Many women think of the excitement a new child brings, but one of the often overlooked steps is planning for the pregnancy. Preconception care, the care that a woman receives during her reproductive years, is important to allow the patient and her doctor time to identify concerns that might affect getting pregnant or increase risks during pregnancy. It is about optimizing the health of the mother with the goal of a healthy pregnancy and healthy infant.
So before you plan for pregnancy, here are some questions to keep in mind.
What do I need to do before I get pregnant?
Assess your lifestyle. Am I at a healthy weight? Do I drink alcohol, smoke or use any other illicit drug? Do I have medical problems and are they controlled? What medications am I taking, prescription and nonprescription? Will any of these medications affect my pregnancy and fertility?
Many of these questions can be addressed when meeting with your doctor during a preconception visit. At this visit, we will often talk about your diet, weight, medical problems, family history, complete an exam and often lab work.
It is important to stop smoking and using any illicit drugs.
You should know what medications you are taking, including herbal medication and supplements to know if they are safe in pregnancy.
Get up to date with vaccines.
Make sure you are in a safe environment. This means eliminating possible chemical exposures but also making sure you are in a safe environment with your partner.
Do I need to start a prenatal vitamin?
Ideally, you should start a prenatal vitamin at least two months prior to conception.. One of the most important nutrients a vitamin will provide for you in the very early stages of pregnancy is folic acid. Most prenatal vitamins are different than general vitamins because prenatal vitamins will often have more folic acid but may contain less of other vitamins. A prenatal vitamin will not have any vitamins over 100 percent as seen in some supplements. The minimum folic acid recommended is 400 mcg; yet, most over-the-counter will have at least 800 mcg.
Deficiencies in folic acid are associated with birth defects, so it is important to start a prenatal vitamin prior to conceiving because many of the baby’s organs begin forming prior to you knowing you are pregnant.
In addition to prenatal vitamins, folic acid is also found in many carbohydrates in the U.S. because it is added to flour and grain products. It can also naturally be found in legumes, nuts and leafy green vegetables.
Iron is also an important nutrient found in prenatal vitamins, but it is important to note that is not present in the gummy varieties. Your body works hard to increase red blood cell production and iron is used quickly. Many women will develop even a mild anemia in pregnancy. Having iron supplementation can help to reduce significant anemia at the end of pregnancy.
When should I stop my birth control?
When to stop depends on the method being used to prevent pregnancy. Some medications like medroxyprogesterone, a birth control shot, can shut down the normal cycle so effectively that it may take months to resume normal cycles. With IUD options, return to fertility is often quick. With birth control pills, the time to return to normal monthly cycles can vary, but should generally be within three months. Many women will return to monthly cycles immediately.
If you were started on birth control for irregular menses, you may continue to have irregular menses after stopping the hormonal therapy. If you do not resume monthly menses, you should see your doctor.
Having regular menses, not on hormones, generally reflects monthly ovulation, which is important to increase your chances of pregnancy.
Can my medical history affect my pregnancy?
There are many medical problems that affect pregnancy. Medical problems can affect how your pregnancy will be managed and may affect timing of delivery. Make sure your medical problems are controlled prior to pregnancy. For example, if you are a diabetic you may have a high-risk pregnancy because diabetes increases many complications seen in pregnancy; however, your pregnancy will be at a much higher risk if your diabetes is not controlled prior to conceiving. Other examples of when this is true include high blood pressure (hypertension) and thyroid disease.
Some medication is also considered unsafe in pregnancy. It is important to discuss your medication with your doctor who manages your medical problems and with your obstetrician. Many doctors will change medication if they know you are trying to get pregnant rather than waiting until you get pregnant. Ask the following questions to your doctor: Is there a safer alternative? Am I on the lowest therapeutic dose? Do the benefits outweigh the risks?
In high-risk pregnancies, you are often seen by a general OB/ GYN, a high-risk specialist (perinatology or maternal-fetal medicine specialist), and the specialist that cares for your medical problems such as an endocrinologist or cardiologist. We like the “team” approach.
If this is not your first pregnancy, it is also important to discuss your obstetrical history as well. It is helpful to have any prior records, especially if your pregnancy or birth was complicated.
Can I get pregnant?
As an old professor of mine once said, “You only need three things to get pregnant: sperm, an egg and a way for them to meet.” Although this is reducing it to simple biology, it often can seem and actually become more complicated.
Many factors can affect fertility including your diet, weight, medications, supplements, medical problems, timing and age. Age is the main factor that we cannot change.
Older studies have found that for most women, 85 percent are pregnant within a year. Most couples will have around a 25 percent chance to get pregnant within a month. This may decrease some with age. For couples under 35, we generally suggest trying to conceive for one year before beginning an investigation for causes of infertility. For women over 35, we recommend seeing your doctor after six months without success.
Timing is everything for pregnancy. You should try to have intercourse approximately two or three times each week. If you know the time you are ovulating, you should time this on days prior to ovulation, during ovulation, and even after when you think you have ovulated. Generally, most women ovulate 14 days prior to their menses. Sometimes, you will need a few cycles to calculate your overall cycle length, and it is not uncommon to have small fluctuation in your cycle length. Some women use other tools to help them know when ovulation occurs such as a change in the vaginal discharge or cervical mucous, change in the basal body temperature, while some may use ovulatory predictor kits.
How will my stress affect getting pregnant?
Many women, including myself, often wonder when is the best time to have a baby. Where am I in my career or education? Are my partner and I in a good financial place? Am I too stressed? Unfortunately, there may never be a “best time.” However, it is important to recognize additional and modifiable stressors in the life of the mother and with her partner.
I do think that stress can affect conception. Not only can stress affect you emotionally but also physically. Stress can also result in some other unhealthy behaviors. Does your stress affect your diet, ability to exercise, or ability to sleep?
It is important to examine what and why one feels stressed. Is it anxiety? Do you have depression? Are there modifiable things to decrease your stress? Would you, or you and your partner, benefit from counseling? If there are sources of stress including problems with your partner, financial concerns or work concerns, it is important to address them prior to pregnancy. The addition of a new baby will not improve these issues.
Getting pregnant can also become stressful for some couples. Although many hope to get pregnant the first month of trying, most do not. It is important to be patient with yourself and your partner. Continue to optimize your health and make good choices to help yourself have a healthy pregnancy. Are you ready for a baby?
If you have additional questions about your health, join us for For Women For Life, an upcoming women’s health seminar near you.