Planning for a healthy pregnancy
(This information provided by the March of Dimes Birth Defects Foundation)
You know that you need to take special care of yourself when you are pregnant. You need to eat right, get plenty of rest and change potentially harmful habits such as smoking and drinking alcohol. You also know it's important to begin regular prenatal care at the first sign of pregnancy.
What you may not know is that there are steps you can take -- before you conceive -- to improve your chances of having a healthy baby. They include: taking the B vitamin folic acid daily; visiting your health care provider for a pre-pregnancy check-up; and adopting a healthy lifestyle. So, if you think you're ready to have a baby, think ahead.
How can taking folic acid improve the baby's health?
The most crucial stages in your baby's development will occur before you may realize you're pregnant. Harm from certain infections or illnesses, drugs, alcohol, nutritional deficiencies and environmental hazards can be minimized if precautions are taken early.
You can help prevent certain birth defects of the brain and spine -- called neural tube defects -- by starting to take the B vitamin folic acid before you become pregnant. The U.S. Public Health Service and the March of Dimes Birth Defects Foundation recommend that all women of childbearing age consume 0.4 milligrams (400 micrograms) of folic acid daily. Since it is difficult to get enough folic acid through diet alone, you can make up the difference by taking a daily multi-vitamin.
Studies show that folic acid reduces by at least 50 percent the risk of spina bifida (open spine) and anencephaly (a lethal defect involving the brain and skull) and related birth defects. It is important to begin taking folic acid at least a month before you become pregnant, as these defects develop in the first month after conception.
Women who have already had a baby with a neural tube defect can reduce their risk of recurrence by taking a higher dose of folic acid. Your doctor may recommend that you take 4 milligrams from at least one month prior to pregnancy through the first three months of pregnancy. Studies show that this amount reduces recurrences by more than 70 percent.
How important is a pre-pregnancy check-up?
"The pre-pregnancy visit may be the single most important health care visit viewed in the context of its effect on pregnancy," according to a 1989 report of a federal panel of experts on prenatal care. The panel recommended that all women visit their health care provider at least once before conception.
A pre-pregnancy visit is especially important if you had a problem with a previous pregnancy, such as miscarriage or pre-term delivery. The cause of the problem can often be diagnosed and treated, so that your next pregnancy is likely to be a healthy one. Such a visit is crucial if you have a chronic health problem, such as diabetes, which can increase your risk of having a baby with birth defects.
As part of your pre-pregnancy visit, you will be asked questions about your medical history, past pregnancies and lifestyle. This is the time to ask questions and discuss concerns you may have, such as whether medications you take are safe during pregnancy or whether your workplace or hobbies expose you to potential hazards.
Before pregnancy is the best time to evaluate a woman's health. The better your health is before conception, the better your chances are for having a healthy pregnancy -- and a healthy baby.
What problems can a pre-pregnancy visit identify?
Screening tests for infections, sexually transmitted diseases or other health hazards can be done before pregnancy, so that existing conditions can be treated before conception. Blood tests can measure immunity to infections that could cause mental retardation or other birth defects if contracted by a pregnant woman. These include:
- Rubella: Women not immune to rubella (German measles) can be vaccinated before pregnancy, though conception should be delayed for three months after vaccination.
- Toxoplasmosis: Some doctors screen for immunity to toxoplasmosis, a mild parasitic infection that can seriously affect a fetus. Unless the woman knows she is immune, she should avoid known sources of infection, such as eating undercooked or raw meat, handling cat litter, or digging in the ground or dirt without wearing gloves.
- Hepatitis B: The Centers for Disease Control and Prevention recommend that all pregnant women be screened for hepatitis B. Untreated infants of infected mothers have about a 50 percent chance of contracting the virus, which commonly results in liver disease and cancer in adulthood. Though prompt immunization and treatment after birth can usually prevent infection in the baby, screening prior to pregnancy can help uninfected women (e.g. health care workers who handle blood) get protection through vaccination.
- Other Infections: A doctor may also screen for certain vaginal and urinary tract infections that may increase the risk of premature labor.
A pre-pregnancy visit also can include discussion of inherited diseases that might be passed on to the baby. Blood tests can identify carriers of a number of serious disorders, including:
- Tay-Sachs disease, which causes fatal brain damage and primarily affects people of Eastern European Jewish ancestry.
- Sickle-cell disease, a blood disorder that mainly affects African Americans.
- Thalassemia, a blood disorder primarily affecting people of Mediterranean descent.
Carrier screening before pregnancy may reassure a couple that their children are not at increased risk for a specific inherited disease. It can also allow carriers more time to discuss their options and make decisions about further steps, such as prenatal diagnosis. Age-related chromosomal defects such as Down syndrome should also be discussed if the woman is 30 or older.
What other maternal illnesses can harm a fetus?
Chronic conditions such as diabetes, hypertension (high blood pressure), systemic lupus erythematosus and epilepsy can pose risks to both mother and baby. Expert care beginning prior to pregnancy helps reduce these risks.
- Diabetes: Women with poorly-controlled insulin-dependent diabetes have a four-to-six times greater risk of having a baby with birth defects than non-diabetic women. But if blood sugar is well controlled before and during pregnancy, chances for delivering a healthy baby are excellent.
- High Blood Pressure: Women with chronic high blood pressure are at increased risk of pregnancy complications, including placental problems and fetal growth retardation. It is important to your physician to know how severe your high blood pressure is before pregnancy, in order to determine the best course of treatment during pregnancy. As certain medications for high blood pressure are considered safer than others in pregnancy, your doctor may recommend changing your medication before you attempt to conceive.
- Systemic Lupus Erythematosus (SLE): This autoimmune disorder -- in which the body attacks its own tissues -- can cause arthritis-like symptoms, kidney disease, skin rashes and other problems. During pregnancy, SLE increases the risk of miscarriage or pre-term labor. However, if your SLE symptoms have been inactive for at least six months, you are very likely to have a healthy pregnancy. Preconception care makes it possible to plan the safest timing of your pregnancy. You may also need to alter your medications.
- Seizures: Some medications used to control seizures increase the risk of birth defects. During a pre-pregnancy visit, a doctor can evaluate whether to discontinue drug treatment altogether, adjust the dose or switch to a safer drug. A woman never should stop taking seizure medications without asking her doctor, as seizures themselves might harm a fetus.
- Phenylketonuria (PKU): It is crucial for women with this inherited error of body chemistry to resume the special diet they followed in childhood in order to prevent mental retardation and birth defects in their offspring. The diet must be begun prior to pregnancy and continued throughout pregnancy.
- Medications: During a pre-pregnancy visit, all women -- not just those with chronic illnesses -- should ask their doctors about the safety of any medications they take. This includes even occasional use of over-the-counter medications for a headache or cold.
What other lifestyle factors can affect the growing fetus?
Modifying certain lifestyle behaviors prior to conception can improve your chances for a healthy pregnancy. Women who drink heavily risk having a baby with fetal alcohol syndrome, a pattern of mental and physical defects. But even light or moderate drinking may pose a risk to the fetus, so it's best to avoid drinking completely, beginning prior to conception and throughout pregnancy. Smoking doubles your risk of ectopic pregnancy and miscarriage, as well as your chances of having a low-birth weight baby. Use of cocaine in early pregnancy appears to increase the risk of certain birth defects and miscarriage. Women who continue to use the drug have up to six times the normal risk of having a low-birth weight baby.
You should avoid hot tubs and saunas if you are attempting to conceive, as elevated body temperature in early pregnancy may increase the risk of neural tube defects. It also is a good idea to cut back or eliminate caffeine from your diet, as some studies suggest that drinking as little two caffeinated drinks a day may delay conception and increase your risk of miscarriage. A pre-pregnancy visit also is a good time to ask your doctor about any potential hazards in your work place, such as lead, mercury, industrial solvents or radiation, or any posed by your hobbies.
Does the father need pre-pregnancy care, too?
Research suggests that factors ranging from a father's exposure to work place hazards to his smoking or alcohol use may play a role in pregnancy outcome. While this is a new area of research, men may be wise to change unhealthy behaviors before conception, and to bring any questions about exposure to harmful substances to their doctors.