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Tobacco, alcohol, and drug use;exposure to toxic substances in the workplace or at home;and exposure to other teratogenic agents must be determined. Women who smoke cigarettes place their fetuses at a higher risk of complications and should be encouraged to stop smoking. The fetus is more likely to exhibit intrauterine growth retardation and to become hypoxic during labor as a result of a reduction in placental exchange. Special note must be made of any drugs taken during pregnancy. Ideally, this issue should be discussed before the woman conceives so that she can be properly counseled.

Any of these hazards may increase the risk of maternal or fetal morbidity and mortality and should be evaluated.

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