Most pregnancies are unplanned and progress normally, resulting in a healthy mother and baby.
However, if you are trying to become pregnant there are a few things you can do to improve your general health and give your pregnancy the very best chance of progressing smoothly.
Preparing for pregnancy – get physically fit
Generally speaking, women who are physically fit have easier pregnancies and births. Pregnancy places a lot of physiological demands on your body as ligaments soften and loosen under the influence of pregnancy hormones. (This looseness accounts for many of the aches and pains you can look forward to in later pregnancy!)
Since it’s not wise to start a demanding new fitness programme once you’re pregnant, the time to act is before conception. Getting ready to have a baby is as good a reason as any to make healthy lifestyle changes.
Keep an eye on your weight
It’s best to not be too overweight when you conceive, the extra weight gained during pregnancy is hard enough to shift on its own. Women who are obese when they conceive are at increased risk of developing diabetes during pregnancy.
In addition, if you are very overweight, it will be more difficult for your carers to scan and feel the baby to check its progress, and labour and delivery could be more difficult for you.
Weight gain in pregnancy comes from two sources: what you eat, and the pregnancy itself. The HSE recommend an average weight gain of 0.5kg per week in the second and third trimesters.
Eating a healthy balanced diet means any weight gain can be attributed to your pregnancy and will be lost within a few months of the birth.
The amount of weight you gain in pregnancy bears no relationship to your baby’s size. This is why many obstetricians do not weigh women on a regular basis during pregnancy.
Preparing for pregnancy – take folic acid supplements
In terms of specifics, folic acid supplementation is the only factor in a woman’s diet that has been shown conclusively to improve a baby’s chances of being born healthy.
It is particularly important for women who have previously had a baby with a neural tube defect such as spina bifida, or anencephaly. If you fall into this category, you should begin supplementation (5 mg/day) two months before conception and continue taking it for the first twelve weeks of pregnancy.
This will not eliminate the risk but will reduce the chance of recurrence by more than two-thirds.
For women who have not previously had an affected baby, there is good evidence that a multivitamin preparation containing a much lower dose of folic acid (0.4 mg/day) protects against neural tube defects and indeed all other congenital malformations apart from cleft lip and/or palate.
If you didn’t know about these supplements before getting pregnant or if you forget to take them, try not to worry. Spina bifida is a rare occurrence, even without pre-pregnancy folic acid and multivitamin supplementation.
It’s best not to smoke before, during or after pregnancy. Smoking is directly harmful to your own health, causing lung cancer and other chronic respiratory conditions like emphysema and bronchitis. It also predisposes you to other types of cancer, such as cancer of the cervix.
Smoking affects you and your partner’s fertility adversely and thus can make conception more difficult. Once you’re pregnant, smoking reduces both food and oxygen supply to your baby and may result in premature delivery and/or a low birth weight.
Avoid drinking too much
Heavy drinking can reduce male sperm count and prolonged excessive drinking can harm a developing foetus. It’s best for both you and your partner to moderate your alcoholic intake when trying to get pregnant.
Check your medication
Certain drugs prescribed for particular illnesses or ongoing conditions may be associated with or directly cause abnormality in a developing foetus. For example, retinoic acid (Roaccutane) or tetracycline antibiotics which are used in the treatment of skin acne.
If you’re taking medication, it’s wise to check with the prescribing physician or obstetrician regarding their continued use while you’re trying to conceive. It may be that the dosage or type needs alteration before pregnancy.
Never stop taking any medication without consulting your doctor first. Medication taken for the control of epilepsy is particularly important.
Check your immunisation
If you are contemplating pregnancy you should ensure that you are immune to rubella (German measles) Contracting the disease during pregnancy, particularly in the early stages, can cause significant damage to the developing foetus, though the risk to baby appears to reduce sharply after 16 weeks gestation.
In most Western societies, immunisation is offered to all schoolchildren and congenital rubella is extremely rare as a result. However, immunity may disappear later, so it’s best to check your immunity before trying for a baby.
All pregnant women in Ireland are routinely tested for rubella immunity.
Find out if you’ve had chickenpox
Try to find out before you get pregnant whether or not you have had chickenpox because it has the potential to harm your baby in early pregnancy. A routine blood test will show if you have had the disease; in which case your baby will enjoy complete protection.
If you haven’t had chickenpox you should avoid children with the disease while you are trying to get pregnant and for the first 12-14 weeks of pregnancy.
Preparing for pregnancy – If you are over 35
More women than ever are having babies later, and unfortunately, after the age of 35, the risks associated with pregnancy do increase, regardless of how young you feel.
There is a slightly increased risk of high blood pressure and diabetes in pregnancy for women over 35 and a higher incidence of random (i.e. not inherited) chromosomal disorders such as Down’s syndrome in their babies.
Although the risk of a random chromosomal abnormality increases with advancing maternal age, the risk is lower than most people expect and it is a gradual, rather than sudden, increase. At the age of 40, you have just a 1 per cent chance of having a baby with Down’s syndrome.
Genetic counselling before pregnancy is generally not necessary unless there is a clearly identified inherited condition present in one of your families such as Down’s syndrome. If your family is affected ask your GP or gynaecologist to refer you to a genetic counsellor.
Have a cervical/pap smear
Every woman who is sexually active should have a cervical smear at least every three years. More frequent reviews may be required if there has been an abnormality in the past. If you haven’t had a cervical smear in the last two years, you should have one before embarking on pregnancy.
Smear abnormalities are generally easily dealt with on an outpatient basis but may deteriorate if left untreated. A mildly abnormal smear can safely be reviewed after your pregnancy. Since treatment is more complicated during pregnancy, it’s best to confirm a normal smear before becoming pregnant.
When to stop contraception
There is no hard evidence to suggest that hormonal contraceptives like the pill taken in early pregnancy are harmful to the early developing embryo. It’s safe to attempt conception in the first month after stopping the pill as the number of hormones in modern preparations is very small and is quickly eliminated from the body.
Likewise, failure of the morning-after pill does not appear to influence an ongoing pregnancy or harm a developing baby in any way.
The coil, or IUCD (intrauterine contraceptive device), on the other hand, is associated with an increased risk of ectopic pregnancy (pregnancy in the fallopian tube) and miscarriage or very premature delivery. Ideally, the coil should be removed prior to pregnancy. If you conceive with a coil in the uterus, it can be visualised on ultrasound. A decision will then be taken on whether or not it should be removed.
Where the threads are visible on vaginal examination, your doctor will usually opt for removal. If the threads can’t be seen, the coil will be left in place and will usually come away at the time of delivery. It will not interfere with the development of your baby.
After a miscarriage
If you have just had a miscarriage, you may try to conceive again as soon as you feel emotionally and physically ready.
Becoming pregnant in the cycle immediately following a miscarriage will not mean you face an increased risk of miscarriage in your new pregnancy.
Each pregnancy is a completely separate event uninfluenced by previous pregnancies. If however, miscarriage has occurred after eight weeks, a d&c (dilatation of the cervix and curettage) may be required to empty the uterus before attempting to get pregnant again.
Preparing for pregnancy – General recommendations
- Eat a well-balanced, sensible diet
- Take folic acid (0.4 mg/day)
- Take a larger dose of folic acid (5 mg/day) if you have already had a baby with a neural tube defect
- Stop smoking
- Cut down, or stop drinking
- Check you are immune to rubella (German measles) and chickenpox
- Have a cervical smear test if you have not had one in the last two years
- Get reasonably fit
- Check with your doctor about whether you should continue with prescription medication
Are you planning on getting pregnant soon? Why not chat with other mums about their experiences over on our discussion boards.