Planning a Healthy Pregnancy
People often plan for college, a career, marriage and buying a home. But while many leave starting a family to chance, careful planning for a healthy pregnancy can give the baby the best possible start in life as well as reduce any medical complications for the mother.
Most pregnancies go well but a small percentage will involve a medical problem that requires special attention. Whether a mother-to-be is 23 years old with no medical issues, or age 37 with a history of chronic health conditions, there are steps she can take to protect her health and prevent birth defects.
“A lot of women don’t realize the value of planning ahead,” said Dr. Armando Fuentes, medical director of perinatology at Children’s Hospital who provides services through the Maternal Fetal Center, a partnership between Children’s and Saint Agnes Medical Center. “They may not know until they’ve missed several menstrual periods that they’re pregnant and therefore lose valuable time in which they could be making necessary changes in their lifestyle or seeking medical treatment that could affect the outcome of their pregnancy.”
Over 40 percent of pregnancies in the United States are unplanned, and many more women who are considering conceiving do not seek prior medical consultation. Healthcare providers recommend that a woman who knows that she wants to get pregnant should begin at least three to six months ahead of time preparing her body to carry new life. This timeframe allows her to better prepare her body for successful conception and pregnancy, obtain testing and reduce potential health risks.
While a mother-to-be should consult her healthcare provider for information specific to her care, key areas to focus on include the following:
Engaging in a lifestyle that promotes optimal health is essential to preventing disease and building vitality to lead an enjoyable life. Never is this more important than when trying to conceive or during pregnancy, when the expectant mother needs to take care of her own body while helping her baby develop and grow. Having a strong and healthy body will prepare her for the stamina required during pregnancy as well as increase the probability for conception and a smoother pregnancy, labor and birth.
It’s best to achieve a healthy weight, eat a wholesome diet and develop a regular exercise program before becoming pregnant. Some other significant changes (detailed below) that women can make are not drinking alcohol or smoking, taking folic acid and reducing exposure to harmful elements in the environment.
“Although many people have heard this, it can’t be emphasized enough – following this advice can prevent a lot of problems for both mother and baby,” said Dr. Fuentes, a maternal fetal medicine specialist with expertise in managing pregnancy complications.
The Maternal Fetal Center combines perinatology services, Saint Agnes’ birthing center, and neonatal and pediatric subspecialty expertise at Children’s. The only program in the Central Valley to offer this level of specialized, multidisciplinary care across a full continuum, the Center’s primary focus is to optimize the mother’s and baby’s chances for a healthy delivery and life.
Alcohol: It is widely known now that drinking alcohol and smoking can cause health issues. But during pregnancy this takes on new meaning when the well-being of an unborn child is also at risk.
Drinking alcohol during pregnancy can cause a wide variety of physical and mental defects. According to the March of Dimes, up to 40,000 babies are born each year in the U.S. with fetal alcohol spectrum disorders (FASDs), a term used to describe the many adverse effects associated with exposure to alcohol before birth. These effects include mental delays; learning, emotional and behavioral problems; and defects involving the heart, face and other organs. The most severe effect is fetal alcohol syndrome (FAS), a combination of physical and mental birth defects. Drinking alcohol during pregnancy also increases the risk for miscarriage, premature birth (before 37 weeks of gestation), and possibly stillbirth.
No level of drinking alcohol has been proven safe during pregnancy. According to the U.S. Surgeon General, binge drinking and drinking seven or more drinks per week place a baby at greatest risk for FASDs. However, FASDs can occur in babies of women who drink less.
Smoking: At least 10 percent of women in the U.S. currently smoke during pregnancy. Known to slow fetal growth and increase the risk of preterm delivery, smoking nearly doubles a woman’s risk of having a low-birthweight baby (less than 5 ½ pounds). Low birthweight can result from poor growth before birth, preterm delivery or both.
Premature and low-birthweight babies face an increased risk of serious health problems while a newborn, chronic lifelong disabilities (such as cerebral palsy, mental delays, and learning problems), and even death.
Expectant mothers should also avoid exposure to other people’s smoke. Studies suggest that babies of women who are regularly exposed to secondhand smoke during pregnancy may have reduced growth and may be more likely to be born with low birthweight.
Folic acid: Daily supplementation (400 mcg) of folic acid, or vitamin B9, in women before conception and during early pregnancy has been shown to reduce the occurrence of birth defects, including neural tube defects such as spina bifida.
Environment: As a woman becomes more mindful of what she ingests into her body before conception and during pregnancy, it is equally important for her to reduce or eliminate other environmental effects that could harm her or her unborn baby. She should avoid any radiation or chemical exposure, for example, as much as possible, from X-ray machines if employed in the healthcare industry, to strong household chemicals found in weed killers and cleaning fluids. If using household chemicals, wearing rubber gloves can prevent these toxic substances from getting into the body through the skin, and not using them in confined or poorly ventilated places will decrease the danger of breathing harmful vapors.
Effective pre-pregnancy planning includes a physical exam that assesses the mother’s current health, medications and immunization history.
Medical disorders: Controlling and/or detecting medical disorders – such as diabetes, high blood pressure, asthma, nutritional deficiencies, and thyroid, kidney and heart disease – before becoming pregnant can prevent a variety of complications for the mother and her baby.\
Medications: Since some medications can harm the fetus, the healthcare professional should review the mother’s prescriptions as well as any herbs, supplements or other over-the-counter products. “The woman’s doctor may suggest alternative medications as necessary,” said Dr. Fuentes. “There are medications for hypertension, for example, that she can take that will not hurt her baby.”
Immunizations: The new mom’s immunization status should be updated. To prevent birth defects, miscarriage or stillbirth that can be caused by such infections as rubella or measles, she should receive the necessary immunizations and wait the recommended time before trying to get pregnant.
Preconception consultation and testing
Preconception counseling and testing provides the opportunity for a woman to be prescreened for health and risk potentials before attempting to become pregnant. Potential risks include maternal age, prior pregnancy losses, family history of congenital anomalies or genetic conditions, maternal illness, and possible exposure to alcohol or substance abuse. Sometimes genetic testing or counseling is recommended before pregnancy. This information helps the woman make informed decisions about her own health and that of her baby before birth, and institute appropriate interventions, when possible, before conception to improve the pregnancy outcome.
Preconception care has been shown to reduce neonatal morbidity and mortality especially in women who are at risk. Preconception care is especially important in the prevention of congenital anomalies. A baby’s organs begin to form within 17 days after conception, but as many as one third of pregnant women don’t begin traditional prenatal care until the second trimester (after 13 weeks of gestation).
“If we can identify patients at risk early on, we (perinatologists) can work with the mom’s family practitioner or obstetrician and monitor the mom and her baby throughout her pregnancy,” said Dr. Fuentes. “If problems do come up, there are a number of tests and interventions that we can do to ensure that mother and baby receive the best care possible.”
Some of these procedures, which are offered through the Maternal Fetal Center, include: chorionic villous sampling, amniocentesis, nuchal translucency, antepartum fetal surveillance, fetal magnetic resonance imaging (MRI), 3-D and 4-D sonograms, fetal echocardiograms, intrauterine transfusions, bladder shunting, thoracentesis and percutaneous umbilical blood sampling.
As part of the Maternal Fetal Center, Children’s Hospital’s state-certified Prenatal Diagnostic Center (PDC) provides a comprehensive approach to prenatal diagnosis. The only hospital in the region with both American Institute of Ultrasound in Medicine (AIUM) and American College of Radiology (ACR) ultrasound accreditation, the PDC’s services geared toward each individual include prenatal screening, state-of-the-art diagnostic testing, genetic counseling and in-depth patient education. All of Children’s sonographers are American Registry of Diagnostic Medical Sonographers (ARDMS) certified, and experienced geneticists and genetic counselors are on staff.
Becoming pregnant and bringing new life into the world is usually a joyous event for a woman. But just like with most complex tasks, careful planning can aid in making proper assessments and good decisions, reducing risks or loss and achieving success. And while most expectant mothers do not experience medical complications, taking steps to promote a healthy pregnancy increases the odds of giving a newborn the best beginning in life – success doesn’t get better than that.