Many women conceive before they have any idea they are pregnant. For most women, ovulation occurs two weeks before the onset of the next period. Since most women will occasionally “miss” a period or be “late,” a significant number are often several weeks or even a month or two pregnant before realizing they truly are carrying a baby. Because baby’s organs are formed during this early period, preconception health is critically important -- and often neglected by women who may be “at risk” for conceiving. By the time a woman is aware that she truly has missed a period or more, there may be several influences on the health of the baby and the pregnancy that she would wish to have avoided or at least changed. For anyone “at risk” for pregnancy -- or hoping to become pregnant, the time before conception occurs is the opportune time to give any baby conceived the optimal start in life.

Nutrition
Whether are not you are planning a pregnancy, good nutrition is the foundation of health and vitality. The ideal preconception diet is also ideal for anyone seeking optimal health. Fruits, vegetables, grains and good quality, low-fat meat are the essentials. In addition, a multivitamin mineral supplement containing 0.4 mg of folic acid is a standard recommendation. The addition of folic acid in this amount is known to prevent spinal cord defects. Folic acid is also available in fruits and vegetables. Ideally, folic acid supplementation should be started at least one month before conception. Calcium is another important part of a good preconception diet. All sources should equal 1200 mg a day. Dairy products and greens are good sources of calcium. Iron is also an essential element in a good preconception diet. Iron is available in meats, eggs, greens, and some nuts and seeds, as well as in supplements. However, no supplement can completely take the place of good nutrition.
Recent research is showing added benefits from essential fatty acids, which are available in some prenatal vitamins. Natural sources of EFAs are flax seed, cold water fish such as salmon and tuna and walnuts. An added benefit of EFAs is an improvement in skin and hair.

Hazards
While fish are a rich source of fatty acids, tuna should be limited to one small can a week because of high levels of mercury found in these fish, according a recent recommendation. Some women may choose to avoid tuna because of potential risks. Mercury may be found in the work place as well. Anyone thinking about becoming pregnant should check exposure to any harmful substances that may be present at work. These could include chemicals found in cleaning products, paints, hair dyes, and petroleum-based substances. Lead levels may need to be checked in an old house. If there is any doubt about well water, it should be tested.
While some exposures can’t be known until after the fact, there are some that are recognized and can be eliminated or minimized. Many women suffer feelings of guilt because of drinking or taking drugs early in pregnancy before they had any idea they were pregnant. Many experts feel these very early exposures (in the first two weeks) are “an all or nothing at all” risk. Either the baby may experience no bad effects or the pregnancy may be lost. However, exposure after the first missed period (after 2 weeks) can have devastating effects. This in itself may be enough for most women to limit or stop consumption of agents that are not only harmful to a possible pregnancy but to the woman as well. Possibly the most prevalent harmful substance to a woman and a baby is cigarette smoke. Because smoking limits the amount of oxygen the baby receives, the effects begin early. Any woman who may be “at risk” should certainly begin to decrease the number of cigarettes she smokes with a goal of stopping altogether. Second hand smoke is now recognized as harmful to mother and baby. Think of avoiding all tobacco smoke as the gift of good health and normal development for you and your baby.
Recent research indicates that high levels of caffeine may interfere with conception. Any woman trying to conceive should at least limit the amount of coffee to one to two cups a day. Black and green teas have less caffeine, but moderation should be the rule.
Anyone using herbal remedies should consult an herbalist as to the possible harmful effects on a developing fetus. There are a number that may cause miscarriage, as well.
Hot tubs are another source of potential harm to the baby. They should be avoided altogether in early pregnancy. Immersion at any time should be in water no more than 101 degrees F. In addition, exercise that causes the woman to over-heat or her heart rate to exceed or remain at 140 beats per minute should be discontinued.

Planning Ahead
For someone actually planning a pregnancy, a dental check up is important. Gingivitis, a gum disease that can be treated, is known to cause pre-term labor and delivery.
For parents farsighted enough to truly plan a pregnancy, genetic factors should be considered. If there are medical conditions that recur in a family or if the mother is over 35, a consultation with a genetics center is a must. Their experts can calculate your risks and make suggestions regarding your care. Another goal for women planning a pregnancy is being close to an ideal body weight. Often women enter pregnancy more than a few pounds heavier than they actually want to be, gain more than the recommended 25 to 35 pounds, and then have difficulty for years losing the extra weight. Since pregnancy is no time to diet, every effort should be made to attain an ideal weight before becoming pregnant.
Women who are on medications, either prescription or over the counter, should schedule a preconception visit with a care provider who provides obstetric or midwifery care. Such a visit will include a medical, gynecological, obstetrical, and surgical exams, social and family history, physical, PAP and recommendations for a healthy pregnancy.
If a woman is not immune to rubella (German measles) and varicella (chickenpox), she should be vaccinated before becoming pregnant. Both these diseases can cause serious birth defects. Any medical problems should be checked and discussed prior to becoming pregnant. A woman with diabetes can reduce the chance of defects by having her glucose under good control. Sexually transmitted infections should be screened for and treated before a woman becomes pregnant. Since HIV infection does not cause symptoms in the early stages, any woman contemplating (or “at risk” for) pregnancy should have an HIV test. Treatment in early pregnancy can decrease the risk of transmission of the virus to the baby.
If a woman is using an effective method of birth control that determines the woman’s cycles (such as the pill or the Depo Provera shot), they should stop that method and use condoms to allow two to three normal cycles before attempting to conceive. Any woman using Depo Provera should be aware that she may take several months to conceive. A calendar of the woman’s cycles should be kept to help establish the estimated due date. Such a calendar would include the date her flow began and whether it was light, moderate or heavy and for how many days her period lasted. Such information may be very important in determining the estimated due date.

Role of the Father
While the mother’s lifestyle and medical condition have the greater influence on the baby, potential fathers should certainly consider their health when planning a pregnancy. Men who are a healthy weight will be more fertile than their overweight brothers. Some herbals as well as medications may interfere with fertility. There are known hazards associated with the work place and with service in war. These should be evaluated by a physician. Activities that cause the scrotum to become over heated or possibly injured should be avoided.
While it would be ideal for every couple to visit a midwife or doctor and truly plan each and every pregnancy, this is not possible for most families. However, if pregnancy is a possibility, attention before or early in pregnancy to nutrition, lifestyle issues, possible hazards and general health can go a long way to providing the ideal environment to grow a baby.

Jan Verhaeghe is a Certified Nurse-Midwife with New Dawn Midwifery in Asheville, NC. She can be reached at 828-236-0032.

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