Folic acid can prevent neural tube defects. The benefit outweighs the risk and cost in most patients. Moderate caffeine intake is acceptable in pregnant women, but the recommendations vary from up to 200 mg to up to 300 mg per day. Increased caloric intake is not needed until the second and third trimesters. At which time, increased caloric intake is scaled to the woman. Normal weight woman should generally increase by 300 calories per day; obese women may not need to increase as much. Phenytoin is a known teratogen. The physician should seek to transition women to other anti-seizure medications when possible. In any case, it is inappropriate for the nurse to counsel the patient to stay on this medication during pregnancy.