Planning for pregnancy

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Ways to increase your chances of a healthy baby
By Sonia Elguero, MD*

Get rid of the bad habits: There are several habits listed below that can decrease fertility and can also have a detrimental effect on a pregnancy.
• Smoking: Women who smoke during pregnancy are at increased risk for premature labor, decreased fetal growth and other complications. During pregnancy, smoking is absolutely contraindicated. In addition, studies have demonstrated that men and women who smoke have decreased fertility. Therefore, if you do smoke, you must stop. If you are unable to stop smoking on your own, then you should contact your primary care physician for help.
• Alcohol: Alcohol use during pregnancy has been shown to increase the incidence of birth defects. Therefore, during pregnancy, use of alcohol should be completely avoided. Recent studies have demonstrated that women who drink alcohol have a decreased chance of achieving pregnancy. We recommend that a woman who is attempting pregnancy should limit alcohol intake to the first week of the menstrual cycle.
• Caffeine: Previous studies have demonstrated that caffeine use may be associated with a decreased chance of pregnancy and so we recommend that women switch to decaffeinated beverages or limit their intake to one caffeinated beverage a day. Caffeine is present in coffee, tea, soft drinks and chocolate.
• Recreational drugs: The use of recreational drugs is contraindicated while attempting to conceive and during pregnancy. Are you medically fit for pregnancy? Before you try to get pregnant, it is important to make sure that you are medically fit. This would include an evaluation by your primary care physician or your gynecologist with focus on the following issues. Routine gynecologic care: It is recommended that every woman should have a yearly blood pressure check, physical examination, pelvic examination and Pap smear. As a screening for breast cancer, all women should have a baseline mammogram between ages 35 and 40 and have a mammogram performed every one to two years after age 40. Screening for infectious diseases: Some infections during pregnancy can cause harm to the baby. Immunity to these infections can result from routine childhood immunizations or a previous infection.
• German measles (Rubella): During childhood, it is routine to be vaccinated against German measles. Even so, about 1 in 9 women remains susceptible to this infection. A rubella infection is self-limiting but if it occurs during pregnancy it can have severe effects on the baby and cause birth defects. Therefore, it is recommended that you have a blood test to determine whether you are immune to rubella. If you are not immune, then you should receive an immunization.
• Chicken pox (Varicella): Chicken pox is a highly contagious viral infection that most get during childhood. Following an infection, lifelong immunity results. However, some women either have never had an infection or remain non-immune to chicken pox and are therefore susceptible. If a chicken pox infection occurs during pregnancy there is an increased risk of birth defects. In addition, 10 to 30 percent of adults who have chicken pox develop a serious pneumonia, which can be fatal. If you are uncertain about whether you had chicken pox as a child, a blood test can be performed to determine your immune status. If you are found to be non-immune, then you can receive a vaccine that will give you protection against this infection.
• Hepatitis screening: Hepatitis is a viral infection that affects the liver. In most cases the infection is resolved but in other cases the individual develops a chronic infection and the virus can be passed to the fetus. A vaccine exists that will immunize the individual against Hepatitis B. If you are at risk by the nature of your employment, that is, if you work in the healthcare field or come in contact with blood products, you should talk with your physician about receiving the Hepatitis vaccine.
• HIV testing: An HIV infection can lead to AIDS (acquired immunodeficiency syndrome). This viral infection targets and debilitates the immune system, which normally provides protection against infections. Many people who are infected with the virus have no symptoms. A great concern is that a woman who is infected with the virus can pass the infection to her unborn child. The course of the HIV infection in infants is the same as in adults. Because of the consequences of an HIV infection, it is strongly recommended that HIV testing be performed on all couples contemplating pregnancy.
Medical problems: If you are being treated for a medical condition, it is important that the treating physician be made aware that you are interested in becoming pregnant. With this knowledge your physician may change your treatment or may prescribe a different medication that is safer for use during pregnancy.
Medication use: When attempting pregnancy you should avoid taking aspirin and aspirin-like compounds (e.g., Advil®, Aleve®, Ibuprofen® and Motrin®) around mid-cycle, since these medications can interfere with ovulation. Tylenol® is a suitable alternative. If you are taking a prescription medication, you should contact the physician who prescribed the medication to let him/her know you are attempting pregnancy and ask whether the medication is safe to take during pregnancy. Herbal remedies should be completely avoided since their effect on fertility and pregnancy is unknown.
Assessing genetic risk: Before pregnancy is attempted, you should determine whether you are at increased risk of passing a genetic condition on to your baby. The genetic condition can be transmitted from either the male or female partner. A list of conditions that raise genetic concern is listed below. If any of these conditions have affected you or your spouse, an immediate family or a first-degree relative (uncle, aunt, and cousin), you should consider genetic counseling. If you or your spouse has any disorder in your family tree that is not on this list, then we encourage you to discuss this further with your primary care physician or gynecologist. In some situations, a consultation with a genetic counselor will be needed to clarify the risk.
• Stillbirth • Repeated miscarriages • Down’s syndrome • Birth defects • Bleeding disorders • Hemophilia • Deafness • Blindness • Polycystic kidneys • Psychiatric illness • Muscular dystrophy • Sickle cell disease • Tay Sachs disease • Cystic fibrosis • Mental retardation • Tuberous sclerosis • Chromosomal problems • Thalassemia

Ancestral backgrounds: Individuals of certain ancestral backgrounds can have an increased risk of developing certain diseases. The diseases that are more prevalent in this inheritance pattern are autosomal recessive. In this type of inheritance, carriers do not have symptoms of the disease but if both partners are carriers, then there is a 25 percent chance that the baby will be affected by the disease.
If a person’s ancestral background puts them at risk, he/she can be a carrier of the condition even if there is no family history of the disease. On the other hand, any individual who has a family history of the disease should undergo genetic screening regardless of their ancestral background.
Depending on the specific disorder, if a baby is born with the disease, it can result in death or serious health problems. Some of the commonly inherited diseases are discussed in the chart.

*How to determine whether you are at risk: Both you and your partner should locate your ancestral backgrounds in the second column. If they both fall in the same category (A, B, C or D), then you are at increased risk, as compared to the general population, of having a child with the disease(s) in the third column. If you are at risk, contact your physician to undergo counseling. Your risk can be further defined with blood testing.
Nutrition: Women should maintain a balanced diet of fruits, vegetables, breads, meats and dairy products. Use of foods with a high content of fats and oils should be kept to a minimum. In addition, caloric intake should be limited to maintain a normal body weight.
Body weight: Body weight extremes (too light or too heavy) can cause irregular menstrual cycles, which can result in infertility. Women who are overweight have an increased chance of complications during pregnancy and the delivery. The body mass index (BMI) is a determination of whether your weight is appropriate for your height. Calculate your BMI by multiplying your weight in pounds by 704 then dividing by height (in inches) squared. For example, a woman who is 5 feet (60 inches) tall and weighs 155 pounds would calculate her BMI as follows: 155 x 704/ 602 = 30.3. A woman is considered “normal” if the BMI is 20-24; “overweight” if the BMI is 25-29; “very overweight” if the BMI is 30-39; and “extremely overweight” if the BMI is 40 or higher. Recommendation: All women with a BMI of > 30 should try to decrease their weight before attempting pregnancy. Talk with your physician about a referral to a nutritionist or a weight loss program.
Vitamins: A woman who is attempting pregnancy should take a daily multivitamin or a prenatal vitamin to supplement her diet with folic acid. Folic acid has been shown to decrease the chance of neural tube defects which are birth defects affecting the spine (i.e., spina bifida). If a woman has a family history of neural tube defects or has given birth to a child with this condition, she should talk with her physician about taking a higher dose of folic acid. While vitamins are beneficial, taking excessive vitamins can result in too much Vitamin A, which can increase the chance of some birth defects. Daily intake of Vitamin A should be limited to 8000 IU per day (the amount present in a multivitamin).
Exercise: The benefits of moderate exercise on general health and mental well-being are well established. Exercise during pregnancy is also beneficial. If you are already in an exercise program, we would encourage you to continue. One of the most important things we do in life is plan for a pregnancy to build our family. Our hope is that this article will increase your chances of not only getting pregnant but also having a healthy pregnancy. We wish you good luck with a future pregnancy!
*Sonia Elguero, MD, is a reproductive endocrinologist at the Boston IVF – The Albany Center, 399 Albany Shaker Road, Loudonville; 434.9759; www.albanyivf.com.

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