it up, the earlier we can address it together.”

9. Seek medical care if needed during pregnancy

You should seek emergency medical care if you experience these symptoms during pregnancy:

• Severe abdominal pain with or without bleeding

• High blood pressure persistently above 140/90 or very elevated above 160/100

If you have questions about getting pregnant or staying healthy during pregnancy, talk to your gynecologist or primary care provider.

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