1. Stop contraception!
Of course this sounds obvious, but its not always straightforward! If you are using condoms, the cap or a diaphragm, then its obvious how to go about it and what to expect. If you have been using the pill, then its best to stop at the end of a packet to help avoid irregular spotting. If your periods before you started the pill were irregular, you may find that it takes a few months to settle down again to a normal cycle. If this hasn’t happened by 6 months its is worth seeing your GP to see why this might be happening. Some doctors suggest leaving it a few months to allow your cycles to get back to normal and this will help with dating of the pregnancy. It isn’t strictly necessary, however.
If you have a coil in, this can be taken out at any time of the cycle, but is least uncomfortable just after the end of a period. Even if you have one of the newer coils, such as the Mirena, your fertility should return within a month or two.
If you have been using the depot provera injection, which is used every 3 months, it can take some time for your periods to come back and for pregnancy to occur. This can be even as long as 12-18 months, so plan early!
2. Prenatal vitamins
Folic acid supplements are now well proven to help prevent neural tube defects, such as spina bifida and anencephaly. The dose needed is 400 micrograms per day, or 5mg per day if you have had a previously affected child or are taking medication for epilepsy. This is best taken for 3 months prior to pregnancy or at least as soon as you think you are pregnant – most of its useful effect will be before you even realise you are pregnant, so taking it beforehand is preferable. These can be stopped at 13 weeks gestation. For women who otherwise have a healthy diet, there is no need for extra vitamin supplements, but if you do not eat a healthy range of foods, then one of the multivitamins specifically for pregnancy might be advisable. Be sure it is one that does not have high levels of Vitamin A, which is toxic for a developing baby.
3. Optimising health
There are some medical conditions that may affect pregnancy directly, or that may be affected by pregnancy. The particular medications that are needed for these may need to be altered or stopped before pregnancy. Some conditions where pre-pregnancy counselling might be useful include: diabetes, epilepsy, hypertension or thyroid disorders. Your Obstetrician will probably wish to see you in a joint medical clinic at the hospital and keep a closer eye on things throughout pregnancy.
4. Avoiding risky infections
Listeriosis is cause by a bacteria, which if caught during pregnancy, can result in miscarriage, stillbirth or illness in the baby. It affects around 30,000 births each year in the UK. High levels of listeria are found in some foods, so it is advisable to avoid the following: unpasteurised milk, pate’ made from meat, fish or vegetables, mould-ripened and blue-veined cheese, soft-whip ice-cream from ice-cream machines, pre-cooked chicken & cook-chill meals and prepared salads unless washed thoroughly.
Toxoplasmosis is an infection caused by a parasite which is normally harmless in adults. Around 10% of adults catch it each decade of their life, so you may have already had it & not be susceptible. If it is caught during pregnancy, it can cause miscarriage or congenital problems for the baby. In the UK it is very rare, but the effects can be severe. The parasite lives in cats, and cat litter, which can remain infectious for up to 18 months. Fresh fruit, vegetables and lettuce are all potential sources of infection. The following safety precautions are all that is needed: wear gloves for gardening & wash your hands afterwards, ask someone else to empty the cat litter tray or take the same precautions as for gardening, wash vegetables well before eating. There is no need to get rid of your cat or stop petting it!
Chicken-pox can cause problems early in pregnancy, so if you are pregnant, or have missed your period and aren’t sure, try and avoid anyone with this. It is much less of a risk if you have already had the disease before. If you accidentally come into contact, your GP will be able to check your immunity with a quick blood test.
Parvovirus is also called slapped cheek syndrome and is common among young children. There is a typical appearance to the cheeks, as you might expect by the name. The infection is most risky for pregnant mothers later in gestation than early, but affected children are best avoided if possible!
5. Alcohol and smoking
Alcohol, particularly in excess, can affect fertility in both partners. More than one or two drinks a day is associated with an increased risk of difficulties getting pregnant. Once you are pregnant, excess alcohol can lead to growth problems, malformation, mental handicap or even stillbirth. These are at excessive levels and a standard unit of alcohol or two, a couple of times a week has not been found to be harmful. Smoking is a risk for getting pregnant, during pregnancy and for a new baby. For both partners, it can delay conception. Smokers who are pregnant are more likely to miscarry, experience bleeding during pregnancy, give birth prematurely and have smaller babies than if they hadn’t smoked. Having a smoker in the household also increases the risk of sudden infant death syndrome (SIDS) as well as making infections more common in the first year of life.
Before embarking on pregnancy, exercise will improve your stamina, suppleness and strength, helping you deal with the extra strain placed on your body as pregnancy progresses. Exercise has other health benefits, such helping you relax and assisting weight loss, if this is a problem. Excessive exercise, however, can lead to difficulties conceiving, and some women who exercise excessively do not have periods at all because of this. Fertility will return with reducing the frequency of exercise.
7. Weight control
You should try and aim to be the right weight for your height before becoming pregnant. If you are overweight, consider losing some weight first of all, by a combination of calorie reduction combined with a graded exercise programme. Do not attempt to crash diet! You are more likely to conceive if you are within an ideal weight range. Being underweight has an effect on fertility, too, and adding a few pounds will improve success at conceiving.
8. Toxic drugs
Drugs which are toxic for the baby include: some epileptic drugs, vitamin A preparations (sometimes used for acne treatment), warfarin, tetracycline antibiotics and chemotherapy drugs. It is best to avoid any drugs if possible during the early weeks of conception, when the baby is developing her organ systems – this is up until around 10 weeks. If you are unwell or have chronic problems then it might be necessary to use some treatments, but this should be discussed with your doctor.
9. Inherited conditions
Does anything run in the family? If there is something, such as: sickle-cell, thalassaemia, haemophilia, cystic fibrosis or another genetic condition, it would be worthwhile seeing your doctor about pre-conceptual counselling. A clinical geneticist will be able to give you a better idea of how likely the condition is to affect your baby and if there is any way of preventing this or detecting it at an early stage where appropriate.
10. Take a pregnancy test!
But not too early! It is true that modern pregnancy tests can become positive before the missed period, but they are not that reliable at this stage. If you leave it until a week after the missed period, you’ll have a more accurate idea of whether you’ve been lucky this month!
Danny Tucker MBBS, MRCOG is a Specialist Registrar in Obstetrics & Gynaecology from Sheffield.