OBGYN.net: The Universe of Women's Health

Planning to start a family is an exciting time. Many women and their partners wonder if there is anything they can do to help make this both successful and safe. In fact there are many things that can be done to increase the chances of a healthy mother and baby.

Folic Acid Prevents Birth Defects!

We know that many things can affect an unborn baby and lead to birth defects. In fact, about 4% of all babies have some type of birth defect. While many of these are beyond our control, some can be prevented by rather simple steps. For example, we know that folic acid (sometimes called folate), can prevent most cases of a devastating type of birth defect called a "neural tube defect." This includes spina bifida, which can lead to paralysis, and anencephaly, a condition where the baby has no brain and dies shortly after delivery. Fortunately, folic acid is easy to take and comes in most multivitamins! We believe that at least 0.4 mg (400 micrograms) a day is necessary to prevent birth defects. Folic acid should be taken for at least 3 months before you get pregnant. Many doctors feel that *all* sexually active women should take folic acid just in case they become pregnant. You can eat foods rich in folic acid, such as leafy green vegetables, liver, asparagus, beans, oranges, orange juice, peas, rice, and soybeans. Or, you can easily obtain a prescription prenatal vitamin from your doctor or midwife.


Medical Problems and Planning a Pregnancy

There are a number of serious medical problems that can possibly harm an unborn baby (or the mother). For example, women with diabetes should always see a doctor before getting pregnant. If diabetes is well controlled before getting pregnant, there is less risk of birth defects and harm to the baby. The mother, too, gets a lot of benefit from having her blood sugars controlled before getting pregnant. Certain heart problems make becoming pregnant dangerous. There are only a few of these, such as Marfan's Syndrome, pulmonary hypertension, and certain serious heart valve problems. In some cases, up to half of the women with these heart problems who become pregnant will die! Thus, if you have a serious heart problem, always see your doctor before starting a family. Women with kidney disease should also see their doctor before starting a family. Kidney disease may become worse in some pregnancies, so your doctor will want to check out your kidneys before you conceive. Asthma can get better, worse, or stay the same in pregnancy. Contrary to popular belief, it is almost always better to take asthma medications during pregnancy. After all, the baby needs oxygen through the umbilical cord to grow and develop. If you have asthma, see your doctor before you get pregnant.

Of course, there are other medical problems that should prompt a visit to your doctor before you conceive. One pregnancy-related problem is a history of a tubal ectopic pregnancy (when the pregnancy is stuck in the fallopian tube). If you are over the age of 35 or have had complicated pregnancies, discuss these with your doctor before becoming pregnant. Indeed, if you have any medical problem that you receive regular care for, make an appointment with your doctor to discuss the impact this condition will have on pregnancy. Your doctor will appreciate the chance to review things with you before you become pregnant.

The Weight Connection

Doctors now know that being very overweight can sometimes cause serious problems during pregnancy. These problems include a higher chance of spina bifida (see above), high blood pressure, diabetes, and very large babies. Also, it is much harder to feel the size of the uterus (womb). Sometimes this prevents your doctor or midwife from diagnosing a problem that can harm the baby. Being very overweight also makes it much harder to do an ultrasound (sometimes called a sonogram) to evaluate the baby, or to even tell if the baby is a girl or a boy. Women who are overweight should try to gain a little less weight during pregnancy than women who are at normal weight. For example, the average pregnant women should aim for a weight gain of about 25-35 pounds, while overweight women should attempt a weight gain of only 15-25 pounds. Always discuss appropriate weight gain with your midwife or doctor.


Smoking: Very Dangerous for Babies

It is now obvious to doctors that smoking is very dangerous for pregnant women and babies. Women who smoke have a higher chance of delivering small babies, and babies that die after being born. Smoking during pregnancy also can lead to growth restriction of the baby from lack of oxygen, preterm birth, miscarriage, and placenta previa (where the afterbirth is too low and can cause hemorrhage during pregnancy). Therefore, if you smoke, make a very serious effort to quit *before* you become pregnant.


Alcohol and Drugs

Both alcohol and street drugs are dangerous to babies, and can even cause them to be stillborn or have devastating birth defects. Many babies born to women who use drugs or alcohol have painful withdrawal symptoms after they are born. Since we do not know how much (if any) alcohol is "O.K." to drink when pregnant, we strongly advise staying completely away from all alcoholic beverages during pregnancy. This goes for street drugs (cocaine, heroin, marijuana, etc.). If you have an addiction to alcohol or drugs, now is the time to get help from your doctor.


Caffeine, Exercise, Hot Tubs.

Since caffeine may be linked to miscarriage and fetal growth restriction, most doctors suggest limiting caffeine intake to 2 cups of coffee or 3 soft drinks, or less, per day. Exercise is generally an excellent idea during pregnancy, but very heavy exercise, for instance running marathons, water skiing, and vigorously riding personal watercraft may be unhealthy for the baby. Swimming is an excellent all-around exercise during pregnancy. Hot tubs and very hot baths are probably not a good idea during pregnancy, particularly during the first few months. This is because excessive heat has been linked to birth defects like spina bifida and anencephaly.


Family History

If you have a family history of sickle cell, thallasemia, mental retardation, Tay Sachs, or any other inherited diseases, make an appointment with your doctor to discuss special testing.
Medications

Although many medications are safe for use during pregnancy, some may be harmful to your baby. Specific medications that may be harmful include oral diabetes pills, some seizure medications (including valproic acid), oral blood thinning agents (coumadin), a specific type of blood pressure pill called an "ACE-inhibitor," and some hormone medications, specifically those that contain male hormones. However, do not stop taking these medications without first consulting a doctor, as stopping the pill suddenly may be even more harmful than taking the medication! Contrary to popular belief the hormones from the birth control pill are out of your system within a few days, and, regardless, they have not been found to be harmful to an unborn baby. However, it is helpful to stop them a few months before trying to get pregnant because it makes it easier for your doctor or midwife to determine your due date. Finally, even though most over the counter medications are safe during pregnancy, we discourage the use of any unnecessary medication when pregnant.


The Menstrual Cycle: When Should We Try?

In medicine, we call the very first day of menstrual bleeding "cycle day number 1." Using this system, most women have the best chance of getting pregnant around cycle day numbers 12-15. This is the time when most women ovulate, which is when the egg is released from the ovary into the fallopian tube. Begin counting each cycle beginning the first day of your period, and when you get to day number 12 or 13, have intercourse. Most authorities suggest having intercourse at least one more time over the next few days. If you use a personal lubricant, consider using mineral oil, which does not seem to damage sperm. The position of intercourse does not seem to matter for most couples trying to get pregnant. Finally, the best time to take a home pregnancy test is when you miss your next period.


Summary of Things You Should do When Planning a Pregnancy

• Obtain a prescription for prenatal vitamins that contain 400 micrograms of folic acid.
• Discontinue smoking.
• Discontinue alcohol.
• Discontinue all street drug use and obtain addiction counseling if needed.
• Stop using any unnecessary over-the-counter medications.
• If necessary, review all prescription medication use and medical problems with your doctor.
• If very overweight, start an exercise plan and eat healthier. If necessary, ask your doctor.
• Keep close track of your menstrual periods.

D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida