Often, patients who come see me ask whether I deliver babies. Indeed I do! And it’s always nice to build a relationship with patients before they get pregnant so that they are more comfortable with me during the 9 months we’ll spend caring for mom and baby.
In addition to what usually happens during an annual gynecologic visit, good pre-pregnancy care deserves special consideration. The peroid of thime before you get pregnant is the best time to improve control of any chronic medical conditions you may have (high blood pressure, asthma). A doctor should talk to you about any medications you may be taking which pose a potential risk to a developing fetus.
One medication is routinely recommended for all pregnant women. Folic acid (folate) supplementation should begin prior to conception. Ideally, it should begin at least 2-3 months prior to trying to conceive. Most women require 400 micrograms (mcg) of folic acid to prevent a specific birth defect (Spina Bifida, which can cause a child to be unable to walk).
Some women require more folic acid (800-4000 micrograms) depending on their risk factors for delivering a baby with spina bifida. These risk factors can include certain medications (especially anti-seizure drugs), certain medical conditions, and a prior history of a child or other family member with spina bifida.
Prenatal vitamins usually contain 400-800 micrograms of folic acid in combination with other vitamins and minerals. You can bring your prenatal vitamin (in the bottle) to your doctor’s visit to review whether it contains everything you’ll need during pregnanty. Alternatively, ask your healthcare provider to recommend a prenatal vitamin or other supplements for you.
Good pre-pregnancy care also includes certain blood tests. A test may be required to determine whether a prospective mother is immune to Rubella (also called “German measles”) and Varicella (a.k.a. “Chicken pox”). That’s because both of these disease can cause birth defects if the virus that causes them is contracted during pregnancy. Immunizations are available for both Rubella and Varicella and should be administered to non-immune women several months prior to attempting to get pregnant. Neither vaccine is administered during pregnancy.
Testing for infections, including HIV (Human immunodeficiency virus), gonorrhea, chlamydia, and tuberculosis may be a good idea for women who are at risk for these conditions. A conversation with your doctor can help him or her determine whether you are at risk and require screening.
It’s always a good idea to maintain a healthy weight. This is espceially important before and during pregnancy. Managing your weight before you get pregnant may help reduce your risk of diabetes and blood pressure problems during pregnancy. Avoiding excess weight gain during pregnancy can make for an easier delivery and a faster return to your pre-pregnancy body. A healthy diet and regular exercise will help you manage your weight. Advice from a doctor, nutritionist, or weight-loss counselor may help if you’re having trouble.
Lastly (and perhaos most importantly) avoiding alcohol, cigarettes, illicit drugs and other toxic substances is of tremendous importance when you are pregnant. All of these substances can seriously impair maternal health. They may also contribute to to an increased risk of miscarriage, preterm birth, low birth weight, and (in the case of alcohol) low I.Q. and birth defects. The best time to stop using these substances is before conception. Again, assistance from a doctor or substance-abuse program may help.
It’s a good idea to schedule a visit with your gynecologist to discuss the best way to prepare for a healthy pregnancy.