Congratulations! You’re surviving parenthood! Your baby or toddler is thriving. Your body has adapted to less sleep, high-pitched shrieks, and some previously unimaginable smells. If you are thinking about having another baby (or if you are hoping to be a first-time mom), what issues should one focus on before a pregnancy?

First, the obligatory disclaimer. I’ll address a handful of issues here, but there is much more that can be addressed and should be individualized for each person. Please see your friendly family physician or obstetrician for complete details.

Folic acid in a prenatal vitamin is key to be taking before you’re thinking of becoming pregnant. Why is it so important? It can decrease the risk of many birth defects, particularly neural tube defects like spina bifida. Specifically, taking 400 mcg per day may decrease the rate of those defects by a whopping 75 percent. But, you need to be on this before pregnancy, as those parts of the fetus are developing early in the first trimester. In general, over-the-counter prenatal vitamins now have this recommended 400 mcg amount of folic acid.

Next, how is your weight? A good objective snapshot is by using a BMI calculator (readily available on the internet). If you are underweight (less than 18.5), there is a higher risk of preterm delivery and low birth weight. If overweight (25 or greater), one can have a larger baby, diabetes, high blood pressure, and shoulder dystocia. As I counsel my pregnant patients later in a pregnancy, we don’t want to find out when pushing that we have a ten-pound baby. As hard as it is, try to optimize your weight prior to conception.

As your baby has been getting shots to be healthy, consider your own immunizations. I would recommend having TDaP and flu shots. If for some reason you didn’t have MMR and varicella shots as a child, those should be updated. And when you get an immunization, try to cry slightly less than your child.

Look closer at the quantity and quality of other things going into your body. Do you drink pop out of a travel container with two handles and wheels? That’s probably too much. Try to keep any caffeine intake to about one serving (or 200 mg) per day. If you smoke, or your significant other smokes, now would be a great time to quit. If you are on prescription medications, talk to your doctor about being on the lowest effective dose, or about if you need it at all. Look for harmful exposures in your workplace. Try to keep fish intake to no more than twice per week.

I would be negligent if I didn’t cover hair dyes. I’m often asked about safety of dying one’s hair during pregnancy, and I respond—we don’t really know. More recently from, these reviewers felt that dyes had very limited systemic absorption, and would be unlikely to cause adverse effects on baby.

Again, I wish those of you congratulations on successful parenthood, and more parenting to come. I suppose the toast can involve single-shot lattes while munching on folic acid tablets (bon appetit!). May there be adequate sleep and manageable amounts of shrieks and odd smells in your enlarging family.

David Pommer, MD practices family medicine with obstetrics at Selah Family Medicine. He is married with three children.