A 25-Year-Old Woman, Gravida 1 Para 0 Aborta 1, Comes

A 25-year-old woman, gravida 1 para 0 aborta 1, comes to the office for a preconception counseling visit.  Her sister recently developed abruptio placentae after a motor vehicle accident and underwent an emergency cesarean delivery at 32 weeks gestation.  The patient had been considering stopping her oral contraceptive pills to conceive but is now feeling apprehensive about pregnancy complications after what happened to her sister.  She has a history of generalized anxiety disorder and major depression.  Her only surgery was a suction curettage for an elective abortion 5 years ago.  In addition to oral contraceptive pills, the patient takes a selective serotonin reuptake inhibitor and multivitamin daily.  Family history is noncontributory.  The patient does not use alcohol, tobacco, or illicit drugs.  She reports feeling safe at home.  All her vaccinations are up to date.  She works as a babysitter for elementary school children, with the responsibilities of driving them to after-school activities and preparing meals.  The patient enjoys running and competes in 1 or 2 marathons a year.  BMI is 23 kg/m².  Physical examination is within normal limits.  She is considering quitting her job when she becomes pregnant and asks what else she can do to decrease her risk of complications in pregnancy.  Which of the following is the best response?

A) Continue routine safety measures including wearing lap and shoulder seat belts.
B) Even though your vaccinations are up to date, you should receive the tetanus, diphtheria, and pertussis vaccination as soon as you conceive.
C) Go on bed rest during your first trimester to decrease the risk of abortion.
D) Stop working during pregnancy to limit your exposure to possible infection.
E) You will have an improved outcome if you discontinue your selective serotonin reuptake inhibitor prior to conceiving.