Preparing for pregnancy: Women's Preconception Health

You may not be pregnant yet, but you may plan on being pregnant in a near future (next three to six months). If you do, now is the time to start planning (health-wise). Having a healthy baby starts before you conceive, so preconception health is important. According to the CDC, preconception health is the health of women and men during their reproductive years, which are the years they can have a child. It focuses on taking steps now to protect the health of a future baby.  A woman's preconception health check should include the following:

1. Treating or controlling underlying medical conditions

Conditions such as diabetes, hypertension, asthma and others can affect your pregnancy. It is important to discuss any underlying health conditions you have (and medications you're taking) with your doctor. If necessary, your doctor may refer you to a specialist. Note that women with chronic health conditions can still have healthy pregnancies and healthy babies. Chronic health conditions include autoimmune diseases, epilepsy, mental health conditions, conditions that affect hormones, and others. A chronic health condition is one that lasts for a year or more, that needs ongoing medical care and that affects a person's daily life.

2. Scheduling a preconception visit

During a preconception visit, your doctor will review your personal and family medical history, your current health condition, and any medications you may be taking. Some medications and supplements are not safe during pregnancy, and may need to be changed before you even try to conceive because they are stored in your body's fat and can stay there for long. You may be required to have a pelvic exam, a pap smear and be tested for STDs if you are at risk.

3. Undergoing genetic carrier screening

Many parents-to-be ignore this step when planning pregnancies. Genetic carrier screening will enable you and your partner if either of you carry a genetic mutation that could cause a serious inherited disorder in your baby. The common diseases screened for are cystic fibrosis, sickle cell disease, thalassemia and Tay-Sachs disease.

4. Taking folic acid

It is important that you start taking a supplement that contains at least 0.4 milligrams (400 micrograms) of folic acid. Taking folic acid helps prevent many birth defects. Taking the aforementioned dose of folic acid a day for at least one month before you conceive and during your first trimester can reduce your chances of having a baby with neural-tube defects such as spina bifida by 50 to 70%. However, avoid taking high doses of vitamins, especially vitamins A, D, E, and K. Getting too much of vitamin A which is not in the form of beta-carotene can cause birth defects. Taking higher than the normal recommended daily amounts of these vitamins can cause birth defects.

5. Giving up alcohol and recreational drugs

Heavy drinking increases the time it takes to get pregnant and reduces your chances of having a healthy baby. Light drinking also reduces the chances of pregnancy. For women planning a pregnancy, taking no alcohol at all is the safest option. Smoking affects fertility in both men and women. If you smoke, you should quit before getting pregnant as the effects on the fetus are terrible. The effects of recreational drugs are deplorable as well. Smoking marijuana during pregnancy could cause the baby to have a bowel movement while in the womb which can lead to fetal distress and early onset of labor. Cocaine exposes the baby to brain damage, sudden infant death syndrome and other sad outcomes. Narcotics (heroin, methadone) and amphetamines should be avoided as well.

6. Eating healthier

The best foods for those who plan on getting pregnant are the same as those for general well-being. Eat more fruits, vegetables, unsaturated fats and wholegrain high fiber foods. Avoid saturated fats, and sugary foods and drinks.

7. Limiting caffeine intake

Heavy caffeine intake - more than 200 milligrams a day (about two 6-ounce cups of coffee) - have a detrimental effect on fertility and on pregnancy. Stay within the recommended limits or avoid caffeine.

8. Aiming for a healthy weight

Being underweight or overweight puts you at increased risk for problems during pregnancy. If you're overweight, try losing some weight. These problems include premature birth, birth defects, diabetes and high blood pressure. It is important to know your BMI when trying to conceive. As such, your doctor can figure out the right amount of weight you ought to gain during pregnancy. The table below is a useful guide. The ideal BMI ranges between 18.5 and 24.9.

9. Following an exercise routine

It is important to start an exercise program if you are not already involved in one. This will help your body deal with all the changes your body will go through during pregnancy and labor. It is important to start an exercise program of 30 minutes of moderate exercise four or five days per week before conceiving and throughout the pregnancy (unless pregnancy complications disallow exercise).

10. Taking care of her dental health

Women who take care of their periodontal health before they get pregnant reduces their chances of experiencing gum diseases during pregnancy. Hormonal shifts in pregnancy (higher progesterone and estrogen levels) makes pregnant women more susceptible to gum disease. It is thus important to see your dentist for a checkup if you haven't done so in the past six months.

11. Avoiding bacterial and viral infections

This is very important, especially avoiding all infections that could harm your baby-to-be. Avoid foods such as raw and undercooked fish, poultry and cold deli meats (sausages, luncheon meats etc). They can harbor dangerous bacteria that cause listeriosis - a food-borne disease that can lead to miscarriage or stillbirth. Toxoplasmosis is an infection that can be very dangerous for a developing baby. To avoid it, wear gloves when gardening and during any contact with soil or sand because it might be contaminated with cat feces that contain toxoplasma. Also avoid drinking untreated water and unpasteurized milk. Also note that felines are a natural host for toxoplasma so cat owners will have to take extra precautions.

Sexually transmitted infections can affect your chances of getting pregnant, and harm the fetus. The most common STIs are chlamydia and gonorrhea. If you have an STI, get treated as soon as possible. Also, avoid sex until seven days after you and your partner have completed treatment and the infection has cleared.

Women living with incurable STIs can still get pregnant safely and have healthy babies if the STI is treated and managed well.

12. Considering her mental health

Reduce stress as much as possible and relax often. Less stress increases your chances of getting pregnant. Women, especially those with a personal or family history of depression need to do a mental health check before they get pregnant. Women who suffer from depression are twice as likely to have problems with fertility than non-depressed women. Stress management techniques such as yoga and meditation can be of help and can help depressed women conceive. However, it is better to heal from depression before conceiving. Depression makes it hard to take care of yourself, so it would be much more difficult taking care of yourself and a child in a depressed state.

13. Considering financial matters

The financial considerations for expectant parents include thinking about employment, health and/or life insurance, housing, and spending and saving. Ask yourselves (the couple) questions (adapted from parents.com) such as:

• How do I/we add a child as a beneficiary on existing insurance policies?
• How can I add baby to my or my partner's health insurance plan?
• What is my or my partner's family leave policy at work?
• What benefits am I entitled to under the law?
• Is my/our home large enough for a family?
• Do I have a budget for baby clothes and furnishings?
• If we need fertility treatments, how will these be financed?
• Do I/we have six months of living expenses set aside in case of emergency?

14. Thinking her decision through

Ask yourself questions such as:

How will you handle childcare responsibilities and balance work and family life?

Are you and your partner equally committed to becoming parents?

If you and your partner have religious differences, have you discussed how they will be handled with regards to the child?

Are you mentally and financially equipped if the child turns out to be a special-needs child?

15. Stopping birth control

You can get pregnant days or weeks after you stop using a progestin-only pill (the "minipill"). If you were using a combination pill (one that has both estrogen and progestin), you can get pregnant within one to three months of stoppage. Women using injectable birth control will take much longer after stopping. It may take 10 or more months before you ovulate again; some take as long as 18 months. If you're using a barrier birth control method such as condoms or a diaphragm, it's possible to get pregnant as soon as you have sex without it.

16. Figuring out when she ovulates

Knowing when you ovulate helps time sex for conceiving. A woman only gets pregnant during the fertile window of her menstrual cycle. A woman's fertile window depends on the length of her menstrual cycle. It is easy to determine when you ovulate if you have a regular menstrual cycle. Ovulation is the time when a mature egg is released from the ovary. Ovulation lasts between 12 and 24 hours. The egg then travels down to the fallopian tube where it can be fertilized if sperm are present. 

Ovulation occurs halfway through your menstrual cycle. It's best to have sex four to five days before you ovulate and on the day you ovulate. It is therefore important to mark your calendar. You can do this by yourself or use a menstrual cycle tracker such as My Calendar -Period Tracker. 

If your menstrual cycle lasts 28 days and your period is regular, it's likely that you'll ovulate on day 14. Your fertile window begins on day 10. You're more likely to get pregnant if you have sex at least every other day between days 10 and 14 of a 28-day cycle. The first day of your period marks the beginning of your menstrual cycle, and the last day before your next period marks the end of the cycle.

The following are symptoms of ovulation: 

• You may notice light spotting.
• Your sex drive may increase.
• Your breasts may get tender to the touch.
• You may experience mittelschmerz (ovulation pain) (a one-sided pain in your lower abdomen which lasts no longer than a day).
• Your cervix will soften and open up.
• Your cervical mucus will become clear and thinner, with a more slippery consistency, similar to that of egg whites.

To track ovulation with more precision, when you're ready to conceive, buy an ovulation predictor kit. It identifies the date of ovulation 12 to 24 hours in advance by looking at levels of luteinizing hormone, which is the last of hormones to hit its peak before ovulation. You pee on the stick and the indicator tells you whether you're about to ovulate.