Pregnancy – what to do in the first few weeks

South African maternity guidelines ask women to book for antenatal care as early as possible, ideally in the first trimester. Many women book far later, and late booking is one of the clearest predictors of a problem being found too late to do much about.

The first visit is not just a scan. It is when high blood pressure, anaemia, diabetes, HIV, syphilis and TB are screened for — all of which are treatable, and all of which affect the baby if they are not found. Antenatal care is free at public clinics.

Folic acid reduces the risk of neural tube defects such as spina bifida. The catch is timing: the neural tube closes in the first weeks, often before a woman knows she is pregnant, so starting after a positive test is already later than ideal.

Anyone who could become pregnant is advised to take folic acid daily. Iron is usually added during pregnancy because anaemia is common in South Africa and affects both mother and baby. Your clinic will supply both.

• Alcohol, completely. No safe amount has been established, and South Africa has among the highest rates of foetal alcohol spectrum disorder in the world. This is the single most preventable cause of intellectual disability here.
• Smoking and vaping. Both are linked to low birth weight, prematurity and stillbirth.
• Any medicine, herbal remedy or traditional preparation not cleared by a clinician — including things bought over a counter. Take your full list to the first visit.
• Anti-inflammatory painkillers, particularly in the last third of pregnancy. Paracetamol is the usual choice instead, at the lowest dose that works.

Every pregnant woman in South Africa is offered an HIV test, and retesting through the pregnancy, because this is where the programme has achieved the most. With treatment taken consistently, the chance of passing HIV to the baby becomes very small.

A woman already on treatment continues it. A woman newly diagnosed starts immediately. Neither is a reason to avoid the clinic — it is the reason to go.

The headache, vision changes and swelling together suggest pre-eclampsia, which is why blood pressure is taken at every single visit and why those visits matter even when you feel well.

• ambulance10177Emergency Medical Services
• local_police10111South African Police Service
• sos112Universal Emergency (mobile)
• psychology0800 029 999SADAG Mental Health Crisis Line
• science0861 554 911Poisons Information Helpline

Morning sickness usually settles by around the middle of the second trimester. Small frequent meals, dry starchy food before getting up, ginger, and avoiding smells that set it off all help a little. Ask the clinic rather than a pharmacy shelf if it is severe.