Experts say there are many things women can do to increase the health of their pregnancy -- and their baby -- long before they conceive.
Reviewed By Brunilda Nazario
But while most women are concerned about what happens after they conceive, doctors say more should be thinking about what to do before they even try.
"We've attempted to get the message out there, but I don't think enough women take advantage of the fact that there are things you can do prior to conception to not only ensure your own health during pregnancy, but also that of your baby," says Michael Silverstein, MD, an obstetrician and assistant professor of obstetrics and gynecology at New York University Medical Center in New York City.
At the top of most experts' preconception "to do" list is quitting smoking -- a leading cause of problems for both mother and baby.
"We still have an epidemic of smoking during pregnancy, and the single most important piece of advice I could give women contemplating pregnancy is to stop smoking," says Bryan Hecht, MD, professor and chairman of the department of obstetrics and gynecology at Northeastern Ohio Universities College of Medicine.
About 20% of low-birth-weight births, 8% of preterm deliveries, and 5% of all delivery deaths are linked to smoking during pregnancy. It is important to stop smoking during pregnancy to help give your baby the best chance of survival.
Studies show smoking can also make it harder for you to get pregnant. Smoking lowers a women's fertility level by directly affecting the ovaries and decreasing estrogen levels. Stopping during pregnancy planning may not only help you get pregnant faster, it will also help ensure that your pregnancy -- and your baby -- starts off in the right direction.
Folic Acid Important
Once pregnant, most women know it's important to take folic acid supplements, which studies show can protect your baby from some serious birth defects, including spina bifida, a life-threatening spinal malformation. What experts say many women don't realize, however, is how important it is to take this supplement prior to attempting conception.
The reason: "Folic acid is important right from the very moment your baby is conceived, and since many women can be pregnant four, six, or eight weeks before they know it, taking folic acid prior to conception is one important way to ensure your body has a good supply right from the very start of your pregnancy," says Carol Bates, MD, assistant professor of medicine at Harvard Medical School and a primary care physician at Beth Israel Deaconess Medical Center in Boston.
In fact, Bates says taking folic acid is not only her "No. 1 recommendation" for women trying to get pregnant, she adds that "it's so important that I believe every woman who is sexually active and not using a highly reliable method of birth control should be taking folic acid, just on the off chance that she does get pregnant."
In the past, doctors routinely suggested that any woman trying to conceive take prenatal vitamins since they were the only ones containing high enough levels of folic acid to make a difference. Today, however, nearly all multivitamins contain at least 400 mcg per dose, the minimal amount needed for a healthy pregnancy. So many experts are less stringent about the type of supplements you take during the preconception time.
"I always suggest a prenatal vitamin, but if a woman feels more comfortable taking a multivitamin instead, that's OK too, as long as she is getting at least 400 mcg of folic acid daily when she is trying to get pregnant," says Bates.
The Two-Week Rule
When it comes the dietary or lifestyle factors that might be questionable during pregnancy -- such as caffeine and artificial sweeteners -- doctors say there is less to worry about when trying to conceive. Still, some precautions still apply.
"During the preconception time you really only have to be concerned about what's in your body at the time you actually get pregnant -- and that is usually possible just a few days a month," says Silverstein.
As such, he says, if you confine your intake of caffeine, for example, to the two weeks after your period starts -- a time when you generally can't get pregnant -- and abstain during the last two weeks of your cycle -- when you ovulate and are more likely to get pregnant -- then your conception is probably safe.
"If you find you just can't live without something," says Silverstein, "just use common sense and moderation."
For John Williams, MD, the "two-week" rule does make sense, but he adds that since the timing of conception isn't an exact science, you shouldn't panic if you find you were doing something questionable at the time you got pregnant.
"While we don't recommend throwing caution to the wind, if you do find out you conceived at the same time you were drinking or doing something that you would be fearful of doing during pregnancy, don't panic or terminate the pregnancy, because chances are everything is going to be OK," says Williams, director of reproductive genetics at Cedars-Sinai Medical Center in Los Angeles.
Easy on the Seafood
The one area where he and others do suggest exercising a little more caution is in the consumption of seafood.
"The problem with seafood is related to the mercury content, and because this is a heavy metal it can accumulate in fatty tissue, so it can remain in the body long enough to cause at least some potential harm after conception," says Williams.
As such, he recommends that women trying to conceive follow the same fish safety guidelines suggested for pregnant women, which is to limit seafood to 12 ounces weekly. Seafood to completely avoid includes tilefish, swordfish, king mackerel, and shark, as well as any raw fish.
Williams also says he believes in limiting exposure to other potentially harmful lifestyle factors, like pesticides, cleaning chemicals, or strong paint fumes.
"If you should avoid something during pregnancy, it makes sense to try and avoid it when you are trying to conceive, just in case you are pregnant and don't know it," says Williams.
The one area where there is little cause for preconception concern is in the fitness arena, since experts tell WebMD that most workouts are safe while trying to conceive. Where you should exert some caution, however, is when engaging in any activity that increases the risk of impact or injury, such as downhill skiing, horseback riding, or kick boxing, as well as things like scuba diving. Again, this is important if you may be pregnant and not know it.
The Preconception Exam
A number of years ago, the American College of Obstetricians and Gynecologists began recommending that all women see their doctor for a pre-conception exam -- a physical that takes place prior to trying to conceive and focuses on the key factors necessary for a healthy pregnancy.
Among the most important features of that exam, say experts, is testing for several infections that may not only interfere with conception but also affect your pregnancy.
"You should be checked for common sexually transmitted diseases (STDs) linked to pregnancy complications, such as chlamydia, and you also need to make sure you are protected against the rubella (measles) virus, either through prior exposure or by vaccination, which you should get prior to conceiving," says Bates.
Also important: Obtaining your doctor's help in controlling any pre-existing medical conditions before getting pregnant.
"If you are overweight, try to lose the extra pounds; if you have a blood sugar problem, make sure it is under good control; if you have high blood pressure, be certain that it is treated. Whatever the problem is, your pre-conception exam should address it because the better control you have over your health, the healthier your pregnancy and your baby will be," says Silverstein.
In addition, if you are using any medications for chronic health concerns -- including migraine headaches, diabetes, autoimmune disorders, seizure disorders, high blood pressure, depression, stress, or chronic pain -- experts say check with your doctor before attempting conception.
"Certain medications are very safe to use during pregnancy, others are very unsafe, but even those which are not recommended can often be switched with less toxic treatments, so you don't have to sacrifice relief in order to have a safe pregnancy," says Silverstein.
Finally, in certain instances, you may also benefit from an extended preconception exam -- one that includes genetic testing.
"One of the things we're seeing in the dawning of the 21st century is a tremendous amount of new information on genetic risk assessment -- and obviously the time to be aware of any potential genetic risks is before you conceive," says Hecht.
Other experts agree. "One thing that many patients don't think about it is that certain ethnic groups may be at risk for certain types of genetic disorders -- African Americans are at risk for sickle cell anemia, eastern Europeans need to be checked for Tay-Sachs disease, Mediterranean people and southeast Asians have to watch out for thalessemia, while Caucasians of northern European extraction should be screened for cystic fibrosis, all before getting pregnant," says Williams.
Regardless of what your exam uncovers, doctors say that by knowing the potential trouble spots ahead of time, you can be better prepared to deal with any problems that might develop during your pregnancy, regardless of the cause.
Says Silverstein: "If you optimize your health prior to getting pregnant, ultimately, you can have a healthier pregnancy, which is not only good for you, but important to your baby."
Colette Bouchez is the co-author of Getting Pregnant: What You Need To Know Now and the author of the forthcoming book Your Perfectly Pampered Pregnancy.
Published Dec. 15, 2003.
SOURCES: Michael Silverstein, MD, assistant professor of obstetrics and gynecology, New York University Medical Center, New York City. Bryan Hecht, MD, professor and chairman, department of obstetrics and gynecology, Northeastern Ohio Universities College of Medicine, Rootstown; medical director of women's services, Mercy Medical Center, Canton, Ohio. Carol Bates, MD, assistant professor of medicine, Harvard Medical School; primary care physician, Beth Israel Deaconess Medical Center, Boston. John Williams III, MD, director of reproductive genetics, division of maternal-fetal medicine, department of obstetrics and gynecology, Cedars-Sinai Medical Center.
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