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Planning for Pregnancy

This page was reviewed or revised on Friday, October 15, 2004.

Introduction

So, you plan to have children and you want to make sure that everything goes well. There are many things that couples can do to maximize their chances for having a healthy pregnancy and a healthy baby. But you must remember, there is no "magic formula" that comes with an absolute guarantee. Some things are beyond our complete control; however, the odds can certainly be tipped in your favour if you and your partner are both in the best health possible when pregnancy occurs.

Why Plan for Pregnancy?

We all know how important it is for a woman to take care of herself during pregnancy. What most people don't realize however, is that the health of a woman entering pregnancy is just as important. From 17 to 56 days after a baby is conceived, its major body organs are being developed and are most susceptible to damage. Throughout this time, it is especially important for the mother to be in good health and to avoid exposing herself to harmful substances such as tobacco, alcohol, drugs or other chemicals.

It's important for couples to plan for pregnancy to have time to correct any underlying health problems and to break unhealthy habits.

What areas should be considered when planning a pregnancy?

1. Family Planning & Birth Control
2. Weight & Nutrition Before & During Pregnancy
3. Medical Care: Genetic Counselling, Age
4. Sexually Transmitted Diseases & Other Infections
5. Lifestyle: Smoking, Caffeine, Alcohol, Drugs, Medications
6. Work
7. Stress
8. Physical Activity

What about Dad?

Regardless of this, it makes sense for a man to follow a healthy lifestyle in preparation for pregnancy. Not only will it benefit his own health, it will provide support and encouragement to his partner as she makes lifestyle changes which will benefit the health of their future baby. In addition, children learn by imitating their parents. If you practice a healthy lifestyle, your child is more likely to develop healthy habits too. One way or another, men can have a positive influence on their child's health!

Let's examine some concerns which you may have as a parent-to-be.

Low Birth Weight Babies

A baby is considered to be of low birth weight if he is less than 5 1/2 pounds at birth. Low birth weight babies are at risk for experiencing serious health problems at birth and more health problems over the course of their lives. They may even be slower in their learning abilities than other children. Babies are born low in weight for one or both of the following reasons: either their growth has been slowed down during the pregnancy, or they are born prematurely.

Miscarriage

Most miscarriages occur very early in pregnancy. They often go unnoticed, appearing to be just heavy or prolonged menstrual periods. Although miscarriage is often beyond our control, couples can reduce their risk by ensuring that they are in good health and are practicing healthy habits when they begin trying to conceive.

Stillbirths and Birth Defects

We usually can't pinpoint the exact causes of stillbirths and birth defects. However, many precautions which can be taken to reduce these risks will be discussed further. In addition to these pregnancy-related health concerns, this guide will also deal with the following problem:

Infertility

Fifteen percent (15%) of couples experience difficulty getting pregnant. Infertility is defined by failure to conceive after one year of planning a pregnancy. Many of these couples will go on to eventually get pregnant; however, special medical procedures may be required in order to do so. While we can't always prevent problems, we can avoid many lifestyle-related causes.

1. Family Planning & Birth Control  top

Use birth control and family planning methods to help you have children at a welcomed time in your life. You will want to be in a stable, loving relationship, and if possible, free of worries about your finances and future. This way both you and your partner will have more time and energy to devote to taking good care of yourselves and your developing baby when pregnancy does occur.

Women who use the birth control pill or I.U.D. might be wise to give themselves some time off their method of contraception before getting pregnant. For the pill, a time period of one to three months is usually advised, as this medication can make the body deficient in certain vitamins such as Vitamin C and folic acid. Recent research has found that folic acid is very important for the healthy development of a baby's brain and spinal cord. Healthy levels of this nutrient in a woman's diet (or through supplements) before and early in pregnancy can help to protect against birth defects such as spina bifida. In addition, a time lapse also allows for the return of "normal" periods.

The IUD acts by irritating the lining of the uterus. Allowing 2 or 3 regular menstrual periods to occur after having an IUD removed will help to ensure that this lining is refreshed and healthy for receiving a fertilized egg.

Diaphragms, condoms and spermicides are all considered to be safe alternatives for birth control during the time immediately before conception. Spermicides and vaginal foams should be discontinued as soon as the couple has decided to attempt to conceive.

2. Weight & Nutrition Before & During Pregnancy  top

Women who are considering pregnancy should establish and maintain a healthy weight and good eating habits for at least 3 months before trying to conceive. Women who enter pregnancy underweight are more at risk of having a low birth weight baby or preterm labour. Overweight women are more at risk of developing complications such as high blood pressure and diabetes during pregnancy.

Pregnancy is not a time for restricting your weight. Weight should never be lost intentionally during pregnancy, as the substances which are released when large amounts of fat break down may have a harmful effect on the developing baby. During pregnancy, most women are encouraged to gain 25 to 35 pounds. Even overweight women need to gain. Consult your doctor regarding the best amount of weight gain for you.

Following a well balanced diet is important both before and during pregnancy. An unbalanced diet can affect a developing baby and lead to either low birth weight or birth defects. A healthy diet consists of a variety of servings from each of the four food groups:

1. Grain Products (5-12 servings per day)
2. Vegetables & Fruit (5-10 servings)
3. Milk Products (2-4 servings)
4. Meats & Alternatives (2-3 servings)
   

Women should consult their doctor before taking a vitamin supplement. Too many vitamins can be just as harmful to a developing baby as too few. It is, however, particularly important for women to make sure that they are getting enough of the following nutrients throughout the months before and during pregnancy:

There are other risks associated with unhealthy nutritional habits. Men and women who are either extremely overweight or underweight may experience problems with infertility. When a person's level of body fat is either too high or too low, their hormone balance can be affected. This can result in decreased sperm production of men and irregular ovulation for women.

3. Medical Care  top

Women are encouraged to see their doctor before attempting to get pregnant. This allows the doctor to detect and treat any health problems which might pose a risk to the health of a pregnancy. Then, as soon as pregnancy is suspected, a doctor's appointment should be made. Early medical care allows the health of the pregnancy to be closely monitored and the baby's due date to be determined more accurately.

Women who suffer from health problems such as diabetes, epilepsy, phenylketonuria (PKU) or high blood pressure will want to make sure that their condition is under control for at least 3 months before pregnancy occurs. Uncontrolled health problems can result in low birth weight, birth defects and other problems. Women who take medication on a regular basis will need to ask their doctor if it is okay to continue when planning a pregnancy, or whether a change of medication is required. Please note that you should never stop taking any medication which has been prescribed for you before consulting your doctor.

Genetic Counselling

Some men and women can benefit from genetic counselling before attempting pregnancy. You may wish to ask your family doctor to refer you to a genetic clinic for counselling if you or your partner have experienced any of the following circumstances:

• three or more miscarriages, or a stillbirth
• a previous child born with a birth defect
• you were born with a genetic disorder
• relatives with health problems that are genetic in nature
• you belong to an ethnic group that tends to carry certain genetic disorders (e.g. Tay-Sachs Disease mostly affects people of Jewish and French-Canadian ancestries)
• you and your partner are close relations
• women over 35 years of age
• Genetic counselling will let you know whether the health problem in question could be passed on to your future children, and whether it is possible to reduce this risk in any way. Examples of common genetic disorders include Down syndrome, cystic fibrosis, haemophilia, muscular dystrophy, Huntington disease, thalassaemia and sickle cell anaemia.

Age

Keep in mind that the chances of having a healthy baby are best when the mother is between the ages of 17 and 35. Mothers under 17 are more likely to have low birth weight babies. Women over 35 have a greater chance of giving birth to twins or triplets (which are more likely to have a low birth weight) as well as babies with certain chromosomal birth defects such as Down syndrome. This is not to say that women should not have children if they fall outside this age range, but they do need to know that there are risks. As long as these women are in good health, making healthy choices, and getting good medical care before and during pregnancy, there is no reason why they cannot have a healthy baby.

Once you've started your family, it is a good idea to space pregnancies 1 year or more apart. Having pregnancies too close together doesn't allow mom enough time to recover physically and puts the next baby at risk for being born at a low birth weight.

4. Sexually Transmitted Diseases & Other Infections top

Protect yourself from sexually transmitted diseases (STD's) such as AIDS, chlamydia and gonorrhea by limiting yourself to one sexual partner and by using condoms if you are not sure that your partner is free from infection. STD's and other infections such as rubella and toxoplasmosis can cause problems such as low birth weight, birth defects, miscarriage and stillbirth, or serious infection in the newborn.

Women should have their immunity to rubella (German Measles) tested before getting pregnant. If not immune, a vaccination can be obtained. Pregnancy should be avoided for 3 months afterward.

Toxoplasmosis is an infection caused by a parasite. The parasite enters the body through the mouth. It is mostly a concern for people who clean the litter boxes of cats that hunt or eat raw meat, as the parasite can be found in their faeces. The infection can also be obtained by working with garden soil or eating undercooked meats such a pork, lamb, goat or fowl. All women should take precautions to avoid this infection once they begin to try to get pregnant by wearing gloves, practicing good handwashing whenever they handle any of these items and having someone else change the cat litter daily.

If you think you are suffering from an STD or any other infection, get medical treatment and ask your doctor how long you should wait before trying to conceive. One final note: People who expose themselves to STD's place themselves at risk for becoming infertile. Severe infections in the reproductive organs can cause scars to form which can block the passageways through which sperm and eggs travel. This results in infertility.

5. Lifestyle top

There is much that can be done with regard to lifestyle by men and women hoping to have a healthy baby. It is important to make any necessary changes before the baby is conceived, because one of the most vulnerable periods in a baby's development occurs from 17 to 56 days after conception, so early that a woman may not yet know she is pregnant.

A healthy lifestyle can also help to improve a couple's fertility. We'll take a look at the following lifestyle areas as they relate to fertility and pregnancy: smoking, use of caffeine, alcohol, drugs and medications.

Smoking

Tobacco can affect the fertility of both men and women. In men it reduces sperm production, changes sperm shape and decreases sperm movement. It may also be able to interfere with having a normal erection by reducing blood flow to the penis. In women, smoking interferes with ovulation, fertilization and implantation of the fertilized egg. Women who smoke one pack a day are estimated to be 30-40% less fertile than non-smoking women.

Smoking causes blood vessels to narrow and the level of oxygen in the blood to decrease. During pregnancy, this means a reduction in blood flow and oxygen to the baby. This can cause the baby's growth to be restricted resulting in a low birth weight baby. Tobacco use over five (5) cigarettes a day doubles a women's risk of having a low birth weight infant.  Other complications of smoking during pregnancy include miscarriage and stillbirth. It's important to note also that even if you stop smoking in the third trimester, the risk of having a low birth weight baby returns to normal levels.

Second-hand smoke is also a concern for pregnant women. Excessive levels may lead to a reduction in the growth of a baby, and interruption of fetal lung (breathing) movements.

Children of smokers are more likely to die from crib death (Sudden Infant Death Syndrome) than other children. They tend to have a greater number of health problems and may even have learning deficits. We now also know that exposure to second-hand smoke is a cause of cancer.

Caffeine

Most people don't think of caffeine as being a drug, but it is. It causes the heart to beat faster and makes you more alert. In excessive amounts, it can lead to headaches, jitteriness, addiction (to caffeine) and long term health problems.

If you're having problems getting pregnant, it wouldn't hurt to consider reducing the amount of caffeine which you have in a day. Although the evidence is far from conclusive, there is some concern that caffeine can affect fertility. Some studies have found that women who drink more than three 5 ounce cups of coffee (300 mg of caffeine) per day tend to take longer to get pregnant. Animal studies indicate that caffeine may be able to affect the fertility of men as well. Further research is needed to confirm these results, but if you're having problems conceiving, it might be worth considering.

Canadian guidelines recommend that all adults keep their caffeine intake from rising above 400 mg a day. This amount can easily be obtained in three to four cups of coffee or eight cups of tea. It is important to note that one serving or "cup" is five ounces. Most coffee mugs hold twice this amount! Keep in mind that chocolate, colas and certain medications also contain caffeine.

During pregnancy a woman's body becomes slower at clearing caffeine out of its system. There is some concern that caffeine may restrict the growth of a developing baby.  It is recommended that pregnant women limit their caffeine consumption to 300 mg a day.

Alcohol

Men and women may be able to improve their fertility by avoiding the heavy use of alcohol (2 drinks or more per day). In men, alcohol can lower testosterone levels, decrease sperm production, and interfere with sexual functioning (i.e. the ability to have and maintain an erection). In women, heavy drinking may be able to disrupt normal menstrual cycles.

Women who are planning a pregnancy are encouraged to consider abstaining from alcohol use. We do not know if there is a "safe" level of alcohol consumption during pregnancy, or whether there is a particular time in pregnancy when alcohol can be most harmful. We do know that binge drinking is extremely dangerous at any time and that women who drink heavily throughout their pregnancies are more likely to have a miscarriage, stillbirth, or baby born with some or all of the signs of Fetal Alcohol Syndrome (mental retardation, low birth weight, facial and joint deformities, behaviour problems).

Attention future fathers! You may be interested in knowing that there is considerable interest at this time in the medical community as to whether a father's heavy drinking before conception could have harmful effects upon a future pregnancy. Research is now being conducted in this area to determine whether there is a paternal link to outcomes such as low birth weight and Fetal Alcohol Syndrome.

For more information about Fetal Alcohol Syndrome (FAS), please contact the Family Health Services secretary at 383-8331 ext. 603 for a package of information. Another local resource is "The Fetal Alcohol Parents Support Group Sarnia/Lambton". Contact Rona Stroobandt at (519) 882-1953.

Drugs

Couples who are planning to conceive should avoid use of all illicit drugs.

Drugs such as heroin and marijuana can disrupt normal hormone levels and cause problems with fertility for men and women.

Use of drugs such as cocaine and LSD during pregnancy can increase the chance of miscarriage, while heroin addicts often experience other pregnancy complications such as abnormally implanted placentas and premature labour. Birth defects have been found in the babies of mothers who used inhalants or solvents in combination with alcohol during their pregnancies.

Most illicit drugs that are used heavily during pregnancy can lead to addiction and symptoms of withdrawal in the newborn. Such babies are often very irritable and poor feeders at birth. They usually go on to exhibit hyperactivity and other behaviour problems.

Once again, there may be a link with dad's habits in this area too. It is known that marijuana can decrease the number and movement of sperm and it can increase the percentage of abnormally formed sperm.

Medications

If you or your partner take medication on a regular basis and are having difficulty conceiving, talk to your doctor to find out whether or not the medication could be part of the problem. For men, anabolic steroids can cause sterility (lack of sperm production) and impotence (inability to have an erection), while for women, they can cause menstrual irregularities. Blood pressure medication, antidepressants and tranquillizers can cause a reduction in sex drive for both sexes, impotence for men, and changes in ovulation and menstruation for women.

Before getting pregnant, women should consult their doctors about any medication taken on a regular basis, whether prescribed or over-the-counter. They may be advised to continue with the medication, change to a safer medication, or stop taking the medication completely.

Generally, it is a good idea to avoid taking any unnecessary medication during pregnancy. Many can harm developing babies. An example of a medication which can cause birth defects if taken during pregnancy is the acne medication, Accutane. Even vitamins can cause harm if the dose taken is too high.

6. Work top

If you feel that you are working in an environment which could harm you or a developing baby, consult your doctor, occupational health nurse, local occupational health and safety agency, or public health department. Danger may result from skin contact or inhalation of hazardous substances such as pesticides, solvents (e.g. paint thinners) and lead. Possible effects of the hazardous exposures of men and women include infertility, miscarriage and birth defects. Please note that when proper precautions are used, hazardous substances can usually be handled without danger to the person working with them.

Some studies have found links between male toxic exposures and birth defects amongst children. It is presently unknown whether these defects occur because of direct damage to the sperm or due to indirect exposure of the female partner. Men may indirectly expose their partners to harmful substances by carrying the chemicals home on their clothes or by absorbing them into their bloodstream and transmitting them through their semen during sexual intercourse.

Jobs involving strenuous physical exertion, long hours of work or extensive time on the feet may pose a problem for women during pregnancy. Such women may need to consider requesting a transfer to a new position for the period of time while they are pregnant. A transfer may not be necessary if modifications can be made to make the work environment safer or more comfortable.

A note about working with computers (video display terminals or VDT's): In the past, there has been concern regarding the effects of VDT exposure on pregnant women. Years of research on this subject have been unable to prove any harmful effects from working with VDT's during pregnancy. The wearing of lead aprons is not encouraged because they are hot, heavy and uncomfortable. The main concern for pregnant women who work long hours in front of a computer is the eye and muscle strain that result, so take frequent breaks to move around, stretch, and relieve your tired eyes.

It is always a good idea for a woman to take a few weeks off before her baby is born. This is especially important if she has a strenuous job or a long commute to work (i.e. more than 1 hour per day). Think of it as taking a vacation before starting a new job! The end of a pregnancy can be a very tiring time, and you won't want to enter labour exhausted.

7. Stress top

Stress can be both positive and negative. A reasonable amount can stimulate a person to learn and to grow, while excessive levels can produce physical symptoms and feelings of anxiety.

High levels of stress can be related to infertility for both men and women. During pregnancy, excessive levels can be a factor in the delivery of a low birth weight baby.

Before conceiving, try to reduce your sources of stress as much as possible. This can be done by avoiding too many changes at once, since pregnancy alone is stressful enough. Examples of stressful life changes include getting married, starting a new job, or moving to a new home. Always remember to take time for yourself. Enjoying regular physical activity is an excellent way of doing this, and is a good way to handle unavoidable stress.

8. Physical Activity top

While you are pregnant or trying to become pregnant, it is helpful for you to be active and exercise even if you haven't been exercising before. Check with your doctor to be sure there is no reason for you not to exercise. You may also consult with your fitness instructor about changing your present activity level.

You should not start a new program nor increase the amount of your usual workout from the time you begin trying until the 12th week of pregnancy and after the 28th week.

Although reasonable exercise has many benefits for you, excessive exercise may mean that the baby is competing with the exercising muscles for oxygen and food. Also the baby may be exposed to excessive heat which may cause health concerns.

How Hard Are You Exercising?

Taking your pulse will help you know how hard your body is working while exercising. Most healthy pregnant women can follow the table below, which shows the Suggested Exercise Heart Rate during Pregnancy*.

*At the beginning of a new exercise program and in late pregnancy, women should exercise at the lower end of the recommended heart target range.

Another test to use to make sure you aren't exercising too hard is the "talk test" - that is, you should be able to talk to someone while exercising or hum quietly if alone.

The good news is that even women who haven't been exercising can safely begin to increase aerobic exercise between the 16th and 28th week of pregnancy. However, this new exercise routine should progress gradually and systematically to avoid problems.

Reasons to stop exercising and contact your doctor:

• bleeding from the vagina
• "gush" of fluid from the vagina
• sudden swelling of the ankles and hands
• less frequent or absent movements from the baby
• uterine cramps which don't go away
• very low weight gain
• headaches that don't go away, changes in vision, dizziness, or general fatigue.

One Final Note:

There are many things to think about in preparation for pregnancy. The effects of children on your social life, relationships, finances and career must all be considered along with the many health issues covered here. Before getting pregnant you and your partner will want to discuss many things such as:

For more information, call:

Health Promotion and Program Support
Community Health Services
383-8331

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References:

Littleton, Engebretson J.C. (2002). Maternal, Neonatal and Women's Health Nursing. Albany: Deimar

Lowdermilk, Perry & Bobak, I.M. (2000), Maternity & Women's Health Care (7th ed.) St. Louis: Mosby.

Appendix - Resources For Future Parents

Preconceptional Health

Pre-Conceptions: What You Can Do Before Pregnancy to Help You Have a Healthy Baby.
Author: Norra Tannenhaus
Contemporary Books, Chicago, 1988

Preconception: A Woman's Guide to Preparing for Pregnancy and Parenthood.
Author: Brenda Aikey-Keller
John Muir Publications
Santa Fe, New Mexico, 1990

Before You Conceive: The Complete Prepregnancy Guide.
Authors: John R. Sussman, MD. and B. Blake Levitt
Bantam Books, New York, 1989

Preparing for Pregnancy: A Health Primer for Parents-to-be.
Authors: John T. Queenan, MD & K. Leslie, MD
Little, Brown and Company, Boston, 1989

Making the Decision to Have Children

The Timing of Motherhood.
Author: Walter C. Ambler
Lexington Books, 1986

Sooner or Later: The Timing of Parenthood in Adult Lives.
Authors: P. Daniels & K. Weingarten
W.W. Norton Publishers, 1982

Children by Choice.
Author: Jean E. Veevers
Butterworth & Co., Toronto, 1980

Why Children?
Editors: Stephanie Dowrick & Sibyl Grundberg
The Women's Press Ltd., 1980

Infertility

Missed Conceptions: Overcoming Infertility
Author: Anne Mullens
McGraw-Hill Ryerson, Toronto, 1990

Genetics

The Family Genetic Sourcebook
Author: Benjamin A. Pierce
John Wiley & Sons Inc., Toronto

(1) Reference: "Healthy Beginnings: Guidelines for Care During Pregnancy and Childbirth", Clinical Practice Guidelines for Obstetrics by the Society for Obstetricians and Gynecologists of Canada, December 1995.

Produced by:
Esther Reed, B.Sc.N.
Reproductive Health Program
Regional Niagara Health Services Department
1993

Revised and printed by:
Jan Herbert, B.Sc.N.
Preconceptional Health
Community Health Services
February, 1994

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