Planning for Pregnancy
While most couples who are seen at Center for Reproductive Medicine (CRM) Orlando are in good to excellent health, this is certainly not always the case, and being in less than optimal health may have serious consequences for both mother and baby. At the initial visit to CRM there will be considerable preconceptional counseling and planning such that the couple has an opportunity to assess their health and to make any necessary lifestyle modifications. This brief blog is intended to highlight some of the major steps toward a healthy pregnancy.
First, meet with your Reproductive Endocrinologist and Infertility specialist for assessment of your health. A personal (and family) medical history relative to your conception plans will be taken and a physical examination will be performed. To best benefit from this particular visit it is helpful to anticipate the following topics of questioning:
• Personal or family history of chronic medical problems
• Personal or family history of birth defects or developmental delays
• Current or recently used medications
• Current and past method(s) of birth control, if any
• Previous pregnancy history including spontaneous or elective abortions or ectopic pregnancies.
• Immunization history; Dates and results of pap smears and mammograms
• Diet, Exercise, Tobacco and Alcohol history
• Previous sexually transmitted infection(s)
The answers to these questions form the foundation of diagnostic testing and treatment. After the medical history is taken, the fertility specialist will perform a physical examination. The exam often involves a pelvic ultrasound and may detect medical problems that could require treatment prior to conception. For example, problems such as abnormal Pap smear, uterine tumors or ovarian tumors, and breast or thyroid masses which should be addressed before pregnancy.
After the physical examination, the following tests (and perhaps others) may be recommended: Semen analysis, uterine cavity evaluation, ovarian reserve testing, thyroid function screening, screening for diabetes, genetic carrier screening (e.g., for cystic fibrosis, spinal muscular atrophy, fragile X, etc.), sexually transmitted diseases, complete blood count with differential, and immunity for rubella and varicella. If there are preexisting medical conditions, there may be other tests or consultations recommended before commencing fertility treatment.
The couple’s lifestyle can impose risk for pregnancy attainment and/or maintenance.
Weight: When planning to conceive, it is best to reach a healthy weight (Body Mass Index, or BMI of 18.9-24.9 kg/m2) before pregnancy. Excessive weight can increase the incidence of infertility, miscarriage, diabetes and high blood pressure, as well as cesarean section. In addition, being underweight markedly increases chances of infertility and of delivering a low birth weight baby.
Diet: A balanced diet with appropriate amounts of protein, complex carbohydrates and healthy fats plays a major role in fertility. A lifestyle with frequent snacks and meals featuring colorful vegetables and fruits will be recommended and a diet rich in sugars and simple carbohydrates is to be avoided.
Exercise: Daily aerobic exercise and resistance training 3-4 times weekly, before and during pregnancy, can increase the likelihood of having a fit, comfortable gestation, while decreasing risks of excessive gestational weight gain, hypertension and diabetes.
Tobacco, Alcohol and Illicit Drugs: Smoking tobacco or marijuana, drinking wine, beer or liquor, and legal or illegal drug usage may decrease fertility and can be harmful to the baby. Both partners should discontinue all such usage prior to conception. Exposure to second hand or third hand (tobacco residue and dust on clothes and carpets) has also been related to increased risk of asthma in the baby as well as more frequent respiratory infections and sudden infant death syndrome (SIDS).
Toxins: Many chemicals, including some household cleaners and petroleum distillates are not to be used without gloves and adequate ventilation during pregnancy and certain other toxins as well as radiation in sufficient exposure can lead to congenital defects.
Preexisting Conditions: In general, any preexisting medical problem (e.g., diabetes, hypertension, thyroid disease) needs to be controlled prior to pregnancy. Treatment may involve your CRM physician working in concert with your primary care doctor or other medical or surgical specialist.
The above is a very elementary primer on planning for pregnancy. Please be sure to bring any specific questions to your provider at Center for Reproductive Medicine.