Getting Ready for Pregnancy

When you are thinking about starting a family is the best time to start taking care of yourself. The March of Dimes Web site (www. modimes.org) contains numerous recommendations for pre-pregnancy planning including:
• Taking folic acid (400 micrograms) daily to prevent neural tube defects (NTDs), a easily preventable birth defect.
• Living healthy
• Getting a pre-pregnancy check-up

The importance of folic acid

It is important to take folic acid before your pregnancy is confirmed because the time at which the developing embryo is most vulnerable is well before most women realize they are pregnant

Folic acid is most readily absorbed from synthetic vitamins, so taking a one-a-day prenatal vitamin is ideal. You can also add folic acid to your diet by
eating foods rich in folic acid, such as orange juice, green, leafy vegetables, beans, and whole-grains. Folic-acid fortified cereals are a good source of folic acid.

Living a healthy lifestyle

Pregnancy is a physically demanding nine-month project. Your body will undergo incredible changes and work harder than ever before when it is tasked with making a baby. Follow our do’s to increase your odds of having a healthy baby:

DO WHY?

• Stop smoking and avoid second-hand smoke Smoking may inhibit fertilization and increases the risk of an ectopic pregnancy. Pregnant women who smoke increase their risk of premature birth and complications due to low-birth weight.
• Stop using alcohol and drugs Drugs increase the risk of miscarriage, birth defects and
  low birth weight. Use of alcohol during pregnancy can cause serious mental and physical problems for the baby.
• Avoid chemical exposures Avoid organic solvents, pesticides and herbicides, which can be toxic to embryos.
  
• Avoid exposure to infection Some infections of the reproductive tract can increase the risk of infertility, miscarriage or birth defects if pregnancy does occur.
  
• Become physically fit Attaining your ideal weight may help in becoming pregnant, as weight extremes can be associated with infertility.
  
• Cardiac fitness will make the pregnancy safer for you and your baby. Exercise in moderation can also reduce stress, which is good for both mother and baby.

Have your doctor perform a pre-pregnancy physical

Having a pre-pregnancy physical can be very helpful in promoting fertility and a healthy pregnancy. Your doctor should ask you about your medical history, past pregnancies and your lifestyle. You should discuss the medications you are taking with your doctor to determine if they are safe for pregnancy. Chronic conditions like diabetes, thyroid disorders, or hormonal imbalances that require medications may need to be re-evaluated before and during the pregnancy to see if adjustments are needed. Some anti-depressants are not recommended for use during pregnancy. These chronic conditions, if untreated, can have a negative impact on fertility and threaten a pregnancy. Often, your doctor will be able to suggest pregnancy-friendly medical alternatives.

This is a good time to review your work, home environment and hobbies with your doctor to determine if you come into contact with hazardous chemical or biohazardous substances in any of those areas.

A pre-pregnancy check-up can alert you to other potential problems before you become pregnant such as:

• Lack of immunity to rubella, toxoplasmosis, hepatitis B and chicken pox. Before you attempt pregnancy is a good time to get up-to-date on vaccinations. Some vaccinations require a short waiting period before attempting pregnancy. Your physician will be able to answer your questions and concerns regarding vaccinations.
  Untreated vaginal or urinary tract infections
  
• The risk of passing on inherited diseases to your child(e.g., Tay-sachs disease, sickle cell disease, thalassemia)
• The risk of Down’s syndrome
  
• Diabetes
  
• High blood pressure
  
• Systemic lupus erythematosus (SLE)
  
• Seizures
  
• Kidney disease
  
• Over-the-counter medications or herbal supplements

Prenatal genetic testing includes amniocentesis and chorionic villus (CVS) testing. More recently, pre-implantation genetic diagnosis has become available in conjunction with in vitro fertilization. Pre-implantation genetic diagnosis (PGD) allows the genetic evaluation of embryos for specific genetic defects or chromosomal abnormalities before they are transferred back to the uterus, thus allowing selection of unaffected embryos before implantation can occur. Traditional amniocentesis and CVS testing are usually recommended as a follow-up test once the pregnancy is established to further assure the couple that their baby will be unaffected by the inherited disease they carry.