Often asked at a yearly gynecological exam, this routine question is important. While pregnancies are often unplanned, nowadays women and their partners are definitely in the position to choose when to start their families.
Having the power to determine the best time to conceive can be both daunting and liberating. When is the best time to have a baby? Is my body ready to be pregnant? Will I be able to conceive? Do I (we) have the financial support to start a family?
These are all very relevant and important questions. Preconception counseling and preparedness, allows you to discuss these questions and your fertility goals with your OB/GYN.
Are You Underweight or Overweight?
Having a normal body mass index (range 18.5-24.9 kg/m2) makes conception easier and decreases the risk of blood sugar problems such as gestational diabetes and high blood pressure problems called hypertension during pregnancy. Women who are underweight, overweight, or obese often have dysfunctional menstrual cycles. In order to become pregnant a woman needs to ovulate, which means releasing an egg from the ovary. For women who are overweight or obese who are trying to conceive, even a small decrease in weight of 5-10% can normalize their ovulatory menstrual cycles and increase the chances of becoming pregnant. Similarly, underweight women often are not ovulating consistently. Gaining weight to a normal BMI can normalize ovulatory cycles.
In addition to having an appropriate pre-pregnancy weight, it is important to exercise prior to pregnancy and throughout the pregnancy. Exercise can normalize your menstrual cycles, and it also makes the normal aches and pains of pregnancy easier to tolerate. In fact, women who exercise before and throughout pregnancy have easier labors and lose their pregnancy weight more easily than women who do not exercise. Now, this doesn’t mean that you need to start running marathons. Three to five days of cardiovascular exercise at an intensity that makes you sweat, plus strength training with weights or household items like cans or milk jugs is enough to provide the above benefits.
Do You Have Any Major Medical Conditions?
Chronic conditions such as diabetes, hypertension, and/or thyroid dysfunction must be discussed with your OB/GYN. Poorly controlled diabetes, hypertension, and thyroid dysfunction can decrease your ability to conceive and can lead to miscarriage, difficult pregnancies, difficult deliveries and birth defects. If you do conceive and have these medical issues the pregnancy can be high-risk for you and the fetus. Poorly controlled diabetes can cause excessive maternal and fetal weight gain, which can lead to elevated blood pressures and difficult labor and deliveries. Poorly controlled hypertension can increase maternal risk for pre- eclampsia and eclampsia, which can be life-threatening to both mom and baby.
Luckily, women with well-controlled conditions can have normal pregnancies. With the help of your primary care physician and OB/GYN, women with pre-existing conditions can start appropriate, pregnancy-safe medications prior to attempting conception. This will optimize your chance to conceive and make the pregnancy safer and healthier.
Are You up to Date on Your Vaccinations & Routine Medical Care?
Prior to conception it is important to determine if you are up to date on all of your routine medical care. For women of reproductive age this includes your Pap smear, evaluation for sexually transmitted infections, and vaccination assessment.
Ensuring you are immune or vaccinated for Varicella (chicken pox), measles/mumps/rubella (MMR vaccine), tetanus/diphtheria/pertussis (Tdap vaccine), and Hepatitis B can prevent any risk of acquiring these illnesses during pregnancy. Becoming infected with any of these infections in pregnancy can increase the likelihood of more severe maternal symptoms and possibly fetal consequences. These vaccines cannot be given during pregnancy, so it is important to get them at least 28 days prior to becoming pregnant. It’s important to note that the Tdap vaccine is recommended in every pregnancy between 27 to 36 weeks gestation to provide passive immunity to the baby regardless of the mother’s previous vaccination history.
In addition, it is recommended that every woman who is pregnant or planning pregnancy receive the annual influenza vaccine. The flu vaccine is safe to receive during pregnancy.
Do You Smoke, Drink Alcohol or Use Any Recreational/Illicit Drugs?
Evaluating your use of substances is important prior to planning conception. Excessive alcohol and marijuana use can decrease sperm counts and make conception more difficult. Smoking or vaping tobacco products can lead to high-risk pregnancies because smoking increases the risk of growth restriction for the baby, preterm deliveries and maternal complications. Illicit drug use including opiates, cocaine, and methamphetamines also increases the risk of preterm delivery, growth restriction and developmental difficulties for the baby. While marijuana is legal in Oregon, it is not recommended in pregnancy. Marijuana in pregnancy can increase your risk for severe nausea and vomiting called hyperemesis and has the potential to increase the risk of preterm deliveries. Marijuana use is also linked to learning disabilities and behavioral issues with the baby.
In order to have the safest pregnancy, it is ideal to avoid all substances. Prior to conception you can create a plan with your OB/GYN about best ways to decrease dependence on substances including cessation classes, counseling, or medical management for addiction. Learn more about the affect of these substances on a developing baby.
Do You or Your Partner Have a Family History of Any Genetic Diseases or Major Medical Issues?
This is an important topic to discuss with your partner and OB/GYN prior to planning pregnancy. In the past several years, the technology surrounding genetic testing has grown tremendously. We have found that several diseases are carried in families and are more common than initially thought. These diseases include, but are not limited to, cystic fibrosis, spinal muscular atrophy and fragile x. Prior to conception, women can learn their carrier status from a blood test. This testing checks if a patient carries a copy of the gene that causes these disorders. If so, we can then test the partner to determine their carrier status. If, for example, both prospective parents carry a gene for cystic fibrosis the baby has a 25% chance of having the disease.
The goal of this testing is to have more information about possible risks to your future children and to be prepared should you have a baby with one of these conditions. While this testing is optional, it is something to consider especially if either parent has any family history of inheritable diseases.
Are You Taking a Prenatal Vitamin?
Starting your prenatal vitamin or folic acid supplementation prior to becoming pregnant ensures that you are getting adequate levels of vitamins to support a pregnancy. Folic acid supplementation is necessary for normal development of the neurological system from the brain to the end of the spine in the fetus. As an added benefit, women who start their prenatal vitamin prior to conception have less morning sickness during pregnancy!
Do You Have Psychiatric or Mental Health Conditions?
Pregnancy and the postpartum state create a new hormonal environment for your body. This can make some psychiatric conditions better or worse. Prior to pregnancy it is ideal to address any mental health conditions, such as depression, anxiety, post-traumatic stress, bipolar disorder or other issues that you or your partner may suffer from. In most cases, the benefit of taking medication outweighs any potential risk to the pregnancy. However, it is important to share your fertility goals and plans with your health care provider. While many psychiatric medications are safe to continue throughout conception and pregnancy, it is important to share this information with your doctor.
Are You Financially Ready for a Baby?
Raising children is an expensive lifetime commitment. Having a baby can also cause a financial burden. Without insurance, a normal, healthy pregnancy and delivery can cost around $10,000 and up to $30,000 if there are complications. Having a secure financial plan in place will help ease the anxiety of pregnancy and pending parenthood.
While these questions may be daunting, taking an in-depth look at your physical, mental, emotional and financial health will help prepare you for pregnancy and parenthood. Preparedness eliminates some of the inherent anxiety surrounding conception, pregnancy, and parenthood.