Trying to conceive: First steps for a healthy pregnancy

One of the best parts of being an obstetrician/gynecologist is that I get to see women at all times in their lives, and help them prepare for the future. This preparation is especially important when we discuss trying to get pregnant. There are many steps women and men can take before trying to conceive to make getting pregnant easier, and help your pregnancy and delivery to go smoothly. Here are some of the basics that I cover with every couple pre-pregnancy.

Getting enough exercise is an important part of helping your body to function well, whether you’re trying to get pregnant or not. There are no scientifically proven guidelines for how much exercise is good for conception, or how much could be harmful. The general rule is to keep doing whatever activity you have been doing, at the same intensity level. This is not the time to begin competitive marathons.

If you hate the gym and your current exercise level is walking the mall, don’t despair. Get yourself some cool sneakers and workout gear and hit the pavement. Thirty minutes of walking 4-5 times a week is the goal. If you are already active, make sure to stay safe: lots of water, bike helmets, rollerblade pads, etc are all needed. One side note for the guys: long-distance cycling have been associated with lower sperm counts. Instead of cycling, try walking with your partner.

Bad eating habits can reduce the reserves of nutrients necessary for reproductive hormone systems to work properly. Plus, you feel lousy. This isn’t just a woman’s issue: men who don’t get enough of certain vitamins and minerals may have low sperm counts and low testosterone levels. Most importantly, the eating habits that you learn now are the ones that you will teach your children. As childhood obesity and its related diseases are at an all-time high, we could all use a nutritional tune-up.

Your body is a finely engineered machine; give it the fuel it needs for peak performance. I have two simple suggestions:

1.      Eat yourself a rainbow. The more colors you consume, the greater the range of food types, and respective nutrients. Think red pepper, oranges, yellow mango, dark green leafy veggies, berries of all kinds, salmon, and eggs. Try something new; you might just surprise yourself by liking it.

2.      Eat your way around the supermarket, not through the middle. This piece of advice comes from my best friend’s mother. What she means is that the fresh stuff is always in the outer aisles of the supermarket— fruits, veggies, seafood, meat, poultry, dairy, and fresh bread. The middle aisles contain the nutritional land mines— chips, cookies, candy, soda, processed foods, and instant stuff. Get fresh and be healthy!

With all this eating, you still may not get enough calcium. Calcium builds bones— both yours and your baby’s. Your goal is to consume about 1,200 milligrams (mg) of calcium and 800 international units (IU). of Vitamin D every day. Three 8-ounce servings of dairy products provide that much calcium. I pop a low-fat yogurt into my lunch bag every day, and keep supplements on my desk for that mid-afternoon chocolate (ok, chocolate-flavored calcium) snack.

Supplements such as calcium carbonate, calcium lactate, calcium citrate, or calcium citrate malate are best absorbed when taken with a meal in doses of 500 mg or less. If you can’t take your supplement with food, calcium citrate is the form most easily digested on its own. Check the labels to make sure the one you buy is low in lead.

Both men and women who are trying to conceive a baby should take a multivitamin/mineral supplement. Here are some specific things that people who are trying to get pregnant should look for in a multivitamin:

°                     Make sure it contains only 5,000 IU of vitamin A. A study of 22,000 women showed an apparent increase in the number of birth defects when pregnant women took over 10,000 IU of this vitamin. If your multivitamin has 5,000 IUs, then even if you eat a lot of vitamin-A rich foods you will stay safely under the threshold.

°                     Woman hoping to get pregnant should take a multivitamin that includes at least 400 micrograms (mcg) of folic acid (but no more than 1,000 mcg). Folic acid helps prevent anencephaly and spina bifida, birth defects of the brain and spinal cord, respectively. It’s vital to have enough of this vitamin in your body before you conceive as well as afterward because such problems can occur within the first thirty days after the egg is fertilized.

°                     Men should make sure their supplements contain the RDA of zinc. Some researchers have found that zinc levels affect male fertility.

Being too thin or too heavy can decrease fertility. Equally important to a healthy pregnancy is a healthy delivery, which is more likely if a woman is at a healthy weight. A woman’s body mass index (BMI)—a measurement of weight as compared to height—should be between 20 and 25 for optimal fertility. You can calculate your own BMI by multiplying your weight in pounds by 703 and dividing that amount by your height in inches squared. You can also measure your BMI online here: http://nhlbisupport.com/bmi/.

Patients often ask if they should bother losing weight if they are just going to gain it back with the pregnancy. Big difference here: pregnancy weight gain should range from 25-30 pounds, and reflects the changes of the pregnancy itself. If you are starting out with a BMI greater than 25, then I recommend a nutritional consult to help you change your diet, safely lose weight, and improve your overall health before you get pregnant.

Studies have found that the highest conception rates are among women who don’t drink, don’t smoke, and have less than a cup of coffee or its equivalent per day. Smoking in particular has been linked to reduced fertility in both women and men. Second-hand smoke counts, so get your partner and anyone else you live with to commit to a new healthy lifestyle with you. Marijuana, cocaine, and steroids are all linked to decreased fertility in men.

High caffeine intake has been associated with both delayed conception and increased miscarriage. If you are a coffee fiend, consider cutting back slowly to reduce side effects like fatigue and headache. Gradually adding decaf to your regular brew is a simple way to start.

Prescription and over-the-counter medications and herbs can also have an impact on fertility. Talk to your doctor about all the medications, supplements and natural remedies you take before you start trying to get pregnant.

We all know that stress is bad for you, but getting rid of it is not easy either! Now is the time to focus on managing, and ideally limiting, the stress in your life. Consider your own sources of stress such as your job, family members, your partner, and your social obligations. Are there any changes you can make to improve how you feel? Relaxation techniques such as deep breathing, meditation and yoga may work for you. Exercise is a great stress reliever, so put on your sneaks and get moving. Take your partner with you and you can both benefit from less stress and more emotional connection with each other.

Kristen Eckler, M.D., is an Instructor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, and an Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology at Massachusetts General Hospital.

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Folic Acid: Why you need it and how to get it
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