PREPARING FOR PREGNANCY
If you are trying to conceive it is best for you and your partner to maintain a healthy lifestyle, reduce alcohol consumption and smoking, eat well and exercise moderately. If you have any medical conditions or take prescription medications, natural supplements or other drugs, it may be wise to discuss these with your doctor in advance.
Being very overweight or underweight has been shown to interfere with ovulation and fertility. Aim to keep your weight within the healthy weight range for your height before pregnancy.
For women with polycystic ovarian syndrome this may not be so easy. However, there are some very good management strategies that have been developed in recent years and it is worth speaking to dieticians who have some expertise and experience with this condition.
During pregnancy, it is normal to change weight and shape. Often this is a very difficult issue for many women and it is not unusual to become very self-conscious and even depressed about body image. If you are eating well, exercising regularly and maintaining a reasonable healthy lifestyle it is likely that your body changes are all quite normal. However, if you are feeling concerned about your weight and your body changes, talk to your doctor or midwife who will refer you to an appropriate health professional.
Regular, moderate exercise is recommended as part of a healthy lifestyle. Good exercise patterns developed before pregnancy should help your body cope with the de-mands of pregnancy, childbirth and the postnatal period. Some women may find meditation, relaxation classes or yoga also helpful. Certain contact sports (e.g. judo, weight-lifting) may be unsuitable for pregnant women, so it is advisable to look into this. Check with your doctor if you are uncertain about any aspect of exercise during pregnancy.
Long distance air travel while pregnant may put you at increased risk for deep vein thrombosis (DVT). It may be worth considering the timing of such travel to before, or after, pregnancy.
Diet and nutrition
Attention to diet can help you before, during and after pregnancy. Diet can improve fertility, help to ensure the development of a healthy baby and optimise your own health and wellbeing.
Aim to eat regular meals including a wide variety of foods from each of the main food groups. This will help to ensure an adequate intake of all nutrients and other beneficial factors from food. Nutrients such as protein, iron and calcium will become more important once you are pregnant.
Women with diabetes, an eating disorder or those who follow a strict vegetarian diet, should seek specific advice when planning a pregnancy. Optimal diabetic control is critical to minimise the risks associated with diabetes in pregnancy. Women with eating disorders such as anorexia or bulimia are at risk of nutritional deficiencies that may im-pact on the development of the baby. Women following a vegetarian or vegan diet, which excludes all animal foods, are at risk of B12 deficiency, which may affect the healthy neurological development of the baby.
Folate is especially important both during the preconception period and for the first three months of pregnancy because it reduces the baby’s risk of neural tube defects (spina bifida). Folate-rich foods include green leafy vegetables, cereals with added folate, fruit, dried beans and peas.
It is recommended that women intending to become pregnant take 0.5mg of folic acid a day for one month before pregnancy and for the first three months after becoming pregnant. If you have a family history of spina bifida or cleft palate, or are on anti-epilepsy medication, it is important to talk to your doctor about this before you become pregnant as higher doses of folic acid may be recommended.
Caffeine and guarana
There is some evidence that caffeine can reduce fertility, so it may be advisable to limit yourself to a moderate intake – about two cups of weak coffee or five cups of tea per day.
Remember that caffeine is also present in Coke and energy drinks like V and Red Bull, so also limit your intake of these. Guarana, a caffeine substance used in some of these drinks, is not recommended in pregnancy.
In excess, Vitamin A can be harmful to the developing baby. As liver contains very large amounts of Vitamin A, limit any intake to small amounts (50g per week at most). There is little danger of excessive Vitamin A intake from other foods, however, it is often present in multivitamin supplements so check that they are specifically recommended for pregnancy.
Listeria is a bacteria that can contaminate food. If ingested it can result in an infection that can be harmful during pregnancy. Good hygiene when preparing and storing food is important. There are specific guidelines to minimise your risk of listeria infection, including food handling, food storage and susceptible foods. If there is any chance that you may be pregnant it would be wise to avoid the following foods:
- uncooked or smoked seafood
- deli meats
- packaged and commercially prepared salads
- soft cheeses
All women planning a pregnancy are advised to consult their general practitioner with a view to:
- Detecting any clinical conditions that may be of relevance to the forthcoming pregnancy but are ideally managed prior to pregnancy
- Further assessment of any conditions of relevance and optimising any treatment with respect to the forthcoming pregnancy
- Obtaining general advice regarding personal health care in early pregnancy, in-particular, medications, alcohol, X-rays
Most important is a detailed medical history and clinical examination. The following investigations are recommended:
- Rubella immunity status (if this is unknown)
- Varicella immunity status (if unknown and the patient does not give a clear history of varicella)
- Cervical smear (if clinically appropriate)
First Antenatal Visit in Pregnancy
All women should be advised to attend in early pregnancy with a view to:
- Confirming pregnancy and establishing an estimated date of confinement (albeit that may alter after subsequent ultrasound examinations)
- A comprehensive clinical assessment in order to determine any clinical conditions that may be of relevance to the pregnancy
- Detailed assessment of any particular conditions or circumstances of relevance and optimizing management for pregnancy
- Obtaining general advice regarding common issues of concern in early pregnancy and management of the pregnancy
All women in early pregnancy should be informed with respect to:
- Potential teratogens (medications, alcohol, X-rays)
- Vitamin and mineral supplementation (see college statement)
- Model of care, expected visit frequency, place of booking for confinement, expected costs for both pregnancy and confinement