Preconception Planning: A Guide to Pre-Pregnancy Health Care

Every mother wants what is best for her child. Giving your baby the best starts even before conception occurs. Good preconception planning and pre-pregnancy health care can decrease the risk of birth defects and increase the chance of a healthy and successful pregnancy.

Preconception Planning: When to Start Your Pre-Pregnancy Health Care
Approximately 49% of all pregnancies in the US are unplanned. This means all women of childbearing age should use good pre-pregnancy health practices.

Women who are actively planning to become pregnant should start discussing pre-pregnancy health care plans with their doctor about one year in advance of conception.

Women who have already had a child and would like another should wait approximately 18 months between pregnancies. This provides time for the body to recover enough to support another healthy, full-term pregnancy.

Preconception Planning: Pre-Pregnancy Health Care Recommendations
As mentioned above, almost half of all pregnancies are surprises. Many women, including some who are trying for a baby, do not realize they are pregnant for several weeks after conception. This being the case, pre-pregnancy health care recommendations include precautions normally taken during pregnancy.

• Take folic acid - Folic acid is a B vitamin that helps prevent several forms of birth defects, including neural tube defects, cleft palate and defects of the heart. Up to 70% of all neural tube defects, which start to form within the first 3-4 weeks of pregnancy, could be prevented if women took folic acid before pregnancy. Most doctors recommend 400 micrograms of folic acid daily, either through enriched food or supplementation, for at least 3 months before getting pregnant. Women who take folic acid for at least one least one year before pregnancy have a reduced risk of premature delivery.

• Keep immunizations up to date - It is best to make sure all vaccinations are current, as some vaccines are not safe for use during pregnancy. Illnesses such as chicken pox and rubella (German measles) can cause birth defects if the mother contracts them during pregnancy. If a vaccination is needed, wait at least one month after receiving the vaccine before getting pregnant.

• Quit smoking, avoid alcohol, do not use illegal drugs, limit over-the-counter medicines - As these substances can cause problems for a fetus during early development, it is best to avoid or limit exposure to them during the reproductive years.

• Maintain a healthy weight - Overweight women have an increased risk of high blood pressure and diabetes during pregnancy, as well as labor and delivery complications. Obesity also increases the risk of some birth defects and stillbirth. On the other hand, underweight women have an increased risk of having a premature delivery or a low-birth weight baby.

• Exercise - Exercise lowers the risk of diabetes and high blood pressure, which can cause problems during pregnancy. Exercise also strengthens muscles, which will make carrying a large pregnancy belly easier on the body. Aim for at least 30 minutes of moderate exercise most days of the week.

• Have regular check-ups and properly treat all illness - Many illnesses can increase the risk of birth defects or pregnancy complications. Diabetes, high blood pressure, Lupus, PKU, and kidney disease are all illnesses that must be properly managed before pregnancy to ensure a successful pregnancy and healthy baby.

• Be aware of your environment - Some chemicals used at home or in the work place increase the risk of birth defects and miscarriage. Solvents (such as paint thinners), lead, mercury, copper, carbon disulfide, anesthetic gases and radiation should all be avoided if there is a chance you will become pregnant.

• Do not eat undercooked meat or raw (unpasteurized) milk - Undercooked meat may contain a parasite called toxoplasmosis, which can lead to birth defects. Bacterial infections from undercooked meat and raw milk increase the risk of miscarriage, premature delivery, stillbirth or death shortly after birth.

• Do not change litter boxes - Cat feces is another source of toxoplasmosis. Women with toxoplasmosis have a 50% chance of passing the parasite to a developing fetus. This can lead to birth defects such as blindness, deafness, and brain damage. Care must also be taken when working in garden soil that may be contaminated with cat feces.

• Avoid rodents and their droppings - Wild rodents and pets such as mice, rats, guinea pigs and hamsters can carry the Lymphocytic Choriomeningitis Virus (LCMV). The virus does not cause symptoms in most individuals, therefore women who are pregnant or planning to become pregnant may not know they are infected. LCMV increases the risk of miscarriage and severe birth defects.

• Avoid fish known to have high mercury levels - Eating fish provides health benefits for women who are planning to become pregnant, but certain types of fish can do more harm than good. Some fish, such as shark, swordfish, king mackerel and tilefish, contain high levels of mercury. Mercury can damage the nervous system of a developing fetus. As an added precaution, low-mercury fish, such as tuna, salmon, pollock and catfish, should be limited to no more than 12 ounces per week.

Preconception Planning: Pre-Pregnancy Nutrition
Eating a well-balanced diet on a regular basis provides a good foundation for a healthy pregnancy. Women who are planning to become pregnant should include the following in their pre-pregnancy diet on a daily basis:

• 3 of more ounces of whole grains
• 2 ½ cups of vegetables (especially dark-green vegetables, orange vegetables, beans and peas)
• 2 cups of fruit
• 3 cups of low-fat milk or yogurt

As with all healthy diets, a pre-pregnancy diet should limit salt and sugary foods, including those made with artificial sweeteners.

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Sources:
National Institute of Child Health and Human Development
What is prenatal care/preconception care?

American Congress of Obstetricians and Gynecologists
Good Health Before Pregnancy

Hartford Hospital
Take Care of Baby Before Conception

March of Dimes
Preconception Health Care
Food-borne Risks in Pregnancy

CDC
Steps Women Can Take for Healthier Babies
Lymphocytic Choriomeningitis Virus (LCMV) and Pregnancy: Facts and Prevention

Family Doctor
Things to Think About Before You're Pregnant