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| |    Ten Things to Know before Becoming Pregnant by Marjorie Greenfield, M.D. reviewed by Robert Needlman, M.D., F.A.A.P. While it may be tempting to just let nature take its course, planning your pregnancy can help ensure that your baby gets off to the best start in life. Since an embryo's organs start to form by 17 days after conception, many women are not yet aware that they are pregnant during the most critical part of fetal development. It is important to avoid toxic exposures, get appropriate nutrition, and be at your healthiest in those crucial weeks before your routine prenatal care begins. Here are 10 things to consider before you stop your birth control method and start trying to conceive.
1. Are you ready to be a parent? Knowing that they'd like to have children one day is the easy part for many women. The hard part is knowing when the time is right to start a family. When you're faced with this decision, your health, financial considerations, the impact on your career, your willingness to shoulder the responsibility of being a parent, and your readiness to give up a great deal of personal freedom all come into play. If you're having a hard time deciding, try picturing your ideal life 10 years down the road. It might give you some clues as to what's really in your heart. Whether or not you are ready for the joys and responsibilities of parenting, you also must take into account your relationship with the baby's father. Talk things out, be frank about your feelings, and be prepared to hear your spouse's or partner's honest opinions in turn. Finally, think about your support network. Having a baby is much easier if you can rely on a group of family and friends for practical advice, hands-on help, and the occasional pep talk. Getting these things in order before becoming pregnant can help you prepare for the inevitable stresses of adjusting to pregnancy and for the responsibilities that a baby brings to your family. 2. Folate prevents birth defects. There is clear evidence that folate or folic acid prevents some birth defects. The necessary daily dose of folate, 400 micrograms, is found in a woman's daily vitamin, all prenatal vitamins, and any folate supplement. Since the fetal organs will be starting to form before you'll know that you are pregnant, this vitamin should be begun when you stop using birth control, rather than waiting until you have a positive pregnancy test. In fact, many experts now recommend folate for women of childbearing age who are sexually active even if they are using contraception, since birth control methods can fail, and many pregnancies aren't really planned. 3. Alcohol, cigarettes, and drugs are bad for babies. Smoking can cause miscarriage, low birth weight, and prematurity. It is best to stop smoking before pregnancy, when it is safest to take medicines like Zyban or the nicotine patch that can help with quitting. Alcohol use by a pregnant woman can cause her baby to have learning disabilities and behavior problems. Intermittent heavy drinking and daily drinking are both risky. As little as three drinks a day can cause facial deformities and brain problems. If you are a heavy or regular user, or have a family history of alcohol problems, quitting alcohol can require a treatment program like Alcoholics Anonymous, and is best done before pregnancy. Drugs like cocaine can cause brain problems in the developing fetus. They also may cause premature birth and even fetal death. Caffeine has been associated with an increase in miscarriage risk, although it isn't clear that caffeine actually causes miscarriages. Limiting caffeine to one or two caffeinated drinks a day is reasonable. 4. Fitness is good. Relatively normal body weight--not too thin, not too heavy--is associated with the healthiest pregnancies and best fertility. Eating disorders can worsen during pregnancy. If you have anorexia nervosa or bulimia, it's best to get treatment for it before you become pregnant Exercise promotes healthy pregnancy--shorter labors and leaner babies. Women who exercise regularly usually can continue their program during pregnancy. Even women who are used to being sedentary can benefit from starting an exercise regimen in pregnancy. Talk to your practitioner about what kind of exercise would be best for you. All women who want to exercise during their pregnancy should talk with their practitioner to explore what types of exercise would be best for them. 5. Medical conditions and medications should get a pre-pregnancy tune-up. Diabetes, high blood pressure, anemia, epilepsy, and other medical conditions can complicate pregnancy. Some infections also can be dangerous. For example, hepatitis B, rubella (German measles), and chickenpox are common infections that can pose serious risks to a pregnancy. Your doctor or midwife can help you decide if immunization (or re-immunization) is necessary. If you have a cat, consider getting tested for toxoplasmosis. And if you think it's prudent to get an HIV test, this is a good time to do it. You can prevent problems by being in your best possible health before conceiving. If you know you have any of these conditions or any other medical problem, a consultation with your doctor before getting pregnant can save you a lot of regret later on. In addition, some medications can lead to birth defects and other problems, and these may occur before a woman even knows that she is pregnant. Even some over-the-counter medicines can increase the risk! Before conceiving, talk with your doctor or midwife about drugs that have been prescribed for you, as well as over-the-counter drugs that you take on occasion. 6. Your and your partner's gene pools can have important implications. Sickle cell anemia, Tay Sachs disease, and cystic fibrosis are examples of medical conditions that are caused by recessive genes. That means that each parent may carry one copy of the gene, but have no sign of a problem. If the baby gets a faulty gene from each parent, though, serious illness can result. Genetic testing before pregnancy can help you be aware of potential problems before you conceive. In the past, couples could use this to decide if they should have a baby together. Now there are new technologies available to help couples get pregnant with only the genetically healthiest embryos. In pre-implantation diagnosis, in vitro fertilization or IVF techniques are used to create embryos. The embryos are then tested for the genetic disease before implantation, and only unaffected embryos are chosen for transfer back into the uterus. This is only offered to couples who know their offspring are at risk for a serious condition. 7. Do you know how to make a baby? While this may lead you to think, Well, duh,, you would be surprised how many questions I get asked about the logistics of conception. For example, women often want to know how to get off birth control pills or other methods of contraception. Hormonal methods of birth control are best discontinued a few months before trying to get pregnant. While there isn't a medical risk to getting pregnant right away, the irregular periods that many women have coming off hormonal birth control can be confusing. You may spend a lot of energy wondering if you are pregnant when you aren't even cycling normally yet. As far as the nuts and bolts of making a baby are concerned, here are some statistics you may not know: In general, if a fertile man and a fertile woman have sex regularly without birth control, the chance of getting pregnant is about 30 percent a month. About 80 percent will be pregnant in 12 months, and half of the remaining couples will get pregnant in the following year. Many couples get stressed out from the pressure to have sex at a particular time. If you have sex a few times a week, there is no reason to pay close attention to when you are ovulating, even when you are trying to conceive. The chances are great that you will hit the right time within a few months. Do keep track of your periods so that you will know when you are pregnant and can start taking extra good care of yourself. Also, your practitioner will want to know the date of your last period, so that she can calculate your due date. 8. Your age may affect your fertility. The sad truth is that a woman's fertility goes down after age 35, and rapidly decreases after 40. By 45, it is rare to get pregnant, even if menstrual periods are regular. Many couples underestimate the fertility effects of being older and overestimate the genetic and medical issues. Once they get pregnant, healthy women in their late 30s and 40s are not at high risk of major pregnancy complications. And now that I have advised you to really think about whether you are ready, I have to add this caveat. While there are always social factors that influence when will be a good time to get pregnant, if it is very important to you to have a baby, consider starting by age 35. 9. If you run into trouble conceiving, fertility clinics offer hope to many couples. It can be very hard to be patient when you are trying to conceive. For younger women, trying for a year is reasonable, unless you already know there may be a problem, like your periods are very irregular, your partner had chemotherapy, or you had a serious infection in your fallopian tubes. Even if you have some risk factors for infertility, keep in mind that each month your chance of getting pregnant is almost always greater than zero, and if you wait long enough, your number may well come up. In general, fertility specialists recommend that women under 35 seek help from a doctor if they aren't pregnant after a year of trying. By age 35, consider seeking help after six months, and by age 40, get help if you aren't pregnant by three months. This will give the specialist time to work with you before you get much older. Your regular OB/GYN can start the assessment, or you can see a reproductive endocrinologist, who specializes in fertility problems. 10. Good prenatal care starts before pregnancy. A preconception consultation with your doctor or midwife empowers you to learn about your health and how you can provide the best possible environment for your developing baby, from the moment of conception though birth and beyond. Talk about:
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