Health steps to take before you get pregnant

The steps a woman should take to get herself into optimal health before becoming pregnant are the same steps we all should take to live a healthy life—with a few additions. So while this article focuses on healthy lifestyle elements in terms of pre-conception planning, these elements are essentially the same for any woman, regardless of age or childbearing plans. So read on, and congratulate yourself for taking the time to educate yourself about having a healthy future. Not only are you planning for your own well-being, but also for the health of the next generation. Bravo!

Here are some of the first healthy steps to take:

• Review your medications. Talk with your doctor about any prescription medicines, over-the-counter medicines, vitamins, and herbal medicines and supplements that you take. Some may be harmful during pregnancy, so you'll need to figure out an alternate treatment plan. It can take weeks to taper off a medication, so it's important to have this conversation early. Do not stop your medication just because you want to be pregnant; you could cause more harm than good. Speak with your care provider about your medications and concerns, and come up with a safe treatment plan.
• Eat a healthy, well-balanced diet. Remember to eat yourself a rainbow, which means sampling foods from multiple food groups and colors. Cutting back on caffeine to no more than 150mg a day (one average cup of coffee) and eliminating alcohol are important steps as well.
• Keep at a healthy weight. Numerous women have asked me why they should bother losing weight prior to pregnancy, if carrying a baby is going to make them gain weight anyway. The answer lies in the type of weight. A woman's pre-pregnancy weight reflects her body mass; the pregnancy weight includes the weight of an expanded blood volume, fluid, placenta, baby, etc. The number may be the same on the scale, but the effect is very different. Women who are overweight or obese have increased risks of hypertension, diabetes, pre-eclampsia, and cesarean delivery. Losing the weight before conception is a key step to ensuring a healthy pregnancy. I often refer my patients to a nutritionist who is very familiar with the dietary needs of pregnancy to help do a pre-pregnancy dietary tune-up.
• Exercise. Continue to exercise if you are already exercising, and if you're not active, start an exercise program. Talk with your doctor about what specific exercises you do to make sure they will be safe for you when you become pregnant.
• Take folic acid supplements. This vitamin is critical for development of the fetal spinal cord structures. Prenatal vitamins typically have more folic acid and iron than regular vitamins. Take prenatal vitamins before you get pregnant to ensure that you have adequate stores of both. All women of childbearing age should take a minimum of 400 micrograms (0.4 milligrams) of folic acid supplement daily; many vitamins now have 800 micrograms.
• Stop smoking, drinking alcohol, or using drugs. All of these substances can harm the developing fetus. If you are taking medication to treat addiction, again speak with your care provider about your medication, so you can minimize the exposure to the fetus. And keep in mind that at this time, no amount of alcohol is considered safe in pregnancy.
• Manage any chronic illness. Now is the time to maximize your health, including getting your blood pressure, diabetes, thyroid function, weight and any other medical issues under control. If you have a chronic illness, talk with your doctor about how you are treating it. Your treatment may need to be changed.
• Get tested for infections. While not all of these tests are mandatory, most providers agree that testing for HIV (the virus that causes AIDS), syphilis, gonorrhea, Chlamydia, Hepatitis B, and possibly Hepatitis C are important pre-conception steps. Syphilis can harm a developing infant, and should be treated. While there are no cures for HIV or Hepatitis B, information is power, as we now have medications to help prevent transmission of these viruses to the fetus.
• Prevent infections. Most people recognize that washing hands, eating properly prepared food, and avoiding people with infections are simple steps to prevent infection. If you are considering pregnancy, also stay away from cleaning your cat's litter box. Cats can carry toxoplasmosis, which can harm developing fetuses. Toxoplasmosis can also be found in dirt. If you are gardening or working in dirt, then careful hand washing prior to eating will help protect you.
• Assess your immunity. Make sure that your vaccines are up to date. Most of us don't realize the devastating effects that measles, mumps, and rubella have on pregnancy, as we have grown up in the era of vaccines for these viruses. However, they are still in the environment, and you want to make sure that your vaccines to them are still effective prior to conception. The same is true for the chicken pox virus (Varicella Zoster). Your care provider can do blood tests to make sure you have active immunity.
• Reduce stress. I suggest all my patients consider their sources of support (emotional, financial, etc) and sources of stress (job, family, illness, etc). Pregnancy can be a time of extreme emotions, financial concerns, and health challenges. We all want to be as prepared for these unknown elements as much as possible. So, take an inventory of your life, and see if you can increase the positive elements, and reduce any of the negative ones.

As always, I have written this article from both my experience and information found in the obstetric literature. I hope you find this list a helpful place to start your journey. However, no list is ever fully complete. Much of what I have learned has come from my patients. I look forward to learning about what has worked for you, and what I should include on my next edition of this list!

Be well,
Kristen Eckler MD

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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