Improving your chances by preparing for pregnancy

It is important that you and your partner get off to the best possible start for the much wanted pregnancy. Preparing for pregnancy will not only increase your chance of achieving a pregnancy but may also decrease the risk of complications to both mother and fetus. Increasing numbers of women with often complex medical conditions are now becoming pregnant or seeking fertility treatment, these women should receive pre-pregnancy counselling, ideally by obstetric physicians.

Here are a few suggestions and recommendations:

Weight and nutrition

It is essential to eat a balanced healthy diet with fresh fruits, green vegetables and plenty of water. Avoid eating processed food as it contains flavouring and additives. Reduce coffee intake. Excess caffeine has been linked to miscarriage and low birth rates (Fernandos 1998 and Cnattingius, 2000). Decaffeinated coffee could aggravate the immune system more than caffeinated variety (Mikuls et al 2003). Diet rich in Omega 3 can significantly decrease natural killer cell activity and suppress the production of TNF alpha cytokines (Frank et al 2001; Gazvani et al 2001). Being overweight or underweight can affect normal ovulation, reduce the chance of getting pregnant, increase pregnancy complications and the risks associated with anesthesia etc. If your body mass index is above 30 you need a supervised weight loss program involving dietary advice and exercise. Obese women take longer to conceive and are at higher risk of miscarriage than ordinary women. If your body mass index is less than 20 then you may also need to go on a sensible eating program to correct it. Restoration of body weight may help resume ovulation and restore fertility.

Changes in lifestyle - How to prepare yourself and partner for pregnancy

• Give up smoking, if this is difficult cut down as much as possible. Cigarette smoking is harmful to the woman's ovaries (smoking has been linked to premature ovarian aging. Kinney 2007). Women who smoke reduce their chance of successful pregnancy by approximately 40% compared with non-smokers. Smoking reduce implantation and pregnancy rates (Neal et al, 2005,. Human Reproduction). Smoking also adversely affects live birth rates equivalent to increased female age by 10 years (Linsten et al, 2005. Human Reproduction, Salihu et al. Early Hun Dev 2007; Gray et al BMJ 2009). . Furthermore, pregnant smokers are more likely to have low birth rate babies and premature birth etc. It has also been associated with an increased risk of placenta previa (low lying placenta) and abruption placenta (separation of a normally sited placenta from its attachment into the womb).
• Reduce or eliminate consumption of alcohol as it may affect ovulation. In addition, there is an increasing body of evidence suggesting harm to the fetus from alcohol consumption during pregnancy including increased rate of miscarriage, growth retardation, prematurity, and developmental delay. Furthermore, excess alcohol during pregnancy is associated with fetal abnormalities such as 'Fetal Alcohol Syndrome'. The syndrome can lead to learning and physical disabilities and behavioural problems.
• Do not use recreational drugs e.g. marijuana, cocaine, etc. or antidepressant drugs. The use of Cannabis by women in the year before IVF treatment is associated with a reduction of the number of eggs collected (Klonoff-Cohen et al, 2006. American Journal of Obstetrics and Gynecology).
• Breast self-examination will help to pick up a breast lump. Breast cancer is rare in young women. However, the high levels of hormone estradiol and progesterone produced by the ovarian stimulation drugs could stimulate the growth of a pre-existing cancer. If you find a lump in your breast, your doctor should assess this urgently. He or she will be able to arrange further evaluation and referral to a specialist when necessary.
• Stop or reduce the caffeine intake. Caffeine is present in coffee, tea, coca-cola, chocolate etc. and is associated with an increased risk of fetal growth restriction (Care study group 2008 BMJ).
• Keep your mouth as healthy as possible and, if you have periodontal disease, get this treated before you become pregnant. There is evidence that treating periodontal disease reduce the risk of having a preterm baby.
• If you suffer from chronic medical condition and on regular medications such as high blood pressure or epilepsy etc., check with your doctor if these medications are safe in pregnancy. For example if you are taking ACE drugs such as Ramipril to control high blood pressure, this drug is not safe in pregnancy as it can cause skull abnormalities and renal failure in the fetus.

Screening by your doctor or clinic

• Check if you are immune to Rubella (German measles) as Rubella puts babies at risk of blindness, deafness and mental retardation. Women who are susceptible to rubella should be offered rubella vaccination before they become pregnant.
• Check if you are immune to chickenpox. Nine out of ten pregnant women (90%) in the UK are immune to chickenpox. If you are not immune; have the vaccine. The chickenpox vaccination is effective in making nine out of ten women (90%) immune. The vaccination cannot be given in pregnancy and you should avoid getting pregnant for 3 months after the injection Primary infection with herpes varicella zoster virus (VZV), in pregnancy may cause maternal mortality or serious complications such as inflammation of the lungs (pneumonia) and inflammation of the brain (encephalitis). It may also cause fetal varicella syndrome. If you are pregnant and you are not immune, avoid contact with any person who has chickenpox or shingles and to immediately inform healthcare workers of a potential exposure(FVS).
• Check if your cervical smear (PAP test) is in date.
• Check if you have a high blood pressure.
• Check if you are anemic.
• Check if you are diabetic (indicated by sugar in the urine).
• Check If you have got kidney disease (indicated by protein in the urine).
• Check if you have got genital infection (many genito-urinary infection are asymptomatic).
• Check your dental health.
• Request certain tests to check for genetic diseases, if there is a history of genetic disorders.

Occupation

Some occupations may reduce male and female fertility such as bakers, drivers, welders, radiotherapists, agricultural workers and woodworkers. The exposure to heat, X-rays, chemical pesticides, solvents, mercury, phthalates etc. may all contribute to infertility.

Folic acid

It is advisable that woman who are contemplating pregnancy should take folic acid (Vitamin B9), one tablet a day (400 mcg) till the 12th week of pregnancy. This will decrease the risk of neural tube defects such as spina bifida (a hole in the spine) and anencephaly (absent brain) and hydrochephaly (water in the brain). This dose should be increased to 4 mg daily in women who have previously had a baby with a neural tube defect and women who have epilepsy and are taking medication, women who have diabetes and women who have coeliac disease.

If you are not very keen to take folic acid tablets you need to eat food which is rich in folic acid such as spinach, green beans, fortified cornflakes and oranges.

Advice for men

• Wear loose fitting boxer shorts and trousers.
• Avoid hot baths and take showers instead.
• Cut down smoking and alcohol drinking or stop altogether. Men who smoke heavily or drink too much appear to have lower sperm motility and a higher proportion of abnormal sperm (Fertility and Sterility, 2007).
• If overweight they should loose weight.
• They should avoid exposure to chemicals and radiations etc.