Preparing for Pregnancy
Preparing for Pregnancy
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A woman's body goes through many changes over the nine months of pregnancy and the developing baby makes increasing demands. Being as fit and healthy as possible maximises the chances of a healthy pregnancy.
Many women re-evaluate their health and lifestyle once they know they are pregnant. However, by the time a woman has missed her first period, she is already two weeks pregnant, so it's best to prepare for a pregnancy before trying to conceive.
Contraception allows couples to plan the timing and spacing of children. It is important to consider plans for pregnancy when deciding on a method of contraception. Some methods such as the condom and diaphragm can be stopped immediately. Also, there is no significant delay in return to fertility after stopping the pill or having a coil removed. However, women who use the contraceptive injection need to be aware that because the contraceptive is released slowly over time, return to fertility can be delayed for up to nine months.
Although there are a number of ways of predicting the most fertile time in a woman's cycle, which is generally the five days leading up to ovulation, the Royal College of Obstetricians and Gynaecologists discourages couples from attempting to time intercourse. Instead they advise regular intercourse, two or three times a week, throughout the woman's cycle. 70% of normal, healthy couples conceive within six months, and 95% of couples conceive within two years.
Being very overweight or underweight can make it more difficult to conceive. Dieting is not recommended during pregnancy as this can affect the supply of nutrients to the baby. It is normal and healthy to gain weight gradually over the course of a pregnancy. The Department of Health advises pregnant women to eat according to their appetite, and to keep an eye on weight gain. Women who are the correct weight for their height, with a normal body mass index (BMI), should put on around 11.4-15.9 kg during pregnancy. Women who are underweight, with a BMI of less than 19.8, should gain more weight than average (up to 18.2kg), and those who are overweight, with a BMI of more than 26, should gain less (6.8-11.4kg).
Eating a healthy diet before pregnancy means that the body has adequate stores of vitamins and minerals. A nutritious, well-balanced diet includes foods rich in protein such as meat, fish, eggs and pulses; dairy foods which supply calcium; starchy foods such as cereals, bread, potatoes and pasta; plus plenty of fruit and vegetables that supply vitamins and fibre. It is best to avoid a lot of sugary, salty or fatty foods. A well-balanced vegetarian diet should provide all that is needed, but vegans may need to take advice on supplements such as calcium, vitamin D and vitamin B12.
Folic acid (a B vitamin) is the only vitamin supplement that is recommended for women who are otherwise eating a balanced diet. Folic acid is needed for the development of healthy red blood cells, and adequate intake decreases the chance of a baby being born with neural tube defects. A baby's brain and spinal cord are formed from the neural tube. One example of a neural tube defect is spina bifida, where an area of spinal cord is not properly enclosed. This can cause problems such as paralysis of the legs and lack of control of bladder and bowels. The baby's neural tube is completely formed by the fourth week of pregnancy – when many women have not even realised they are pregnant.
It is therefore best to start taking folic acid supplements while preparing for pregnancy or as soon as a woman realises she is pregnant. 400 micrograms is the recommended daily dose, which should be over and above the usual recommended dietary intake of 200 micrograms. Folic acid occurs naturally in fresh dark green vegetables such as broccoli, peas, green beans and spinach. Many breakfast cereals are fortified with folic acid and it is also found in wholemeal bread.
A higher dose of folic acid is recommended for some women. It is very important that women who have previously had a baby with a neural tube defect, or who have epilepsy or diabetes, consult a GP about folic acid supplementation before trying to conceive.
Most people are aware of the positive health benefits gained from giving up smoking. It is particularly beneficial to stop smoking before becoming pregnant. Smoking may reduce fertility. Smoking during pregnancy is also linked with low birthweight and associated with other risks for the baby such as being born prematurely, death around the time of birth and sudden infant death syndrome (cot death).
Although it can be very difficult to give up smoking, many women find pregnancy is a strong motivation. Many strategies to help people quit are available, such as nicotine replacement therapy or other medications, and GPs can provide advice about these.
Most people also realise that excess alcohol is bad for their health. Too much alcohol may also decrease fertility. Heavy drinking can also cause problems for a developing baby, and lead to poor growth, intellectual impairment or birth defects (fetal alcohol syndrome). The standard advice from doctors is that women who are trying to conceive, or at any stage during pregnancy, should avoid getting drunk, and should drink no more than one or two units of alcohol once or twice per week. It's particularly important to follow this advice during the first three months of pregnancy, when important organs such as the brain are forming.
Ideally, minimise factors that lead to stress and anxiety when preparing for pregnancy. Eating well and getting plenty of exercise and sleep all help.
Hazards at work
Some working environments can have an impact on fertility and others can pose a risk to a developing baby. Chemicals, lead, anaesthetic gases and X-rays can all be hazardous and advice should be sought from a GP or HR representative if you are routinely exposed to these.
Existing medical conditions
It is always best to get advice about any existing medical conditions before trying to conceive. Some conditions are affected by pregnancy and others can have an impact on the developing baby. Prescription medicines may need to be modified. Whether the problem is longstanding such as asthma, diabetes and epilepsy or whether there is a history of an important past event such as a thrombosis (e.g. DVT), specialised, personal advice is needed from a GP as far in advance of pregnancy as possible.
Rubella (German measles) used to be a common childhood illness but most people are now immunised against it. If women catch Rubella during pregnancy, especially in the first three months, this can cause malformations in the developing baby.
Women can have their immunity checked by a blood test before they plan to conceive. If women need to be immunised, then it is recommended that they should not become pregnant for at least one month following the immunisation.
Women or their partners who have a personal or family history of genetic or chromosomal disorders, such as cystic fibrosis or Down’s syndrome, may need to be referred for specialist genetic counselling. Information and advice with regard to future pregnancies can then be tailored to their personal situation.
Advice for the father
All general life-style advice addressed to women, such as eating healthily, stopping smoking and avoiding excess alcohol, are just as relevant to men as their fertility can also be affected by these factors. Men are also advised to wear loose-fitting underwear as excess heat can be harmful to the quality of sperm.
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