Fit for Pregnancy?

A guide to getting your body ready for a healthy nine months

Are you waiting to get pregnant before you improve your health habits? If so, you may be going about things in the wrong way. To make sure that you’ll have the healthiest baby possible, it’s best to make positive changes months before you conceive. “Most women don’t consider their health before they get pregnant, but they should,” says Merry-K. Moos, R.N., an associate professor of obstetrics and gynecology at the University of North Carolina School of Medicine in Chapel Hill. (Moos was on a task force coordinated by the March of Dimes that issued a recent report on newborn health.) Studies show that a woman’s health before pregnancy has a significant impact on her baby’s health and on the ease of her pregnancy and delivery.

Get in shape- Why is your prepregnancy weight so important? Studies show that overweight women have a greater risk of infertility and that losing weight increases ovulation among some obese women. If you need to lose weight, start your eating and exercise program six months or more before you try to conceive, depending on your weight-loss goal. Being too thin (a body mass index, or BMI, of less than 18.5) or overweight (a BMI of 25 or more) during pregnancy puts your baby at an increased risk for birth defects and fetal growth restrictions, Moos says.

Improve your eating habits- As you consider the idea of pregnancy, eat a balanced diet of vegetables, fruits, whole grains, dairy products, and reduced fats and sugars if you’re not already doing so. To reduce the risk of neural-tube defects in your baby, you should also increase your intake of folate-rich foods and take a daily folic acid supplement of 400 micrograms starting at least one month before trying to conceive. See your doctor- “The vast majority of patients don’t have a preconception visit with their doctors,” says Richard H. Schwarz, M.D., chairman of obstetrics and gynecology at New York Methodist Hospital in New York City, “but they should.” If you’re considering getting pregnant, make an appointment now with your OB-GYN. At this visit, you’ll talk about any existing or potential health problems that could affect your fertility, put you at risk or harm your developing fetus. (For instance, among women with uncontrolled diabetes, the rate of birth defects in their newborns is five or six times higher than among non-diabetics.) It’s also important to discuss any medications you’re taking. To avoid the possibility of birth defects, most doctors will recommend that you stop using any drug that is not necessary.

Go off antidepressants, if possible- Women with mild to moderate depression should speak with their doctors three to six months before trying to conceive about possibly weaning themselves from these drugs. For women with severe depression, it may be better to stay on antidepressants because depression can be harmful to the mother and baby, according to Lee Cohen, M.D., associate professor of psychiatry at Harvard. Prozac, Celexa, Paxil, Zoloft and the older tricyclic antidepressants have not been found to cause birth defects or complications during pregnancy. Get vaccinated- If you haven’t been immunized against such diseases as German measles, Rubella and hepatitis B, you risk harming your baby if you get the disease while pregnant. You also risk passing the disease on to the baby. Since live viruses may injure a fetus, get these shots at least three months before trying to conceive.

Go for genetic counseling- If your family has a history of an inheritable disease, a genetic counselor may advise you and your husband to get tested to see if you are carriers of those diseases. People of Ashkenazi Jewish descent are often referred to a genetic counselor to discuss whether they should have a panel of tests for diseases that are more common in that population. Otherwise, you and your obstetrician can discuss tests to check for sickle cell anemia, Down syndrome, cystic fibrosis and other conditions.

Avoid extreme stress- Extreme stress can affect fertility, says Richard J. Paulson, M.D., professor of obstetrics and gynecology and chief of the division of reproductive endocrinology and infertility at the University of Southern California. Young women taking final exams, for instance, frequently miss a menstrual cycle. If you’re ready to get pregnant, try to avoid any situations that might cause high levels of anxiety. Quit alcohol, coffee and cigarettes- Women who avoided this triple threat conceived at a rate of 27 pregnancies per 100 menstrual cycles, according to a study of 124 women by researchers at Johns Hopkins School of Medicine. The conception rate of women who had one alcoholic drink a week was 11 percent, compared with 18 percent among women who did not drink at all. It was 12 percent among women who drank about one cup of coffee a day, compared with 20 percent among women who drank about a quarter cup of coffee. Women who drank alcohol and coffee had a conception rate of 11 percent. Smokers had a conception rate of 6 percent, compared with 17 percent among nonsmokers. Aside from affecting fertility, cigarettes can cause miscarriage, bleeding complications, abnormal presentation and low birth weight.