Preconception: Improving Your Health and Enhancing Your Fertility When Planning for Pregnancy
Topics Covered Below:
The
5 most important things to do:
In this article, I will discuss all the possible things you could do to improve your health and enhance your fertility. If you want to start with just a few basic steps, the Center for Disease Control recommends these steps as the top 5 priorities:
• Take 400 mcg of folic acid a day.
• If you have a medical condition (e.g. asthma, diabetes, epilepsy, or obesity), be sure it’s under control.
• Talk to your doctor or pharmacist about any medicines or supplements you take.*
• Stop smoking & drinking alcohol.*
• Avoid exposures to toxic substances or potentially infectious materials.*
* these items are important for dads-to-be too!
I will add one point to the CDC recommendations, as an essential step during preconception: Decide whether you are really ready for a baby in your life! For lots of questions to discuss with your partner (or to explore on your own if you are considering parenting solo), read this article.
Both mom and dad’s health matter: A key thing to remember is that the health of both the mother AND the father is important for healthy egg and sperm, and thus is important for a healthy pregnancy and a healthy baby! The most important period for improving your pre-conception health is four months prior to conception, as sperm development and egg maturation both take about 100 – 120 days. The sooner you start to get healthier, the better.
Pre-Conception Nutrition:
Women planning a pregnancy are encouraged to take 400 mcg of
folic acid per day (this recommendation is increased
to 1 mg if they have diabetes or epilepsy, or are obese). Folic acid has a huge
impact on reducing the risk of certain birth defects, and the risk of
miscarriage. It may be best to get folic acid in supplement form; the
Institutes of Medicine say that the body only absorbs about 50% of the folate
in foods, 85% of the folic acid in fortified foods (like bread and cereal with
folic acid) and 100% of the folic acid in vitamin supplements.
Improving your diet overall, including steps like choosing healthy, whole foods, organic if possible, with few additives and hormones will be helpful. The Fertility Diet by Chavarro and Willett specifically recommend these steps: Avoid trans-fats, use more unsaturated vegetable oils, eat more vegetable protein (beans and nuts) and less animal protein, choose whole grains and “slow carbs”, have a serving of dairy products each day that has its full fat content (e.g. whole milk instead of skim), take a multivitamin*, and get plenty of iron but not from red meat. They also recommend that you aim for a healthy weight, exercise, and drink plenty of water, caffeine and alcohol in moderation, but avoid sugared sodas. It is also important to diagnose food allergies, intolerances and mal-absorption problems before starting a pregnancy.
*Many care providers also recommend taking prenatal
vitamins during preconception.
For more nutritional recommendations, read this article or any good book about nutrition for pregnancy. Almost all the recommendations for pregnancy will be helpful for you, except don’t add any extra calories in until you’re pregnant!
Pre-Conception Health: Get to a healthy weight before conceiving.
Ideally, before pregnancy, your BMI (body mass index) should be between 20 and 26. BMI under 18 is considered underweight. BMI over 35 is considered overweight. (Click here to calculate your BMI)
If you are underweight, that may reduce your fertility – your ovaries may still be producing and releasing eggs, but the lining of the uterus may not be adequate for a healthy pregnancy. If you are severely underweight, you may not be menstruating, and may be infertile. Beginning pregnancy underweight can increase your chances of pre-term birth and low birth weight complications for baby. If you have a history of anorexia, work with a counselor and your physician to address issues prior to pregnancy. If the father-to-be is underweight or has lost significant body weight recently, he may have decreased sperm count or function.
If you are overweight or obese (BMI over 30), then it may be harder to conceive; you have a higher risk of gestational diabetes, pregnancy induced high blood pressure, preterm labor, complications during pregnancy and birth, and cesarean delivery; your baby is more likely to be big, have birth defects, and experience childhood obesity. So, do what you can to reach a healthy weight, and maintain that weight prior to becoming pregnant.
Pre-Conception Fitness: Exercise
Moderate exercise (2 – 6 hours per week) can enhance fertility by regulating hormones, improving circulation to ovaries, uterus, testes. It also improves mood and reduces stress. “Extreme” exercise (e.g. running 100 miles a week) can decrease fertility through reduced sperm counts for men, impaired ovulation for women.
Manage
medical conditions and improve overall health
Dental Check-Up: Have a dental check-up before conception. Have any fillings that need done, but ask for fillings without mercury (no need to remove existing mercury fillings). It is important to treat any existing gum disease, as that can increase risk of miscarriage or preterm birth.
Medical Check-Up:
Have a Pre-Conception appointment with your physician. They should screen both mom-to-be and dad-to-be for HIV, syphilis, and other sexually transmitted infections, as those can increase risk of infertility, miscarriage, and disabilities including retardation and blindness.
Vaccinations: Moms-to-be should get up-to-date on vaccinations. Rubella and varicella, which are live-virus vaccines, should be given at least one month before conception. If the mom-to-be has not had chicken pox, she should get varicella vaccine. She can be tested for immunity to rubella and if she is not immune (10% of US women are not), she should get vaccinated, as rubella during pregnancy can cause miscarriage, stillbirth, and birth defects. Women who have not received the hepatitis B vaccine should be considered for immunization if they are at risk of sexually transmitted disease or blood exposure.
Genetic screening: may be recommended, depending on the age and ethnicity of the parents-to-be. Here are the diseases that may be screened for, and how common they are, for each ethnic background.
A family history that is positive for certain diseases, such as cystic fibrosis and congenital hearing loss, also indicates the need for additional screening.
For more info: www.marchofdimes.com/pnhec/4439_15008.asp and www.childbirthconnection.org/article.asp?ck=10310&ClickedLink=486&area=27
Medical conditions: At your pre-conception check-up, also address any medical conditions that could complicate conception, pregnancy, or birth. For chronic conditions, try to optimize control of condition and optimize medication levels before pregnancy. Each of these conditions can cause health problems for mom and baby if they are not well-controlled prior to pregnancy.
Medications: Talk to your doctor or pharmacist about any medications you are taking. Several medications are known to cause birth defects or otherwise effect pregnancy and healthy fetal development.
Always let your doctor or pharmacist know that you are planning to conceive, so they can assess new medications, herbs and supplements for any potential risks, and make substitutions as needed.
Limit
Exposure to Harmful Substances and Environmental Hazards
Reduce or Eliminate Use of Harmful Substances
Both men and women who are planning to conceive in the next four months should reduce their use of caffeine, alcohol, tobacco, and illegal substances. This chart summarizes the potential risks of each.
|
|
Effects sperm count / motility |
Causes sperm malformation |
Reduces fertility |
Increases miscarriage |
Increases birth defects |
Increases pre- term birth or low birth wt |
|
|
|
Caffeine |
X |
X |
X |
X |
||
|
|
Alcohol |
X |
X |
X |
X |
X |
|
|
|
Tobacco/Smoking |
X |
X |
X |
X |
X |
|
|
|
Illegal substances |
X |
X |
X |
X |
X |
X |
All effects are dose-related. This means that if you only consume a small amount of a substance, the potential of these side effects is small. The more you use, the higher your risks.
• Caffeine: Consumption of caffeine in amounts up to 200 - 300 mg per day (two cups of coffee or three cups of tea or 72 ounces of caffeinated soda) is considered safe for pre-conception and pregnancy by many authorities. However, studies have indicated that drinking even one cup of regular coffee per day can decrease your chance of conceiving by up to 50%, and have shown a clear correlation between miscarriage and even small amounts of caffeine. (Bolumar
et al; Hatch & Bracken)• Alcohol: Drinking as few as five drinks a week can
significantly reduce fertility. (Jensen et al)
• Smoking: Smokers are more than 3
times as likely to take more than a year to get pregnant. (Hassan & Killick; Sepaniak;
Baird & Wilcox)
• Second-hand smoke: Even when the mother does not smoke, if her partner smokes over 10 cigarettes a day, she is 2.5 times more likely to have a child with birth defects.
• Nicotine patches or gum may be helpful before conception, but most authorities recommend avoiding them during pregnancy. Bupropion (Zyban) may be used during pregnancy.
• For more on substances, and resources to help you quit using: www.childbirthconnection.org/article.asp?ck=10299&ClickedLink=486&area=27
Reduce Exposure to Environmental Hazards
Both men and women who are planning a pregnancy should reduce exposures to these hazards.
• Lead - avoid traffic fumes, lead-based paint, home demolition.
• Mercury– avoid high mercury fish, amalgam fillings, tattoo inks, and manufacturing involving mercury.
• Cadmium - Avoid cigarette smoking and second-hand smoke.
• Aluminum – avoid food or beverages cooked or stored in aluminum, use aluminum free baking powder and antacids.
• For all – Filter your water. Take garlic, vitamins C, B1, B12, calcium, magnesium, iron, zinc and manganese to combat heavy metal toxicity.
• Toxoplasmosis and food-borne illness: Wash hands after contact with raw meat, produce, cat feces, soil. Cook foods thoroughly.
• CMV and parvovirus: health care workers and child care workers – use gloves, hand-washing, and other universal precautions.
If you have workplace exposures to hazards, shower after work, and wash your work clothes separately. Ask employer for Material Safety Data Sheets, good ventilation, and protective gear.
Improve Emotional Well-Being,
Relationship Skills, Finances
Emotional Health: Many of us have experienced challenging situations in our lives that have left us with some emotional baggage and things that challenge our coping mechanisms. Counseling, journaling, workshops, support groups, and self-help books are all ways to explore these issues, and do some processing and learn new coping skills before baby is born.
Reduce Stress: There is no clear evidence that stress can reduce fertility; however, stress can depress your immune system, raise your blood pressure and alter your hormonal function. Stress does increase the risk of miscarriage. Steps to reducing stress: Identify things that cause stress for you. Eliminate those that you can. Find coping techniques: journaling, counseling, relaxation techniques, etc. Do things that help you feel good: exercise, sleep well, eat well, spend times with friends, and doing things that you enjoy.
Work on your Relationship: The stronger your relationship is before baby is born, the more easily it will weather the challenges of parenting. Read When Baby Makes Three, or take a “Bringing Baby Home” workshop (www.bbhonline.org) or Becoming Parents workshop http://becomingparents.com/ Read other books or attend other workshops on relationship skills: Try any by Gary Chapman, Lyons and Psaris, or Gay and Kathyln Hendricks. Consider couples’ counseling.
Financial Well-Being: See questions to consider on the “Are you Ready for Baby” section. Learn more at http://www.pregnancyinsurance.org/ http://www.americanpregnancy.org/planningandpreparing/affordablehealthcare.html and www.childbirthconnection.org/article.asp?ck=10304&ClickedLink=486&area=27
Fertility Issues: Increasing Your Chances of Conception
Planning for Prenatal Care and Birth
Before you conceive, or in early pregnancy, you should research
and choose your maternity care provider (doctor or midwife), and your
birthplace. Your choice depends on your health status, your preference for care
provider style, your philosophy of birth, and your finances. Your choice is
very important, as both your safety and your satisfaction with the birth
experience depend a great deal on how you are cared for by your care provider
and by the staff at your birthplace. Use these resources to learn more:
More resources
March of Dimes Preconception Information: http://www.marchofdimes.com/pnhec/173.asp
American Academy of Family Physicians Recommendations for
Preconception Care. http://www.aafp.org/afp/2002/0615/p2507.html
Center for Disease Control Resources for Preconception: http://www.cdc.gov/ncbddd/preconception/
Optimizing Natural Fertility by the American Society for
Reproductive Medicine: http://asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/optimizing_natural_fertility(2).pdf
Natural Solutions to Infertility: www.marilynglenville.com/infertility.htm
Monitoring Fertility: www.fertilityfriend.com
and/or the book Taking Charge of Your Fertility by Toni Wechsler.
Thinking about Fertility Treatment: http://www.marchofdimes.com/pnhec/173_14308.asp