Preconception – Trying to Conceive
Planning to conceive a baby means different things to different women. Marlene Vickers quit smoking cold turkey. Gail Myers gave up alcohol and caffeine. Angela Peterson started drinking more water and avoided being near cigarette smoke. They all saw their OB/GYNs or family doctors and began taking prenatal vitamins – essential steps in preparing to conceive.
“Preconception counseling is an essential element in attaining the goal of a healthy pregnancy and birth,” says OB/GYN Dr. David Barrere. “Unfortunately, less than 5 percent of women receive any [preconception-related] health care prior to conception.”
It can be hardest to maintain preconception changes when months pass with no pregnancy in sight.
Dr. Barrere’s primary goal in meeting with a patient for preconception counseling is simple: He wants to identify factors in a woman’s (or her partner’s) medical or family history that could lead to problems with the pregnancy or baby. Preparation is key to good maternal and fetal health.
During her first pregnancy, Carrie Hooper* had several health conditions that needed to be controlled in order for her pregnancy to be a safe and uneventful one, culminating in a healthy baby. She suffered from both diabetes and high blood pressure, but with excellent medical care, she and the baby were just fine.
Hooper’s last postpartum visit to her doctor also served as a preconception visit for planning her next pregnancy. “I asked how long I should wait until trying again when I should stop breastfeeding to facilitate pregnancy, if my present medications would be OK for the next pregnancy and for a continuing prescription for my prenatal vitamins,” she says.
Hooper’s preparation made a difference in her first pregnancy and is likely to make a difference the second time around, too.
While not every situation is diagnosable, Dr. Barrere relies on information obtained during the preconception visit to decide whether or not to recommend genetic counseling. He says that in families with a history of cystic fibrosis, sickle cell disease or other blood disorders (hemoglobinopathies) or tay sachs disease, genetic testing to determine the risk of having an affected child may be advisable.
Some of the changes you may make prior to conceiving a child can be difficult to maintain. “Giving up artificial sweetener was tough, because now I have no alternatives,” says Hooper. “I can’t have too much fruit – it has a lot of sugar in it too, after all – so it’s difficult to maintain dietary discipline without artificial sweeteners. We’re born with a taste for sweet (ever try breast milk?) so it’s hard to live without.”
Peterson found family reactions to the preconception changes in her life difficult to take. “I knew for a while that we were going to start trying to conceive in the late fall, so I cut out caffeine and then eventually tried to drink mostly water,” she says. “I kept up with my exercise routine – I’ve been walking 3 miles a day for the past two years. I also stopped being around cigarette smoke. Both of my parents smoke. That was the hardest because they really don’t understand.”
It can be hardest to maintain preconception changes when months pass with no pregnancy in sight. “I gave up alcohol and caffeine entirely for May through July, and then I’ll admit I became pessimistic enough that I went back to the occasional caffeine dose, and I would allow myself the occasional drink in the early part of my cycle until ovulation,” says Myers. “I wouldn’t have had any problem being totally caffeine- and alcohol-free if I had gotten pregnant within a few months, but as time dragged on, it became difficult to keep motivated. Kind of like, ‘If I’m not getting pregnant anyway while being so conscientious, why not enjoy myself a little?'”
Dr. Barrere recommends discontinuing oral contraceptives (birth control pills) at least one month prior to attempting to conceive. “In this case, cycle length can be ascertained,” he says. “This may be helpful in cases of infertility.”
He also recommends immunization for Rubella, if you are not immune, and Hepatitis B. “Since this is a live virus vaccine, a period of three months should be allowed prior to conception.” Although he also recommends immunization for Hepatitis B, this does not require a delay in trying to conceive.
Prenatal vitamins are often one of the easiest – and most important – changes you can make when planning to conceive. Adding a prenatal vitamin with at least 400 micrograms of folic acid to your daily routine greatly reduces the incidence of open neural tube defects such as anencephaly and spina bifida, Dr. Barrere reports. “The vitamin should also contain 30 milligrams of ferrous iron supplementation to support the increase in blood volume that occurs with pregnancy,” he says.
Seeking out preconception counseling and making lifestyle changes can help you get ready for the challenges of becoming pregnant and carry that new life for the following nine months. According to Andrea Miller, who’s been trying to conceive for nearly two years, “It was hard [to give up caffeine] but it will be worth it in the end!”