Preconception planning

So you're thinking about having a baby!

Planning to begin a family is certainly one of the most important responsibilities you will ever have. Beginning early, before conception, will allow you to have the healthiest pregnancy and feel your best from week one to postpartum recovery. Hopefully this will also be the start of a healthy lifestyle that you will share with your children and family for years to come.

In a perfect world all mothers would eat right, take a vitamin, exercise and have any medical conditions well managed. The reality is that approximately half of all pregnancies are unplanned and good habits must then start several weeks into pregnancy. A plan for each pregnancy must be individualized and this is best done with a visit with your obstetrician.

Getting pregnant

Everyone seems to have their own notion of how long it should take to get pregnant. In fact, it is considered normal to take up to twelve months of actively trying to conceive. If in one year a couple has not had a pregnancy, they would fit the textbook definition of being infertile. Some of these couples, though, go on to have a baby if they keep trying - fertility, conception and pregnancy don't always follow the textbooks. One exception to this includes those who are more than thirty-five years of age and especially those more than forty. Fertility may decrease further for these couples if more than a year goes by. Also, others with obvious medical problems that prevent pregnancy, such as no periods, should not delay seeing their doctor for evaluation.

Medical conditions

If you have a serious medical condition such as diabetes, having it well controlled is the most important step in getting ready for pregnancy. Please contact your doctor who manages your medical condition and put in place a plan that includes picking the best medicines for you and your pregnancy. Below is a short, but by no means complete, list of conditions that may affect your pregnancy:

Fitness and nutrition

This is probably the issue that may take the most individual effort. Eating properly needs to be a priority and wholesale changes to a balanced diet might be better done in smaller steps. Your focus should be on low fat, lean meats/protein and good, complex carbohydrates. Learn more on the USDA's Choose My Plate website.

There is more evidence that being overweight or obese increases risks to the baby, both early and late in pregnancy. Miscarriage, gestational diabetes and elevated blood pressure are some of the increased risks for mothers who have an above normal body mass index. It is strongly recommended that any necessary weight loss be done before pregnancy in a safe manner, guided by your physician.

Part of any good fitness and nutrition program should include exercise. Most exercise routines that you are doing prior to pregnancy can be continued. It is wise to avoid any contact or high impact activity once the pregnancy test is positive. It is recommended that you do 30 to 60 minutes of physical activity a day for 5 or more days per week.

Medications

Think of medications as anything that you put in your body that is not food or drink. This would include prescriptions, over-the-counter (non-prescription) medicines, vitamins, herbal remedies and nutritional supplements. They can be tablets, patches, creams, eye drops and suppositories. Prescriptions should be reviewed with your physician and necessary medicines should be continued during pregnancy.

Prenatal vitamins are recommended and should be started at least one month prior to conception. Clear evidence shows that a minimum of 400 micrograms of folic acid daily can reduce the risk of the birth defect spina bifida. All prenatal vitamins will contain this amount or more. Calcium is important for all women but the recommendation goes from 1000mg before pregnancy to 1200-1500mg during pregnancy. This can come from calcium rich foods, supplements or a combination of sources. Also, omega 3 fatty acids promote healthy eyes in babies when their mothers were given this supplement during pregnancy. Some foods, certain prenatal vitamins or a supplement such as fish oil will provide this nutrient.

Herbal or "natural" remedies are not necessarily safer when compared with prescriptions. In fact, most herbal products have not gone through the rigorous testing needed to consider them save for pregnant women. Nothing, regardless of how "natural," should be taken without discussing it with your doctor.

Habits and environment

Number one on every list is smoking. Thankfully there are fewer smokers in this country today and most mothers are aware of the risk. Smoking during pregnancy has been shown to affect the placenta and the baby's ability to grow properly. Smokers have a higher rate of miscarriage and stillbirth. There is also evidence that the children of smokers have more asthma and allergies. Please quit smoking before pregnancy. Please ask for help to quit if necessary.

The current recommendation is that alcohol not be consumed during pregnancy. Fetal alcohol syndrome occurs after a fetus is exposed to critical levels of alcohol. We do not know if there is any safe amount of alcohol or if it would even be the same for all mothers. Other recreational drugs, obviously, are dangerous to mother and baby.

Everyone's life, whether at home, work or play will present potential risks for pregnancy. If you work in an environment where there are chemicals, vapors or injury risks these need to be addressed and removed from your duties. It is expected that most everyone can continue to work throughout pregnancy. At home, the risks should be more easily controlled with a little attention and planning. Also, you are asked to refrain from riding amusement park rides, jet skiing, sky diving, horseback riding and using hot tubs while pregnant. Please discuss any specific concerns with your doctor.

Family history

Your family usually provides the benefits of love and support before, during and after pregnancy. They also have provided the genes that define your genetic risks. Some families pass on abnormal genes that may lead to birth defects or disease. There are tests available for some of these problems before or during pregnancy. Those with Jewish or Mediterranean ancestry, Sickle Cell Anemia, Thalasemia or Chromosomal Abnormalities in their families are some that may benefit from testing. Providing a detailed family history is the first step in this process. Furthermore, it is now typical to offer testing for Cystic Fibrosis to everyone starting a family.

Annual exams

Hopefully it is clear that a well-planned pregnancy can make a difference. The simple things like being up-to-date with your annual gynecologic exam and Pap smear should be on your to-do list. Don't forget your annual dental exam/cleaning and mammogram (if appropriate), and update any immunizations that are due.