Prepregnancy and early pregnancy care.

There is ample evidence to support the familiar message offered to women early in pregnancy that they should stop smoking, limit their alcohol intake to less than two units daily, avoid all unnecessary drugs and eat a normal well-balanced diet. They may continue to take exercise and work (in almost all occupations) without any risk to the fetus. For doctors the challenge is to balance their wish to pass on the scientific evidence with the obligation to address the concerns and needs of their individual patients. Routine screening in early pregnancy should be continued for syphilis and rubella, but the benefits do not justify it for other infectious illness, including urinary tract infection. The arguments for screening for toxoplasmosis in pregnancy are finely balanced; if more effective treatment were available then screening might become worthwhile. Provided a full screening programme for cervical cancer is achieving reasonable coverage for the adult female population, there is no need for additional screening in pregnancy. Unplanned and unwanted pregnancy is a substantial problem in the United Kingdom and will continue to be so. For those that request it, termination is a safe procedure with low morbidity, especially when carried out early on. Women with unplanned pregnancies are entitled to advice from their doctors in order to help them decide whether they want a termination or not.