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Planning a Pregnancy – Preconception Advice
If you’re thinking about having a new baby, it’s never too early to start planning. Your most important prenatal exam may be the one you have before you are pregnant. Schedule a “preconception visit” with your doctor at least three months before you wish to conceive. This is an excellent time to take a personal health inventory and ensure that your body provides the healthiest environment in which to grow your baby.

Past Medical History
Your doctor will review your current and past medical conditions. If you have any long-standing medical problems—such as thyroid disease or diabetes— it is very important that your condition is in good control before you conceive. A thyroid imbalance may make it more difficult to become pregnant, while poorly controlled diabetes has been linked to higher rates of miscarriage and birth defects.

Previous Pregnancies
You should inform your provider of all prior pregnancies. If you had any complications with pregnancy, discuss whether this poses any risks to your next pregnancy. Some conditions, like fetal distress in labor, are unlikely to affect future pregnancies. Others, like pre-term labor, have significant rates of reoccurrence.

If you already have a baby, you know that caring for a child can take a significant toll on your body. Your own diet and exercise may have taken second place while you attended to your child’s needs, but now is a time to focus on your own health. It is best to wait at least one year after giving birth before attempting another pregnancy. If you are breast-feeding, your chances of conceiving will be reduced until your baby is weaned. If you do become pregnant while breast-feeding, your body will need an extra 500 calories a day!

Diet, Exercise and Vitamins
You should take a daily prenatal vitamin before you conceive. Prenatal vitamins containing folic acid have been shown to decrease the chances of having a baby with spinal and skull defects (neural tube defects). But vitamins do not take the place of a healthy diet. It is best to eat a well-balanced diet containing a variety of nutritious foods. Whole grains, fresh fruits and vegetables, dairy products and foods high in protein are part of a healthy diet. Avoid skipping meals or relying on fast foods and junk foods; these are high in fats and chemical additives and lower in nutrition. If you have dietary restrictions—for example, lactose intolerance or vegetarianism—review your diet with your doctor or nutritionist.

Being underweight or overweight can make your pregnancy more difficult. If you are very thin or exercise excessively, conception may be more difficult and you risk having a low birth weight infant. If you are overweight, you will have higher chances of developing fatigue, back pain, high blood pressure and diabetes during your pregnancy. You may have a larger baby and a higher chance of needing a cesarean section. Try to achieve an appropriate weight before becoming pregnant—develop a diet and exercise strategy with the help of your doctor or nutritionist.

Being active and having a regular exercise program will help you to cope with the physical demands of pregnancy. If you don’t already exercise, find activities that you can do regularly like walking, hiking, biking or swimming. Or join an exercise club and try aerobic activities, floor exercises, or weight training. Overheating in the first weeks of pregnancy may be harmful, so sauna and hot tub use is discouraged. You should exercise in moderation; excessive exercise can diminish fertility—ask your doctor for advice.

Medication Use
Medication and vitamin intake should be discussed with your health care provider. Birth control pills should be stopped two months before you wish to conceive. Most substances you ingest have the potential to cross the placenta and may affect your baby’s development. The first eight weeks of fetal life are critical for development of all the major organs (e.g., brain, heart, spinal cord), so it’s especially important to avoid harmful substances during this time. Even non-prescription medications and certain vitamins are restricted in pregnancy. Your health care provider may ask you to wean off of certain medications, or may suggest safer alternatives to use.

Home and Work Hazards Make a list of chemicals you may be exposed to in your home or work environment. These may include lead (found in old paint and water from old pipes), pesticides and insecticides (for garden or in animal flea collars), chemicals from factory work or other industries. If you work in a hospital, think about exposure to x-rays or chemotherapies. If you are a childcare worker, contagious and infectious diseases are more of a concern. Discuss any concerns about work or home exposures with your health care provider.

Smoking, Alcohol and Drugs
Becoming pregnant is one of life’s greatest motivators for making healthy lifestyle changes. Cigarette smoking, alcohol and illicit drug use should all be discontinued prior to conception. Smoking has been associated with miscarriage, placental bleeding, pre-term delivery and babies with low birth weight. Heavy alcohol use has been associated with mental retardation and facial deformities. There are no studies that have determined a safe minimum level for alcohol use in pregnancy, so it is safest to avoid alcohol altogether. Marajuana use during pregnancy has been studied and results are conflicting: pregnancy complications and infant developmental impairment have been suggested. Other forms of substance abuse should be stopped before getting pregnant; cocaine, LSD, heroin and methadone all cross the placenta and can cause harm. Meet with your health care provider to discuss the safest way to discontinue drugs.

Your doctor can advise you about the possible need for vaccines. If you are not immune to rubella (German measles), a preconception vaccine can prevent serious birth defects. Similarly, if you’ve never had chicken pox, a varicella vaccine may be indicated. These vaccines must be given at least three months before you conceive, so you must plan ahead!

Preconception Testing
Discuss any genetic disorders that have occurred in your family. Blood tests can determine if you are a carrier for Cystic Fibrosis, Tay Sachs disease, Sickle Cell, Thalassemia and a whole host of metabolic diseases. Your health care provider can review your family history and determine if it is appropriate to perform any tests before you are pregnant.

Your provider may wish to screen for infectious diseases, as well. A cervical swab during a pelvic exam will help to detect chlamydia and gonorrhea. Blood tests can detect syphilis, hepatitis, and AIDS in you and your partner.

To summarize the recommendations for preconception:
  • Stop birth control and avoid medications
  • Take folic acid (400 mcg) daily for at least one month before you conceive
  • Eat a healthy diet and exercise in moderation
  • Obtain necessary vaccinations at least three months before conception
  • Identify and remove health hazards in your home or workplace
  • Achieve a healthy weight
  • Discontinue cigarettes, alcohol and other drugs
  • Test for infectious diseases and screen for other medical problems

Thankfully, the vast majority of pregnancies result in healthy newborns. By planning ahead for your pregnancy, you will be sure to give your baby the best opportunity for a healthy beginning.
Laura E. Stachel M.D. Obstetrician & Gynecologist