There are several steps that each woman should take before she even tries to become pregnant.

1.       Visit your gynecologist

A visit to a gynecologist (or qualified internist) should occur at least three months before a couple is ready to conceive. During this visit, a full physical examination should be done. A Pap smear and cervical cultures should be performed, and blood tests may be indicated to test for anemia or to find out if the woman is immune to rubella or chicken pox. If she is not immune, she may be vaccinated. In these cases, she should wait three months before trying to conceive. If the couple has a cat, blood tests can be taken to see if the woman has antibodies to toxoplasma. If she does not have antibodies, she should use gloves and a mask if she’s going to change litter boxes during pregnancy. Perhaps most importantly, a woman should begin taking between 400 and 800 mcg of folic acid (most prenatal vitamins have at least this much) before even trying to conceive. Folic acid has been shown to decrease the incidence of birth defects such as spina bifida (the spinal cord is developed at one month after conception, so that by the time a lot of women realize they are pregnant it may be too late to prevent some defects).

2.       Discuss genetic testing with your physician

Given the recent advances in understanding genetic diseases, many couples elect to undergo genetic counseling and testing prior to becoming pregnant. Based on the couple’s family history, targeted tests can be performed to find out whether a couple is at risk for having a child with certain diseases. Some common examples include Tay Sach’s disease for those of Ashkenazi Jewish decent, sickle cell anemia for African Americans, and Cystic Fibrosis for Caucasians. If both husband and wife are carriers for certain diseases, it is possible for the couple to pursue in vitro fertilization using pre-implantation genetic diagnosis (PGD) to have embryos evaluated for genetic status before they are implanted into the uterus.

3.       Ensure you are at a healthy body weight and physical environment

It is extremely important that a woman be as physically fit as possible prior to conception. Maintaining a body of weight no more that 15% above or below ideal body weight will provide an optimal environment for fetal growth period. Most obstetricians recommend that a woman who exercises continue to exercise throughout much of pregnancy, however, some modifications may be necessary. That being said, there are often restrictions placed on the amount of exercise and peak heart rate that a particular pregnant woman should achieve. These guidelines should be applied to the time just prior to conception as well, as the fetus is nearly 2-3 weeks old before most women even know that they are pregnant. Adequate nutrition and hydration must be maintained and overheating avoided (core body temperature [and thus uterine temperature] can exceed 102° by “spinning” or other vigorous exercise in a hot, crowded gym). Attempts to lose weight should occur before, not during pregnancy. A couple should evaluate their surroundings for environmental exposure, as well. Asbestos, lead, and radiation exposures, of course, should be avoided. Cigarette smoking, even second hand, has been shown to decrease birth weight. Caffeine intake should be limited to one serving a day. This includes coffee, tea, Coke and chocolate. Alcohol intake should be limited, if not avoided, in the pre-conceptual period.

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The Importance of Folic Acid by Dr. Susan Hudson

When women are contemplating pregnancy, they often ask, “What can I do to increase my chances?” My first response is that she should take a prenatal vitamin. Amazingly, although most women know they should take a prenatal vitamin, few initiate prenatal vitamin therapy prior to a positive pregnancy test. This is very concerning.

The American Academy of Pediatrics first issued official recommendations regarding folic acid for the prevention of neural tube defects in 1999 and this statement has since been reaffirmed. The information I am going to share with you today is from that statement.

Folic acid is a synthetic compound found in dietary supplements and fortified foods. It is the component of prenatal vitamins which has been shown to reduce the risk of neural tube defects. Neural tube defects are birth defects of the brain and spinal cord including anencephaly, spina bifida and encephalocele which affect approximately 4000 pregnancies in the US each year. Studies have shown that more than 50% of these birth defects can be prevented with supplementation of folic acid.

Folate is used to describe all compounds that have the properties of folic acid including natural sources (not fortified) in food. Less than a third of US women consume enough folic acid according to the US Public Health Service, and the average diet includes only 200 micrograms to folate which is less bioavailable than folic acid. Thus, supplementation is strongly encouraged.

In women who have no history of a pregnancy affected by a neural tube defect, 400 micrograms (0.4 mg) are recommended to help prevent over 50% of neural tubes defects. This is very efficacious as 95% of children born with neural tube defects are to couples with no family history of such birth defects. It is also recommended that this level of folic acid should be taken by all women of child-bearing age as approximately half of pregnancies are unplanned and the neural tube closes during the 1st 4 weeks of gestation. So, by the time you can see a small fetal pole or developing fetus with a flicker of a heartbeat on ultrasound, the primary benefits of folic acid have passed.

In couples who have had a child with a neural tube defect, the risk of another child having a neural tube defect is 2-3%. Use of 4000 micrograms (4 mg) of folic acid daily has been demonstrated to prevent 71% of these recurrences.

Thus, take your prenatal vitamin or folic acid supplement daily. It is the first step to a healthy, successful pregnancy.

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