Plan for your pregnancy

(This article does not apply to couples having difficulty conceiving or infertility)

Planning for a pregnancy? Why? Isn’t pregnancy considered to be a natural phenomenon?

Well, yes! Pregnancy is natural.  One can believe that “whatever will be, will be” or as Doris Day sang “Que sera, sera!”, and actually as I previously mentioned in my post about birth control pills, around 50% of pregnancies in the states are unplanned. However, is there a benefit for planning your pregnancy? Are there any advantages for preparing your mind and body to embark on this journey?

Planning your pregnancy falls under an important yet hidden aspect of obstetrics known as “preconception counseling”. A big proportion of couples are not aware of this facet of obstetrics, as most women present to our clinics after a positive home pregnancy test. Yet preconception counseling is as important as following the pregnancy itself.

The objective is to identify the social, behavioral, environmental and medical risks of the couple, and to try to minimize/eliminate these potential pregnancy hazards.

I personally encourage all ladies attempting pregnancy to schedule with their partners an office visit to help their physician create a customized reproductive health plan. But let’s talk about the basics.

By the time you miss your period, figure out that you’re pregnant, and schedule a doctor’s appointment, the organogenesis (formation of the baby’s organs) is already happening. Organogenesis is a crucial period in the fetal development and it occurs during the first weeks after conception. During this stage babies are most susceptible to their environments, hence having a healthy reproductive plan is of utmost importance before actually getting pregnant.

Stop contraception and have regular SEX

This goes without saying. If you are planning to get pregnant, you should stop all birth control methods. But you should be aware that some birth control methods are irreversible (vasectomy of the partner, or tubal ligation), and some have short term contraceptive effects even after discontinuation (contraceptive injections). So, recognize the contraceptive method you are using and know what to expect (the topic of contraception will be addressed in future articles)

Also, having sex within a day of your ovulation (releasing an egg from the ovary) has the highest chance for you to get pregnant. If you do not know how to predict your ovulation day, then having sex every other day increases your chance of conception.

Stop Alcohol consumption

Alcohol can harm your growing fetus, even if ingested in small amounts as the limit for alcohol consumption that is considered to be safe during pregnancy is not known. So, any small amount is theoretically expected to harm your baby. It can be associated with what we call Fetal Alcohol Spectrum Disorder (FASD) characterized by facial and heart defects (abnormalities in your baby’s face and heart) in addition to learning and intellectual disabilities

Stop Smoking (cigarettes and Hubble-bubble)

Smoking cessation is encouraged regardless of your intentions to conceive, but before planning your pregnancy, you should try smoking cessation as smoking is associated with lower than expected newborn birth weight and other pregnancy complications. Actually, look at the bright side, many smokers quit smoking forever while attempting pregnancy! So, your desire to get pregnant can be your strongest motive to quit.

Quit any recreational drug

Street drugs (cocaine, heroin, codeine…) or any other recreational drugs should be discontinued before attempting conception. I know that it is easier said than done, but i encourage you to always inform your physician about your drug use during your preconception counseling visit so he/she can tailor a withdrawal plan matching your goals.

Limit your Caffeine intake

Caffeine is not contraindicated during pregnancy, but you should know your limits. Studies have shown that a consumption of more than 2 cups of coffee or more than 5 cans of caffeinated beverages per day is associated with first trimester abortion. So, try limiting your intake before planning a pregnancy.

Eat Healthy

Eat a healthy diet high in proteins, fibers, grains, vegetables and fruits, and low in carbohydrates and fats. You can consult your physician or a certified dietitian to help you achieve a healthy diet plan.

What about fish? Fish products are rich in essential nutrients, but also rich in Mercury (a toxic substance that can be found in large ocean fish). So, I would advise eating no more than 2 fish meals per week and to always avoid large ocean fish such as shark, swordfish and tilefish which are rich in mercury. You can check the World Health Organization (WHO) “nutrition counseling during pregnancy” on this link, for detailed information.
https://www.who.int/elena/titles/nutrition_counselling_pregnancy/en/#:~:text=*%20A%20healthy%20diet%20during%20pregnancy,pasteurized%20dairy%20products%20and%20fruit.

Lose these extra pounds

If you are overweight (defined as a body mass index of ≥25 kg/m2) then the best time for you to lose weight is prior to getting pregnant. Being overweight during pregnancy is associated with many pregnancy related complications such as elevated blood pressure, gestational diabetes (diabetes related to pregnancy), the need for cesarean section, preterm delivery (delivery before 37 weeks of gestation), abortion, stillbirth and multiple birth defects. So, the ideal plan is to lose weight before conception for better health and pregnancy outcomes.

Exercise

This will not only help you lose some weight and get ready for a healthier pregnancy, but it can also get you in a better shape for a smoother vaginal delivery.

In case you have never exercised before, do not hit high intensity exercises prior to conception, rather start with mild to moderate walking routines for 30 minutes per day, 5 days per week (a total of 150 minutes per week) (as recommended by the American College of Obstetricians and Gynecologists). Whereas, if you are used to heavy exercise, you don’t have to cut down! As your body is used to these routines and thus it can adapt as pregnancy ensues.

In case you suffer from any medical problem that precludes you from exercising, then consult with your physician before embarking on any exercise routine.

Check your teeth and gum!

There is a known correlation between oral hygiene and pregnancy outcomes. If you have any dental problems, visit your dentist before attempting getting pregnant.

Check your vaccination history

Be up to date with your recommended vaccines. In case it’s the flu season, it is better to receive your flu shot while attempting getting pregnant (even though the flu vaccine can be safely administered anytime during pregnancy). Also some vaccines are contraindicated during pregnancy, so consult with your physician about the timing of these vaccines with respect to your planned pregnancy.

Know your history

Here I stress again about the importance of scheduling a prenatal visit appointment with your physician. If it’s not your first pregnancy, it is crucial for you to inform your physician about all the details of your previous pregnancies (history of gestational diabetes, hypertensive disorders of pregnancy, preterm labor, preterm delivery, infections, birth defects, mode of delivery (vaginal or cesarean section) and reason for cesarean section if it was the case …).

Also, it is preferable if you know your mother’s birth history as some obstetric complications tend to recur with subsequent generations (hypertensive disorders of pregnancy: elevated blood pressure). Moreover, you should know the presence or absence of any inherited or genetic diseases in your or your partner’s family.

Furthermore, in case you have a chronic medical condition (hypertension, diabetes, cholesterol, migraine, epilepsy/seizure disorder…) for which you are taking chronic long-term medications, then consult with your physician about the value of continuing the same medication, switching to another, or stopping it before conception.

So, memorize your personal and family histories, and inform your physician about them!

Take your vitamins

Take your prenatal vitamins before getting pregnant. As I previously mentioned, by the time you miss your period and figure out that you’re pregnant and by the time you schedule a doctor’s appointment, the organogenesis (formation of the baby’s organs) is already happening and thus the golden time for vitamins supplementation might pass unnoticed. Hence if you are planning to get pregnant you should start your prenatal vitamins at least 1 month before conception.

The most important supplement is FOLIC ACID. You hear a lot about it, and yes, it is one of the most important supplements, because a dose of as little as 0.4-0.8 mg per day for at least 1 month prior to getting pregnant significantly reduces your risk for having defects in your baby’s brain and spine. We as obstetricians consider folic acid to be a core supplement for all women attempting pregnancy because it helps avoiding one of the most common preventable birth defects.

To note that some women belong to an already high-risk population for birth nervous system defect (defects in fetal brain and spine, which I will call “neural tube defects”), such as women on some anti-epileptic drugs (anti-seizure medications) and patient with personal history of neural tube defects (personal, partner’s history, or previous child with this condition). Then these patients should take 4 mg per day for at least 3 months prior to the date of conception. So always follow with your physician ahead of time during your preconception counseling visit if you belong to the high risk population.

Other vitamins such as vitamins C, D, E and B are also essential for the fetal development, but you should avoid high doses because there is no known benefit for exceeding the dosages present in most of the commercially available prenatal vitamins. The only vitamin not recommended to be supplemented during pregnancy is Vitamin A! As per the WHO, pregnant women, or women planning a pregnancy should not exceed 10,000 international units per day of Vitamin A.
Not to bother you with numbers, remember that you should not take excessive vitamin A supplementation, as a healthy balanced diet has enough Vitamin A essential for your health.

Iron, is crucial for you and your baby. Iron is important for your blood power in carrying oxygen to your organs as well as to the baby, so you should be taking iron supplementation on a daily basis. Don’t be surprised that sometimes your physician might recommend an extra dose of iron in case of a history of iron deficiency.

Involve your partner

If you have a partner, involve him in every step of your preconception counseling. He too should maintain a healthy lifestyle and better eating and exercising habits as they can impact his fertility.

Relax!

Finally, RELAX! It is true that you can plan for your pregnancy, and you can mold yourself into a healthier bearer, but do not stress about it. Anxiety and stress are associated with miscarriage, worse pregnancy outcomes, higher infertility rates and delayed conception. So, enjoy the journey and don’t stress about the goal.

Karam  

Disclaimer: this article does not apply to couples having difficulty conceiving or troubles with their fertility, as they should be followed with an infertility specialist.