Learning that you're pregnant: sooner can be better!

Having a child changes your life in many, many ways. As any parent can tell you, everything is different post-baby—from how you spend your time and money, to how you set your priorities.

Even before a baby is born, however, being pregnant or even thinking about becoming pregnant may mean important changes in your life and lifestyle.  Focusing on healthful habits and optimizing treatment of any medical problems can mean a healthier you and, as a result, a healthier pregnancy. While pregnancy can be an important catalyst for change, however, these changes should not just be about having a healthy baby---after all, women are more than just baby-making machines. Too often we focus on the pregnancy as if it were somehow separate from the mother. Stopping smoking, for example, isn’t just good for the baby: it’s good for the mother and her baby.  We want women to be healthy whether they are pregnant or not, but one result of a healthier life is a better chance of a healthier pregnancy.

So, ideally the healthy changes I’ll talk about here will happen before conception, or even if conception is never planned. But many pregnancies are unplanned or just happen before you’ve gotten around to those changes you’d been meaning to make. If that’s the case, a key advantage of finding out early about a pregnancy is that it allows you to adjust things at a time early enough to have  important benefit for the pregnancy. 

What are these changes?  Some things to consider in anticipation of pregnancy or once you’re pregnant include:

°          Making your lifestyle as healthy as possible.  For women who smoke, pregnancy may provide an extra motivation to quit, for cigarettes are linked to miscarriage, preterm delivery and too-small babies. For those who are overweight, losing weight and beginning an exercise program before pregnancy can also optimize your health and pregnancy outcomes. Although dieting and weight loss are not recommended during pregnancy, establishing healthy eating and exercise habits before pregnancy or early in pregnancy can help keep weight gained during pregnancy in an appropriate range and speed recovery after delivery. Other lifestyle choices to consider include whether you drink alcohol (you shouldn’t once pregnant), whether you are around people who smoke (also not a good idea when pregnant), and whether you take vitamins (ideally taking folic acid starts three months before conception).

°         Do you have any illnesses that need to be treated? High blood pressure is an example of a disease that can worsen or cause problems during pregnancy if it’s not treated. Women with diabetes should have their blood sugar levels tightly controlled to minimize the risk of birth defects and other complications.

°         Are you taking any medications that might be harmful to your growing baby? Sometimes medications may be stopped or switched to alternatives with fewer risks to the pregnancy. Whether you should change or stop taking any medications you’re already on is a choice that you and your doctor should make together. The sooner you plan for a pregnancy or find out that you are pregnant, the sooner you can begin these conversations.

Ideally, as suggested above and especially for women with chronic medical conditions or regularly taking medications, much of this work happens even before conception. Sit down with your doctor and let him or her know you are thinking about trying to get pregnant. In some cases your doctor may suggest you meet with an obstetrician or high-risk obstetric specialist to get his or her input.  Planning and making changes in advance can save a frantic scramble when the pregnancy stick turns blue.

In addition to the choices and changes suggested above there are other advantages to knowing about a pregnancy early and seeking care. Learning about your pregnancy as early as possible means that you’re able to better take advantage of available tests and tools. For example, if you want to screen for Down syndrome, some other chromosomal abnormalities, and major congenital heart problems with a test called nuchal translucency, you need to do so before week 14 of your pregnancy.  In addition, detecting your pregnancy in the first weeks after conception allows your doctor to establish a more accurate gestational age (measured from the day of a woman’s last period and correlated with findings on physical exam and/or ultrasound). This gestational age will be the basis for planning testing at other points in pregnancy, and deciding when inducing labor might be appropriate much, much later in pregnancy. 

Jeffrey Ecker, M.D., is an attending perinatologist (high-risk obstetrician) at Massachusetts General Hospital. He is also an Associate Professor at Harvard Medical School.

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