By Ann Douglas
Nov. 13, 2000 -- Debra Livingston is every doctor and midwife's idea of a dream patient. The 29-year-old Florida woman got down to a healthy weight, stopped drinking alcohol, and quit using birth control pills months before she started trying to conceive. "I wanted to do everything I possibly could to put the odds of having a healthy baby in my favor," says Livingston, who is now 5 months pregnant with her first child.
Today women are more able than ever to plan when they want to have a child, thanks to advances such as effective birth control and ovulation predictor kits. This means that women, like Livingston, can start preparing for their pregnancies months in advance of the actual conception -- getting their bodies and minds into the best shape possible for carrying a baby.
Some of the most critical stages occur during the first few weeks of fetal development -- often before a woman realizes she is pregnant. By taking precautions prior to conception, a woman can minimize some of the risks that contribute to many serious -- but often preventable -- birth defects, according to the March of Dimes. And while this preparation doesn't guarantee a complication-free pregnancy, a woman will know she's done all she can to provide her baby with a healthy start, says Donald Mattison, MD, medical director of the March of Dimes.
Livingston started getting her body ready for a pregnancy about a year before she attempted to conceive. She was eager to lose weight and improve her eating habits. She lost 30 lbs. and drastically improved the quality of her diet. "I started drinking more milk and eating more red meat and grains than what was normal for me. I also cut out as much junk food as possible."
According to Barak Rosenn, MD, Director of Obstetrics and Maternal Fetal Medicine at St. Luke's-Roosevelt Hospital Center in New York City, it's smart to tackle weight problems far in advance of pregnancy -- and to avoid crash dieting: "Doing so, allows a woman to achieve and maintain her weight before conceiving."
That's important because a study published in the Jan. 15, 1998, issue of the The New England Journal of Medicine reported that women who are obese (with a body mass index over 30 ) before becoming pregnant are four times as likely to have a still-born child. And the extra weight also increases the risk of gestational (present only during pregnancy) diabetes and high blood pressure, both serious complications. But because dieting can seriously harm the baby's development, you should never try to lose weight while pregnant.
A Pre-Game Plan
Livingston's next step was to set up a preconception health check-up with her doctor to go over her personal and family medical history. They discussed the types of lifestyle changes that might be beneficial before switching into baby-making mode. Her doctor recommended that she start taking multivitamins and use a barrier method of birth control (condom or diaphragm, preferably with spermacide) instead of the pill, which she would need to stop a couple of months before trying to get pregnant.
While some doctors (like Livingston's) and midwives recommend prenatal vitamins to their patients, not all choose to go this route. According to Rosenn, most women consuming reasonably healthy diets already get sufficient quantities of many nutrients contained in prenatal vitamins -- the two noteworthy exceptions being folic acid and iron.
The U.S. Public Health Service recommends that all women who could become pregnant get 400 micrograms (0.4 mg) of folic acid every day to reduce the risk of neural tube defects, such as spina bifida. To be sure you are getting enough, the March of Dimes recommends taking a daily multivitamin containing folic acid in addition to eating folic acid rich foods, such as orange juice, whole grains, and green leafy vegetables. To be most effective the folic acid must be present, not only during the first trimester, but also during the three months prior to conception. If a woman starts thinking about folic acid when she finds out she is pregnant -- sometimes more than a month after sperm meets egg -- it's already too late to intervene.
"Women who are anemic -- who have heavy periods or who have babies in rapid succession, for example -- should also consider taking an iron supplement," says Rosenn.
As for the birth control pill issue, it's wise to allow a few months for menstrual periods to return to normal before trying to conceive, Rosenn says. "It is more difficult to establish an accurate due date if a woman gets pregnant right away [before the periods regularize]."
What difference does knowing a due date accurately make? Plenty, says a study reported in the June 2000 issue of Obstetrics and Gynecology. It indicated that women with unreliable due dates face roughly twice the risk of losing a baby (during pregnancy or up to one year after birth) as compared to women whose due dates are firmly established. Furthermore, it found the risks of preterm birth, low birth weight (less than 2,500 g), and low birth weight for age at birth were also significantly increased. Ladies, Start Your Engines....
Livingston made some additional lifestyle changes once she and her partner (see It Takes Two to Tango) decided it was time to become parents. "I stayed away from alcohol completely, and I reduced the amount of stress in my life."
While some may pooh-pooh the importance of these changes, both Rosenn and Houston Northwest Medical Center obstetrician Megan Tirone, MD, agree that Livingston was right on the mark.
"Stress can affect your ability to ovulate because high levels of stress can disrupt the hormones that govern ovulation," says Rosenn. "There's also an increased risk of pregnancy complications -- most notably preterm labor."
And as for giving up alcohol while she was trying to conceive, it's wise to err on the side of caution, says Tirone: "You can be pregnant for a few weeks before your pregnancy is confirmed, and this is a period of critical development for the fetus." To eliminate the risk of fetal alcohol syndrome -- a condition that causes serious life-long mental and physical defects in children exposed to alcohol in the womb -- the March of Dimes recommends avoiding alcohol completely prior to and during pregnancy.
No one can guarantee Debra Livingston the picture-perfect happy ending that every pregnant woman dreams of. But she can rest easy knowing that she's done everything possible to tilt the odds in her favor. And, with any luck, she'll receive the ultimate payoff for her careful planning four months from now: a healthy baby.
Ann Douglas is the author of 14 books, including co-author of The Unofficial Guide to Having a Baby, and The Unofficial Guide to Childcare with John Sussman, MD. She regularly writes on pregnancy-related topics. The mother of four children, ages 2 through 12, she has had firsthand experience with infertility, miscarriage, and stillbirth.
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