If you’ve made the decision to start a family within the next year or two, don’t keep it a secret from your doctor. Bring it up at your next annual exam, or if you don’t have a regular health care provider, you can make an appointment with an obstetrician/gynecologist. You and your doctor can discuss medical and family history, medications and nutrition.
Preconception
Because your baby grows and develops early in pregnancy, ideally you want to be living healthy prior to getting pregnant. I encourage my patients who are trying to become pregnant to stop smoking and eat healthy. Smoking decreases the amount of oxygen and other nourishments to the developing baby. Babies born to mothers who smoke are smaller on average. Smoking also increases the risk of stillbirth and sudden infant death syndrome. For partners, smoking can adversely affect the quality and quantity of sperm.
I also recommend getting daily physical activity and working towards a healthy body weight. If there is a chance you may be pregnant, please avoid getting X-rays.
Nutrition
It’s important that your body is getting good nutrition and the right nutrients and vitamins before conceiving. Taking care of yourself now with good nutrition and taking 400mcg of folic acid before you become pregnant gives your baby the best start. I recommend a daily prenatal vitamin or multivitamin containing no more than 5,000iu of vitamin A.
A recent Norwegian study showed that taking folic acid can decrease the occurrence of severe autism by 40 percent. Folic acid is also known to prevent defects in the spinal cord and brain. Calcium and vitamin D are also important. In general, I recommend eating three dairy products daily or taking 500mg of calcium with 400iu of vitamin D twice daily.
Birth control considerations
If you are using an IUD or implant for birth control, fertility should immediately return once these are removed. For hormonal methods like the pill, patch, ring, and Depo-Provera shot, it may take one to six months before your menstrual period returns. I recommend using condoms until after your first spontaneous period after stopping a hormonal birth control. This makes it easier to determine how far along you are.
Special considerations
If you have chronic medical issues, your doctor can help you to select medications that are safer during pregnancy. Women who have diabetes, heart problems, high blood pressure, epilepsy and mental health conditions should have their medical conditions controlled prior to conception. Anyone taking a prescription medication should see their primary care provider or an obstetrician prior to pregnancy. Women who are underweight or overweight are advised to seek preconception counseling.
What about family history?
Hereditary conditions like cystic fibrosis, birth defects and blood disorders may be passed on to your baby. If you have a family history of blood clots in female family members, this may affect your ability to get pregnant and carry a pregnancy to term. How do you know what factors in your family history matter? An OB/GYN can counsel you.
The right age
A woman’s fertility is limited by her age and the number of eggs she is born with (approximately 500,000 eggs at birth). During each menstrual cycle, one egg is released, and at least 50 to 100 eggs are resorbed. Eggs that can be easily fertilized are released early in a woman’s reproductive life. As we age, our eggs also age.
I encourage women to have their first pregnancy by age 34, or at least discuss this matter with an OB/GYN if they plan to try to conceive later. Eggs that are older than 34 may have problems with fertilization, implantation and be at risk for Down syndrome.
There is technology available to freeze a woman’s eggs so she can later conceive with her own eggs. This may be an option for a woman who has to undergo medical treatment like chemotherapy, which may affect fertility. Currently this is a costly but viable option.
