PRECONCEPTION CARE
Planning your pregnancy can help you make wise choices that will benefit both you and your baby. Many women do not know they are pregnant until they are several weeks into their pregnancies. The first 8 weeks of pregnancy are key for the baby growing inside you. Most of the baby’s major organs and body systems have begun to form. Your health and nutrition can affect your baby’s growth and development in these early weeks. That is why preparing for pregnancy (called preconception care) is so important.
THE PRECONCEPTION CARE CHECKUP
If you are planning to become pregnant, it is a good idea to have a preconception care checkup. During this visit, your health care provider will ask about your diet and lifestyle, your medical and family history, medications you take, and any past pregnancies. The goal of this checkup is to find things that could affect your pregnancy. Identifying these factors before pregnancy allows you to take steps that can increase the chances of having a healthy pregnancy and a healthy baby.
A HEALTHY LIFESTYLE
Your lifestyle can affect your baby’s health during pregnancy. The preconception period, the period before pregnancy, is the ideal time to take a close look at your lifestyle and make changes to maximize your health.
A HEALTHY DIET
A healthy diet is important at all times in your life, but it is vital during pregnancy. You and your baby will start out with all of the nutrients you both need if you eat a healthy diet before you become pregnant.
Your body needs a regular supply of nutrients to grow, replace worn-out tissue, and provide energy. How much of each nutrient you need each day is called the dietary reference intake. You can get your daily reference intake of nutrients from food as well as from supplements. However, most of your nutrients should come from the foods you eat.
One half of your plate should be fruits and vegetables. The other half should be grains and protein foods. Protein foods include meat, fish, beans and peas, nuts and seeds, and eggs. You also should have a small amount of dairy foods, such as milk, cheese, or yogurt, at each meal. Try to make at least one half of the grains you eat whole grains, such as brown rice, whole-wheat bread, and whole-wheat pasta. Eat more low-fat foods, such as low-fat or nonfat milk and dairy products. Eat fewer foods that are high in sugar and fat like cake and ice cream.
Weight Concerns
If you are planning to have a baby, you should try to reach a healthy weight before you become pregnant. A woman who is slightly underweight can gain a few pounds to prepare for pregnancy. An overweight woman should try to lose weight before pregnancy.
IF YOU ARE OVERWEIGHT
Excess weight during pregnancy is associated with several pregnancy and childbirth complications, including high blood pressure, preeclampsia, preterm birth, and gestational diabetes. Obesity during pregnancy also is associated with macrosomia, defined as a larger than normal baby, as well as an increased risk of birth injury and cesarean delivery. It also increases the risk of birth defects, especially neural tube defects (NTDs). Having too much body fat may make it more difficult for your health care provider to monitor your baby with ultrasound and to hear the baby’s heartbeat.
To lose weight, you need to use up more calories than you take in. The best way to lose weight is by making a few changes in your diet and by being more physically active. Cutting back on the number of calories you consume is a good first step. An easy way to cut calories and to reduce how much sugar you eat is to avoid sugary drinks, such as sodas. Also, pay attention to the amount of food you eat. Portion control is key.
Exercise burns calories and helps you lose weight. Try to do 150 minutes of moderate physical activity each week (a little more than 20 minutes a day) or 75 minutes of vigorous intensity activity a week (about 10 minutes a day). Most people who have lost weight and kept it off get 60–90 minutes of moderate physical activity on most days of the week. You do not have to do this amount all at once. For instance, you can do 20–30 minutes of exercise three times a day.
If you are unable to lose weight through diet and exercise, and your BMI is higher than 30 (or higher than 27 and you have health problems caused by your weight), your health care provider may recommend medication to help with weight loss. If your BMI is higher than 40 or between 35 and 39 and you have major health problems caused by your weight, bariatric (“weight loss”) surgery may be an option. If you are considering bariatric surgery or if you have already had it done, you should delay getting pregnant for 12–24 months after surgery, when weight loss is the most rapid.
IF YOU ARE UNDERWEIGHT
Being underweight also poses risks during pregnancy. It increases the risk of having a low birth weight baby. These babies are at risk of problems during labor and after birth. It also increases the risk of preterm birth. To gain weight, you will need to take in more calories than you use up. Like losing weight, gaining weight may be easier with small changes, such as adding high-calorie snacks to your daily meal plan. A dietitian may be useful in helping you to make these changes.
VITAMIN SUPPLEMENTS
Although most of your nutrients should come from the foods you eat, it is a good idea to start taking a prenatal vitamin supplement before pregnancy. These vitamin supplements are available without a prescription. They contain all the recommended daily vitamins and minerals you will need before and during your pregnancy.
One of the most important vitamins needed before and during pregnancy is folic acid. Folic acid helps prevent NTDs when taken before and during pregnancy. It is recommended that all women (even if they are not trying to get pregnant) consume 400 micrograms of folic acid a day by taking a vitamin supplement containing folic acid. Some women, such as those who have had a previous child with an NTD, should take 4 mg of folic acid daily—10 times the amount normally recommended—for 1 month before conception and during the first 3 months of pregnancy as a separate supplement.
Iron also is important during pregnancy. It is used to make the extra blood needed to supply oxygen to the baby. Not getting enough iron can be a problem for some women. Before pregnancy, it is recommended that all women choose foods that have a specific kind of iron called heme iron. This type of iron is found in animal foods and is more easily absorbed by the body. Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits.
Exercise
Good health at any time in your life—including during pregnancy—involves getting plenty of exercise. It is best to have an exercise routine in place before getting pregnant. If you are just starting out, decide on your goals—Do you want to improve your heart and lung function, strengthen your muscles, or both?—then choose the exercises that will help you meet your goals. Good exercises to start with are those you have probably already done before—walking, swimming, or bicycling. If you are not used to a lot of exercise, discuss safety guidelines with your health care provider ahead of time and take it slow at first.
SUBSTANCE ABUSE
Substance abuse by pregnant women is one of the leading causes of problems during pregnancy. Smoking, drinking, and drug use during pregnancy can have harmful effects on a baby’s health. If you smoke cigarettes, drink alcohol, or take drugs, now is the time to quit. Many women do not know that they are pregnant until they have missed one or even two menstrual periods. However, the time when the fetus is most vulnerable to the harmful effects of substances is during the first trimester of pregnancy. Stopping this behavior before pregnancy may reduce or even eliminate the risks of some birth defects that occur early in pregnancy. It also can give you time to seek help if you have issues with substance abuse or dependence.
Your male partner also should give up these harmful substances. There is growing evidence that if your partner smokes, drinks, or uses drugs, it can lower his fertility, damage his sperm, and have a harmful effect on the fetus. At the very least, living with someone who smokes means that you are likely to breathe in harmful amounts of secondhand smoke. In turn, your developing baby is exposed to toxic chemicals. Secondhand smoke also has been linked to an increased risk of sudden infant death syndrome (SIDs).
Quitting harmful behavior takes patience and plenty of support. Do not be afraid or ashamed to ask for help. Your health care provider can suggest ways to get through the early stages as well as refer you to support groups.
SPECIAL CONCERNS
Some health concerns may require special attention before or during pregnancy. Close monitoring or treatment before and during pregnancy can help prevent problems or make them less severe. This is one reason why getting preconception care is so important.
MEDICAL CONDITIONS
Your health care provider will ask about the diseases that you have had in the past and any chronic (long-lasting) conditions that you have now. Some medical conditions—such as diabetes, high blood pressure, depression, and seizure disorders—can cause problems during pregnancy. Some may increase the risk of problems for the baby, such as birth defects. Others may increase the risk of health problems for you. Having one of these conditions does not mean that you cannot have a healthy pregnancy or baby. If you have a medical condition, your health care provider will discuss with you the changes that you need to make in order to bring your condition under control before you try to get pregnant.
MEDICATIONS, HERBAL REMEDIES, AND SUPPLEMENTS
Some medications, including vitamin supplements, over-the-counter medications, and herbal remedies, can be harmful to a developing baby and should not be taken while you are pregnant. It is important to tell your health care provider about all of the medications you are taking. Better yet, take the bottles along with you to your prepregnancy checkup. You may need to stop using a certain medication or switch to another before you try to get pregnant. Do not stop taking prescription medication, however, until you have talked with your health care provider. Although some medications may increase the risk of birth defects, the benefits of continuing to take the medication during pregnancy may outweigh the risks to your baby.
INFECTIONS
Infections can harm both the mother and the fetus. Some infections during pregnancy can cause birth defects or illnesses in the fetus.
Infections passed through sexual contact—sexually transmitted infections (STIs)—also are harmful during pregnancy. Many types of STIs may affect your ability to become pregnant. They also may infect and harm your baby.
If you think you or your partner may have an STI, get tested and treated right away. Your partner also may need to be treated. Neither of you should have sex until you have both finished treatment.
Infection with human immunodeficiency virus (HIV) can cause harm to mother and baby. Early treatment may help prevent the infection from being passed to the fetus. Because of this, your health care provider will offer HIV testing, even if you have no symptoms.
Vaccination (also called immunization) can prevent some infections. Some vaccines are not safe to use during pregnancy. It is important to know which vaccines you may need and to get them before becoming pregnant.
PAST PREGNANCIES
Your health care provider will ask questions about any past pregnancies. Some pregnancy problems may increase the risk of having the same problem in a later pregnancy. These problems include preterm birth, high blood pressure, preeclampsia, and gestational diabetes. However, just because you had a problem in a past pregnancy does not mean it will happen again—especially if you receive proper care before and during your pregnancy.
FAMILY HEALTH HISTORY
Some health conditions occur more often in certain families or ethnic groups. These conditions are called genetic or inherited disorders. If a close relative has a certain condition, you or your baby could be at greater risk of having it. A family medical history helps identify whether you and your partner are at risk of having a child with an inherited medical condition. Your health care provider will ask whether your and your partner’s family members have conditions such as developmental disabilities, diabetes, or seizure disorders. You also will discuss your and your partner’s ethnic backgrounds and any pregnancy complications that you have had in the past.
Finally…
Becoming a parent is a major commitment filled with many challenges, rewards, and choices. Making healthy choices before you become pregnant is an important step to a healthy and happy pregnancy.
