Important information before you become pregnant
The physicians and staff at Women's Healthcare Associates support your desire to conceive and have a healthy baby, and wish to help you throughout this process. Listed below are some of the issues we think are helpful for you to consider prior to pursuing your goal of pregnancy.
Please note: Your personal medical history and your family's medical history may both dictate which of these issues are relevant to you. And this list is by no means complete. Please consult with a physician to determine what issues are most relevant and what potential courses of action should be considered.
- A well-rounded diet with adequate water intake is recommended. Some vegetarian diets do not provide adequate amounts of essential amino acids, iron, or complex lipids needed for normal fetal development. Consultation with a dietitian may be recommended.
- Herbal supplements, many of which contain estrogen, should be eliminated.
- Your diet should be supplemented with daily multivitamins that may be obtained either "over-the-counter" or via prescription through our office. The use of high doses of Vitamin A (>10,000 IU per day) may be harmful to your baby and should be avoided.
- Folic Acid supplementation, beginning at least one month before conception, has been shown to dramatically decrease the risks of certain birth defects known as neural tube defects. The recommended daily dose of Folic Acid is 400mcg (0.4 mg). This dose is found in almost all daily multivitamins as well as prenatal vitamins. Higher doses of Folic Acid may be recommended in certain situations.
- Caffeine intake should be no more than two cups of coffee/tea or one can of soda per day. Higher levels of caffeine intake has been associated with miscarriage, still birth and decreased birth weight.
- Maternal obesity has been linked to an increased risk of infertility, increased risk of having a child with a congenital anomaly, and other pregnancy complications (gestational diabetes, preeclampsia, cesarean delivery, macrosomia, difficult delivery and stillbirth/early neonatal death). Weight loss prior to conception may reduce these risks. We recommend a Body Mass Index (BMI) of <30 prior to conception.
- Mild to moderate exercise is not harmful to the healthy pregnant woman or her baby. Women who exercise regularly prior to pregnancy may continue with their usual level of physical exertion during pregnancy. Initiation of strenuous exercise during pregnancy, on the other hand should be avoided.
Tobacco, Alcohol and Drugs
- Stop cigarette smoking!!!! Cigarette smoking and "passive" exposure to someone else's smoking for both men and women has been linked to decreased fertility and higher rates of miscarriage. Although smoking cessation prior to pregnancy is of maximal benefit, quitting at any time during pregnancy can have some beneficial effects.
- Serious medical complications from direct smoking (lung cancer, emphysema, miscarriage, low birth weight, placenta abruption) and from passive smoke are well known. Evidence has linked all types of smoke to a higher risk of SIDS (Sudden Infant Death Syndrome).
- There are many successful programs available to help you stop smoking. We would be happy to help you in your efforts to quit.
- Stop any alcohol intake and all recreational drugs use!!! Use of either is associated with pregnancy complications, including miscarriage, low birth weight, birth defects and newborn addiction.
- Alcohol use has been associated with Fetal Alcohol Syndrome; the third leading cause of mental retardation in the USA. Safe levels of alcohol consumption have never been established, so we recommend no alcohol consumption during pregnancy.
Pre-Existing Medical Conditions
- The possible impact of a pre-existing medical condition (such as high blood pressure, thyroid disease, depression or diabetes) and prescribed medications should be discussed prior to conception. These conditions and some medications could have serious implications on your pregnancy, health and baby.
- Intervention with regard to ANY medical condition such as changing prescription or non-prescription medications or immunization should occur BEFORE pregnancy.
- Women who undergo periodic screening tests (e.g. mammogram, dental films or chest x-rays) involving ionizing radiation should schedule these tests prior to attempts at conception.
Sexually Transmitted Diseases
- Sexually transmitted diseases (STD's) should be tested for and treated before conception if you are at risk. Because of the high prevalence of Chlamydia in young women and its frequent lack of symptoms, the Centers for Disease Control (CDC) recommends annual Chlamydia screening for all sexually active women aged <25 years. Common STD's include Syphilis, Gonorrhea and Chlamydia.
- Some forms of Hepatitis are considered STD's, which may be associated with long-term liver disease. A vaccine and screening, if indicated, may help to prevent it and/or treat it.
- HIV testing in both partners is recommended before conception. Many new drug treatments are available which, if begun early enough, may have a major influence on the progression of HIV and/or the transmission to your baby.
- Based on the following information, you should consider genetic counseling or screening prior to pregnancy.
- Age, especially women over 35, may be associated with a higher risk of chromosomal as well as other abnormalities in offspring. The same may be true for men over 50. We may advise certain tests during pregnancy, such as Chorionic Villus Sampling or Amniocentesis. Preconception discussion with a genetic counselor may also be warranted.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that all couples consider being screened for Cystic Fibrosis before pregnancy. The carrier state for Cystic Fibrosis is found at high enough frequencies in many ethnic groups in the US population to make the likelihood of two carriers combining to have an affected baby high enough to warrant testing the prospective parents. Further information on Cystic Fibrosis and testing is available to you in our office. As this screening test is costly and some insurance providers do not cover the expense, we recommend that you contact your provider to verify benefit coverage.
- Thorough evaluation of both your and your spouse's personal and family history of inheritable diseases should be undertaken. If any of the following disorders applies to either you or your spouse's family history, further discussions with us and possibly a genetic counselor may be warranted.
- Do you/your spouse have any family members born with birth defects (e.g. Spina Bifida, Cleft Lip)?
- Did you/your spouse have any family members that developed any medical conditions or learning disabilities while growing up?
- Do you/your spouse have any family members with a history of mental retardation?
- Have you/your spouse or any family members been told that there are abnormal chromosomes or any of the following inherited diseases? (Downs Syndrome, Hemophilia, Muscular Dystrophy or Cystic Fibrosis)
- Other Chromosomal Abnormalities
- Do you/your spouse have any family members that have had more than one miscarriage, stillborn baby, an infant with birth defects or an infant who died soon after birth?
- Do you/your spouse have any family members that terminated a pregnancy because of a chromosomal or genetic abnormality in a fetus?
- Do you/your spouse have any family members that are mentally retarded, learning disabled, or physically disabled?
- Are you/your spouse Jewish? If yes, have you been tested for Tay-Sachs disease, Gaucher Disease, Canavan Disease or Cystic Fibrosis?
- Do you have longstanding or persistent anemia?
- Are you/your spouse African-American? If yes, have you been tested for Sickle Cell Trait?
- Are you/your spouse of Mediterranean background? If yes, have you been tested for Beta Thalassemia?
- Are you/your spouse of Asian background? If yes, have you been tested for Alpha Thalassemia?
- Do you/your spouse have any family members in common or you related by blood?
- Have you/your spouse been treated for cancer?
- Have you/your spouse been exposed to chemicals, radiation, or biological agents (e.g. chemotherapy, Agent Orange or radiation therapy)?
Additional Preconception Testing
- Rubella and Varicella Immunity – Immunity to German Measles (Rubella) and Chicken Pox (Varicella) should be confirmed. Vaccinations should take place before pregnancy in non-immune individuals. Both of these illnesses may cause birth defects if you are not immune and if they are contracted during pregnancy. Following vaccination, you MUST avoid pregnancy for one month!
- Complete Blood Count (CBC) – This is a screening test for anemia and should be done prior to attempting pregnancy.
- Blood Group and Rh Factor – We advise determination of blood group and Rh factor of both partners before conception as incompatibilities may have implications for your baby and future pregnancies.
Work related issues regarding maternity leave, work load and financial implications of a baby should be considered prior to conception.
Regularly scheduled activities such as teeth cleaning or hair coloring should be undertaken prior to pregnancy. Recent studies suggest that there is a connection between periodontal disease and preterm delivery and preeclampsia.
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The Physicians and staff of Women's Healthcare Associates hope you have found this Preconception Information helpful. There have been many advances, especially in the area of genetics, and recommendations for screening of various genetic conditions are quickly progressing. After reading this handout, we urge you to address any questions or concerns that you may have with your Physician.
Further reliable medical information may be obtained at www.nlm.nih.gov/medlineplus/pregnancy.html, www.babycenter.com/preconception or through additional handouts in our office.
Please check with your insurance provider regarding benefit coverage for any and all preconception testing.
We wish you good fortune in conceiving and having a healthy pregnancy outcome.