If you are planning to become pregnant, you should aim to give yourself the best chance of a healthy baby.
Because a woman’s health and wellbeing before conception can affect her baby’s health and development, there are many factors to consider prior to becoming pregnant to give the best chance of a healthy pregnancy and baby.
Steps taken prior to conception to optimise your health can have significant long-lasting benefits for you and your baby.
A healthy lifestyle is of prime importance.
A balanced diet that includes appropriate portions of a variety of food groups is recommended.
This means eating plenty of vegetables of different types and colours, as well as fruit, grain (cereal) foods, lean meat, poultry, fish, eggs, nuts, and dairy products.
Where possible, fresh unprocessed food is best as processed foods may have unhealthy additives such as sugar and salt.
A healthy, well-balanced diet is recommended before, during and after pregnancy. Some women will need specific supplements.
All women should take at least 0.5mg of folic acid for at least the month before a planned pregnancy, and for the first three months of pregnancy to redue the risk of neural tube defects and spina bifida (incomplete development of the baby’s brain, spine or spinal cord).
Where there is a known increased risk of neural tube defect, a 5mg daily dose of folic acid is recommended. Women who should take 5mg of folic acid are those taking anticonvulsant (epilepsy) medication, women with diabetes, women who are obese, or who have had a previous child or a member of their family affected by a neural tube defect, and those who are at a risk of poor absorption of their food.
An iodine supplementation of 150mcg per day is also recommended pre-pregnancy, during pregnancy and while breastfeeding as it is imprtant for your baby’s brain development.
Women who are underweight or overweight have a higher risk of problems in pregnancy. Women who are very underweight may have reduced fertility and may expose their babies to nutritional problems.
A common problem is overweight and obesity. Carrying too much weight can reduce fertility and may increase the risk of miscarriage and other serious problems for the baby. The more overweight a woman is, the greater her risk of problems in pregnancy. These risks include diabetes, pre-eclampsia (high blood pressure), excessive bleeding and developing blood clots. There are also higher anaesthetic risks and greater likelihood of requiring a caesarean section.
Weight is a very sensitive issue for many women. However, because of the great benefit to the mother and her future baby, it is recommended that steps should be taken to lose weight in a healthy manner. These steps include dietary change (help from a dietician can be valuable) and exercise. We recommend that obese women not try for pregnancy until steps have been taken to reduce weight.
Moderate exercise improves fertility, particularly for people who are overweight or obese. If you are overweight or obese, you should aim to return your weight to normal with a healthy diet and regular exercise. Exercising together with your partner may be beneficial for both your health and relationship.
Having the best possible control of any medical problems before pregnancy can improve pregnancy outcomes. For example, for women with diabetes, blood sugar control is important prior to pregnancy and during the first three months of pregnancy – better blood sugar control lowers the risk of harm to the baby. It is important to discuss the management of any medical conditions with your doctor prior to conception.
Check your medication
It is important to review all current medications, including over-the-counter preparations, for appropriateness and safety in pregnancy. Some women may need to change medications prior to trying for pregnancy. Avoid stopping long-term medication abruptly without discussing this with your doctor.
Cigarette smoking affects the quality of a woman’s eggs and the number of healthy eggs she has in reserve. Smoking can also reduce the quality of the man’s sperm.
Smoking during pregnancy can harm the placenta, and the placenta is vital for the baby’s nourishment and ability to rid the baby’s waste products. Smoking may restrict the growth of the baby in the mother’s womb. Babies whose growth has been restricted by the placenta not working well, have a higher chance of childhood obesity and adult diseases such as high blood pressure.
Babies of mothers who smoke are at risk of problems both before and after birth. It is important to stop smoking before trying for pregnancy – seek help from your family doctor to quit.
Alcohol and illicit drugs
Alcohol reduces fertility in men and women, and can harm the developing baby. For women who are pregnant or planning a pregnancy, not drinking alcohol at all is the safest option.
Illicit drugs can also adversely affect fertility, the development of the baby and pregnancy. Illicit drug use should cease prior to and during pregnancy – seek help with this if you need to.
Check and reduce the risk of exposure to toxins, infections or radiation for both you and your partner in the household, workplace, or during recreational activities.
Travel may expose women and their partners to infections which could adversely affect a pregnancy. Specific medical advice may be required depending on the area visited. For example, a woman or her partner returning from a Zika virus affected area should avoid pregnancy until their doctor advises it is safe to conceive.
Seeing a doctor before trying for pregnancy is important. This allows your doctor to make sure that:
- any existing medical condition is well-controlled
- you are up to date with appropriate vaccinations. For example, checking your immunity for German measles (Rubella) and chickenpox. Each of these infections occurring during pregnancy can cause serious harm to the baby. Vaccines are available for both Rubella and chickenpox. You should vaccinate at least four weeks prior to becoming pregnant. Women should not receive the vaccine if they are pregnant or might become pregnant within four weeks
- you have a blood pressure check and general examination and, where appropriate, breast examination and a pap smear.
- if there is a significant risk of a chromosomal or genetic condition based on your or your partner’s family history or ethnic background, then pre-pregnancy genetic testing and counselling may be needed. This includes inherited diseases such as Cystic Fibrosis, Muscular Dystrophy and Thalassemia
- a review of the outcomes of any previous pregnancies (e.g. pregnancy loss, children born with health problems, mother having gestational diabetes) is worthwhile to determine whether there are any measures which could reduce the chance of recurrence
Making sure the future father is in good health is important too. Obesity, cigarette smoking, excessive alcohol use, some medications, illicit drug use and a poor diet all may affect a man’s fertility and may also affect pregnancy outcomes.
A healthy lifestyle with regular exercise and a healthy diet, as described above, are just as important for men.
DISCLAIMER: This information is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This information reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. RANZCOG disclaims all liability to users of the information provided.