Preparing for Pregnancy

So you are planning to start a family? What should you do prior to conceiving?

Here are some simple things you should do when trying to fall pregnant:

Folate Supplementation

All women of child-bearing age should take extra folate, as almost 50% of all pregnancies are unplanned.  Folate (also known as folic acid) is a B-group vitamin that is essential for healthy development of babies. If it is taken before conception and early in pregnancy, folate can prevent 7 out of 10 cases of neural tube defects, including spina bifida.  Every year in Australia, more than 600 pregnancies are affected by neural tube defects.  Ideally, Folate supplements should be taken for at least 3 months prior to conception, and continued into the first trimester of pregnancy.

Healthy eating during pregnancyMost women should take 0.5mg Folate per day, but if you have increased risk factors, you should take 5mg per day.  These risk factors include:

  • Previous baby or pregnancy affected by a neural tube defect
  • Personal history of neural tube defect
  • Close relative affected by a neural tube defect
  • Medications for epilepsy or seizures (these medications may affect the absorption of folate supplements)
  • Type 1 diabetes
  • Obesity, with Body mass index (BMI) >27
You should see your GP or Dr Law before starting the higher dose of Folate.

 

The following foods are high in folate, but supplementation is still recommended even if your diet is rich in these foods:
  • Dark leafy greens (e.g. spinach, turnip greens, collards)
  • Bean sprouts (e.g. soybean and pea)
  • Sunflower seeds
  • Dry roasted soybeans (Edamame)
  • Beans and legumes (e.g. chickpeas)
  • Asparagus
  • Peanuts
  • Fortified cereals and breads
  • Citrus and Fortified fruit juices
  • Liver

Ensure Pap Smear is Up-to-date

If you are due for your Pap smear soon, it is recommended that you have your Pap smear prior to conception, so that any abnormalities can be investigated and treated prior to your pregnancy.  According to the National Cervical Screening Program, every woman presenting for antenatal care should be offered cervical screening by Pap smear if they have not had a Pap smear within the past two years.  Even if you have had the HPV vaccine, you still need to have regular Pap smears.  Pap smears can generally be undertaken during pregnancy, ideally before 24 weeks gestation.  It is not uncommon to have some spotting and minor bleeding following the Pap smear, and this can cause anxiety for some women during pregnancy.  However, there is no evidence that a properly collected Pap smear causes any pregnancy problems.

 

Ensure your Vaccinations are Up-to-date

Immunisations not only protect yourself, but can also protect your unborn baby.  During pregnancy, the immune system is normally suppressed, making it even more important to ensure your vaccinations are up-to-date prior to conception.  Important immunisations to consider prior to conceiving include Rubella (“German measles”), Varicella (“chicken pox”), Measles, Mumps, Pertussis (“Whooping cough”) and Influenza (“the flu”).  You should have a blood test to check your immunity levels for some of these infections.  Even if you have had a Rubella vaccine previously, your immunity level can sometimes fall, and you may require another Rubella vaccine prior to your next pregnancy.  Influenza vaccine needs to be given yearly, and is safe to be given any time even during pregnancy.

Infection screening to prepare for pregnancyThese infections are particularly important as it can cause specific problems in pregnancy:
  • Rubella – may lead to defects in the baby’s brain, heart, eyes and ears. It also increases your chances of miscarriage and stillbirth.
  • Chickenpox – may cause defects in the baby’s brain, eyes, skin and limbs.
  • Measles – increases your chances of miscarriage, premature birth or stillbirth.
  • Mumps – increases your chances of miscarriage.
  • Hepatitis B – may cause acute hepatitis B infection, as well as being passed onto the baby during birth. The mother and baby can also become hepatitis B carriers for the rest of their lives.
  • Influenza – increases your chances of miscarriage, premature birth or stillbirth, and increases the risk of severe illness and death in the mother (due to the suppression of the immune system during pregnancy).
  • Whooping cough – may cause the baby to have pneumonia, seizures, encephalopathy and even death.

Following live vaccines (Measles, Mumps, Rubella, Chickenpox), you should generally wait 1 month prior to conceiving.

You should also consider vaccination for your household, to protect your newborn baby from infection.

Optimise your Weight

Having a healthy weight not only makes it easier for you to conceive, but can also make your pregnancy and delivery safer.  The ideal Body Mass Index (BMI) is between 20 and 25.

Calculate your BMI by entering your height and weight into this calculator:

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If you are extremely overweight, aiming for a BMI of <25 may not be realistic, but any weight that you can lose prior to conception does help, and will improve your fertility and reduce complications during pregnancy.

All women planning to conceive should have a healthy nutritional diet.  An consultation with Dr Law’s dietitian may be useful to ensure a well balanced diet.

Optimise your Health

If you have a pre-existing medical condition (e.g. Diabetes, Heart Disease, Hypertension), it is recommended that you arrange a consultation with Dr Law for a pre-pregnancy assessment prior to conception.

Greenslopes Obstetrics and Gynaecology