How should moms prep for pregnancy and why is it important?

Preparing for pregnancy is important, as lifestyle changes and healthcare interventions before pregnancy can prevent some birth defects and lower the risk of developing problems during pregnancy.

Ideally, a woman should make a preconception counseling appointment with her obstetrician-gynecologist or other primary healthcare provider to identify medical conditions, medications, and other problems that might increase the risk to the patient or her baby.  Screening for medical problems such as diabetes and hypertension, pap smear screening, and screening for sexually transmitted diseases can be performed as indicated.

Some of the important issues to address are listed below.

1. Folic acid, 400-800 mcg daily, usually taken in a multivitamin, should be started at least 3 months before pregnancy and continued during pregnancy to lower the risk of neural tube defects in the baby.
2. A healthy diet is recommended with the following pre-pregnancy changes:
   • Limit caffeine consumption to less than 200-300 mg/day.
   • Stop nonessential dietary supplements and megavitamins.  High doses of Vitamin A  have been associated with birth defects.  Limit Vitamin A to 5000 IU daily.
   • Eat only cooked fish and avoid fish with high mercury levels (king mackerel, marlin,        orange roughy, shark, swordfish, tilefish and bigeye tuna).  May eat canned light tuna 2-3 times weekly and albacore tuna once weekly.
   • Do not eat undercooked meats or unpasteurized foods, such as some soft cheeses.
   • Wash hands thoroughly after gardening or touching soil and wash fruits and vegetables before eating.
3. Weight reduction is advised if overweight, and weight gain if underweight.
4. Stop smoking, do not drink alcohol, and do not take recreational drugs such as marijuana,     heroin or methamphetamines.  Help is available to stop using these substances.
5. Avoid travel to areas where Zika virus infection is occurring because Zika virus can cause microcephaly and severe developmental delay in the infant.  If Zika exposure has occurred, wait 2 months after the last Zika virus exposure for the woman, and 3 months for her partner (since Zika virus can live longer in semen) before attempting to conceive. 
6. Review all medications, including herbal medications and supplements with your health care provider as some medications and supplements can increase the risk of birth defects or other problems during pregnancy.
7. Review all chronic medical problems including mental health problems with your healthcare provider to determine if pregnancy is advisable and then optimize treatment, which sometimes requires medication changes. 
8. Keep current with influenza and other regular vaccinations.  Document immunity to Rubella (German measles, which can cause birth defects during pregnancy) and Varicella (chickenpox, which can cause severe problems for the baby) and vaccinate if not immune.  Wait for 1 month to conceive after vaccination for Rubella or Varicella since these are live virus vaccines.
9. Genetic screening is recommended for hemoglobin abnormalities, cystic fibrosis, Fragile X syndrome, and spinal muscular atrophy.Other genetic screening is offered as indicated by ethnicity or family history.
10. A dental exam is recommended because cavities and gum disease are common and may increase the risk of preterm delivery and other pregnancy complications.

Taking the time to prepare for pregnancy can help produce lifelong benefits for the mother and her child. 

Dr. Cynthia Cork
OB/GYN
Fountain Valley Regional Hospital & Medical Center