Healthy Moms, Healthy Babies
By Celeste Heckman, MD
If you are considering becoming pregnant, you are most likely hoping to have a problem-free pregnancy and a healthy baby. One very important way to achieve this is to see your doctor before you are pregnant. This is called a preconception visit and it has become a routine part of care for many doctors. The baby is at greatest risk of harm from about two to 8 weeks after conception – before you may even know that you are pregnant. This makes it important that you schedule the preconception visit as soon as you decide that you want to try to become pregnant. A preconception visit should include assessment of nutrition status, medical history, genetic factors, environmental toxins and lifestyle issues.
Taking folic acid before conception reduces the incidence of neural tube defects, including spina bifida and anencephaly. Beginning at least one month before conception and continuing for the first three months of pregnancy, women should take a daily vitamin containing at least 400 mcg of folic acid. A dosage of 1 mg per day is recommended for women with diabetes mellitus or epilepsy. Women who have given birth to babies with neural tube defects should take 4 mg of folic acid.
Women over the age of 35 are at increased risk for having a baby with a genetic problem. Genetic counseling and information about antenatal testing (amniocentesis, chorionic villus sampling) could be offered prior to conception if the couple desires.
Ethnic background is also an important consideration for determining genetic risk. For example sickle cell in African American, Tay-Sachs in persons of Jewish descent, thalassemias in persons of Mediterranean or Asian descent. A family history that is positive for certain diseases including cystic fibrosis or congenital hearing loss may warrant additional screening.
An evaluation for infectious diseases should also be undertaken prior to conception. Women should be tested for HIV, hepatitis B, gonorrhea, Chlamydia, and syphilis. A blood test can also be done to see if a woman has protection against chicken pox and rubella. Immunization for rubella and varicella (chicken pox) may be given, but must be given at least one month before conception. Certain other infections can cause problems during pregnancy, including cytomegalovirus (CMV), toxoplasmosis, and parvovirus B19 (fifth disease). There are no immunizations for these infections. The best means of protection is avoidance. Toxoplasmosis is a parasite commonly found in raw meat or cat feces. Women should be counseled to avoid contact with cat feces in litter boxes, wear gloves while gardening, and avoid raw or undercooked meat. CMV and parvovirus are of particular concern for childcare workers, teachers, and healthcare professionals. Persons at risk should wash their hands frequently and use gloves or masks to prevent transmission. All women planning on pregnancy should be up to date on the following immunizations: tetanus, polio, measles, mumps, rubella, and chicken pox.
It is important to assess risk for exposure to environmental toxins- drug or chemical exposures account for 3 to 6 percent of congenital anomalies. You should review all prescription and over-the-counter medications you take with your doctor. Employers are legally required to inform workers of exposures to hazardous materials and to furnish them with Material Safety Data Sheets. Women should avoid prolonged contact to pesticides and solvents such as paint thinners and strippers. Make sure that you are not being exposed to lead in your home. If you have a child with a high lead level or are refinishing an old home, you should have your lead level tested before you are pregnant.
Smoking increases the risk of miscarriage, low birth weight, preterm labor, sudden infant death, and attention deficit disorder. Stopping smoking before you get pregnant is one of the best things you can do for your baby. Alcohol abuse can cause mental retardation, malformation, growth retardation, miscarriage and behavioral disorders in infants. The risk of having a baby with fetal Alcohol Syndrome depends on how often and how much you drink, but there is no safe level of alcohol use while you are pregnant. Women using illegal drugs such as cocaine, marijuana, or heroin will need help in quitting before pregnancy.
Women with underlying medical illnesses should visit their doctor to make sure these medical illnesses are under control and to see if any medication changes are necessary before becoming pregnant. Problems like high blood pressure, asthma. and diabetes need to be under excellent control before pregnancy. Women with history of epilepsy should discuss anticonvulsant medications and their association of congenital anomalies with their doctor. It is important for women with seizures disorder to make sure they are getting adequate amount of folic acid. Women with a history of blood clots should also seek medical advice prior to pregnancy.
Exercise and nutrition are important factors in preconception care. Obesity, as well as being underweight, increases pregnancy risks. Obesity increases the risk of hypertension, preeclampsia, and diabetes. Underweight women are at risk for preterm labor. Regular exercise is beneficial before and during pregnancy. It is important to make sure that you drink plenty of fluids and avoid becoming overheated. In the first trimester, hyperthermia associated with hot tub use has been associated with congenital anomalies. A diet which includes milk, whole grains, vegetables and fruits is recommended. Overdoses of vitamin A, vitamin D and caffeine may be toxic. Vitamin A should not exceed 3,000 IU per day. Vitamin D should be limited to 400 IU per day. Caffeine in amounts of 300 mg (two cups of coffee) is considered safe by most authorities. Common mineral deficiencies of women of childbearing age include iron and calcium. Taking a prenatal vitamin with 30 mg of elemental iron is recommended. Before conception, women need 1200 mg of Calcium per day.
If you are planning a pregnancy in your future, plan to see your family doctor to discuss your medical history, genetic factors, nutrition status, environmental exposures, and lifestyle issues that may affect your pregnancy to achieve the goal of healthy mom, healthy baby.