Pregnancy and childbirth are exciting events for the entire human family. However, before a mother becomes pregnant her own physical and mental health, economic circumstances, desire to have a child, age and behaviors may have an effect upon her future pregnancy, her health and a growing fetus. It is widely believed by experts in maternal and child health that future reductions in infant mortality will be the result of improving the health care behaviors and practices of all women of childbearing age (e.g. nutrition, folic acid, alcohol and substance use, weight). “The period of greatest environmental sensitivity for the developing fetus is between 17 and 56 days after fertilization” — a time period when most women do not know they are pregnant.^{(2, 3)}   Health care research gives us insight into how to best ensure a healthy mother and a healthy baby. Some risks include:

• Mother's Age (less than age 17 and older than age 35): ^{(4, 5)}   Child and adolescent births have greater risks due to health, educational, economic and social reasons. While many teens will have a healthy birth and be good mothers, their risk for poor outcomes for themselves and their children is great.⁽⁶⁾   Pregnant adolescents tend to seek prenatal care later in their pregnancy; their bodies are often not fully developed for bearing children; and they often lack social supports. A lower maternal education completion rate is related to a higher risk of infant mortality and low birth weight. Adolescents who are mothers are at greater risk for experiencing domestic violence ⁽⁷⁾   and as a perpetrator of child abuse or neglect. ^{(8, 9)}   Mothers over age 35 and their children are at greater risk for poor childbirth outcomes.



• A recent pregnancy or birth: The recommended interval between births is 24 months to give a woman's body time to heal and become strong enough to carry another fetus. Expanding the time period to 24 months between births also contributes to healthy infant emotional development by providing an infant special bonding time with their mother. ^{(10, 11)}



• Illness during pregnancy: Illnesses such as diabetes, anemia, or a sexually transmitted disease require special handling during pregnancy to protect both mother and infant. ⁽¹²⁾



• Nutrition and weight gain: Adequate consumption of folic acid prior to pregnancy and in the early prenatal period may prevent spina bifida. Appropriate weight gain is correlated to improved birth outcomes (e.g., birth weight above 5 ˝ pounds). ^{(13, 14, 15)}



• Unhealthy behaviors: Smoking, drugs or alcohol consumption put both mother and the newborn at risk. Binge drinking and alcohol consumption can result in a baby with fetal alcohol syndrome; and smoking is related to low birth weight and sudden infant death syndrome (SIDS). ⁽¹⁶⁾



• Wanting a baby: ⁽¹⁷⁾   While most women will be happy about having a child after learning they are pregnant, an unwanted child and pregnancy is a risk factor for maternal health, a growing fetus and a child after birth. Women who do not want a pregnancy are more likely to engage in risky behaviors and to experience maternal depression and domestic violence from a partner who does not want the child. The child is at greater risk for child abuse, low birth weight and infant mortality. ⁽¹⁸⁾   The social context and support systems in a family and a community are critical for a woman who is pregnant, her partner, and the newborn, particularly those for whom a pregnancy is difficult or unwanted.



• Mother's race/ethnicity: Maternal race/ethnicity effects include an increased risk for African American mothers for maternal death, premature birth, a low birth weight birth, fetal death and infant mortality. For example, maternal death rates are four times higher for black women than white women. ⁽⁴⁾



• Single mothers: Raising a child is hard work. Single mothers, particularly young mothers, are likely to have fewer support systems and experience greater risk in their pregnancy and as parents. ⁽¹⁹⁾



• Maternal education: Premature, low or very low birth weight births are more likely to occur to mothers with less than a high school education. A lower education level is associated with a greater likelihood of risk taking behaviors of smoking during pregnancy and inadequate or no prenatal care, but interestingly, women with more education are more likely to drink alcohol during pregnancy. A lower education level increases the likelihood of living in poverty and being unmarried, lower levels of breastfeeding and failure to thrive in infants. A lower education level is more frequent among Hispanic and black mothers.^(20-30)