Pre-Conception Planning – How to Optimise your Chances of having a Healthy Baby
There’s lots of information that you need to know about pregnancy, below is a very brief overview of many factors that may impact your pregnancy. If you would like further information, please arrange an appointment with me. All my patients undergoing fertility treatment receive a pregnancy information pack with detailed information regarding pre-pregnancy advice and information relating to how to keep healthy during pregnancy.
Folate – The Australian recommendation is that folic acid should be taken for a minimum of one month before conception and for the first 12 weeks of pregnancy. The recommended dose is at least 0.4mg (400mcg) daily to aid the prevention of neural tube defects (such as spina bifida). Where there is an increased risk of a woman having a baby with a neural tube defect (including women who take anti-convulsant medication, have diabetes, have had a previous child affected with a neural tube defect or have a family history of neural tube defects, or have a BMI of 30 or higher) or have a risk of malabsorption, a 5mg daily dose is recommended.
Iodine – It is recommended that women who are pregnant, breast feeding or considering pregnancy should take an iodine supplement of 150 micrograms daily. Most of the pregnancy multivitamins on the market such as Elevit or Blackmores Pregnancy contain the required amounts of folate and iodine – make sure you check the packet when you buy a product to ensure they meet the Australian recommendtations.
Weight – It is important to maintain a healthy weight before and during pregnancy. A body mass index (BMI) of 18.5-24.9 is recommended. To calculate your BMI take you weight in kilos and divide it by you height in metres squared, eg, if you weighed 60kgs and you were 165 cm tall, your BMI would be 60 / (1.65 * 1.65) = 22. Women with a low BMI are at increased risk of miscarriage, premature delivery, low baby birth weight and nutritional problems. Women with a high BMI are at increased risk of numerous issues including blood clots, gestational diabetes, gestational hypertension or pre-eclampsia and problems at the time of delivery; problems with the baby include increased risk of miscarriage, higher rate of neural tube defects and an increased risk of developing obesity or diabetes later in life.
Cigarette smoking – Smoking can reduce fertility and cause problems for your baby during pregnancy. Complete cessation is recommended, both for your own health and the health of your baby. There are numerous organisations that can provide advice and assistance with quitting including the Australian Department of Health, ‘Quit for You – Quit for Two’ app and Quitline.
Alcohol – No amount of alcohol is safe during pregnancy. The safest thing for your baby is not to drink at all. Drinking alcohol (especially large amounts or binge drinking) can have serious negative consequences for your baby, including fetal alcohol spectrum disorder. There are a multitude of support organisations that you can help you reduce your alcohol intake including Reachout and ‘Hello Sunday Morning’.
Other substances of abuse – Studying the effect of illicit substances on an unborn baby is difficult – partly because users of illicit drugs often use multiple substances at the same time, making it difficult to determine the effect of each substance, and also because many users do not accurately report their usage of these substances. Illicit drugs may affect unborn babies by increasing the likelihood of miscarriage; fetal malformations, issues with brain development resulting in issues with sleep, attention, behavioural, short term memory and academic performance, pregnancy complications such as pre-eclampsia, hypertension or placental abruption causing fetal/newborn complications such as premature birth, low birth weight, stillbirth or perinatal mortality, and withdrawal in the neonatal period.
Mental Health – If you are struggling with anxiety, depression or other mental health issues, the good news is that lots of people care about you and there are many support services available. If you think your partner or baby would be better off without you, or you are having thoughts of suicide or of harming your baby, seek emergency assistance by calling triple zero (000) or go to your local hospital emergency department. If you are in crisis, contact Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467
Difficulty conceiving and the IVF process can be distressing. The Centre of Perinatal Excellence (COPE) provides support during fertility treatment. Trained counsellors are available at Genea, or referral to an independent psychologist can be arranged.
Miscarriage can be extremely distressing. Pink elephant is a charity that was set up to support women who have experienced miscarriage. See their website https://miscarriagesupport.org.au .
Medications – If you are concerned regarding the safety of any medication you are taking in regards to pregnancy, Mothersafe (https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/services-clinics/directory/mothersafe) is a fantastic resource that will clarify this for you. There is an over-the-phone service (phone 02 9382 6539 or 1800 647 848) for straightforward enquiries, as well as a face-to-face consultation service for situations that require more extensive discussion.
Infections that can impact pregnancy:
- Cytomegalovirus (CMV) – This is a common virus that usually causes very mild symptoms in healthy adults. However women who catch CMV infection whilst pregnant may pass the virus to their unborn child. If an unborn baby is infected, health problems such as hearing loss, developmental delay and learning problems may occur. The most serious cases may result in stillbirth or infant death. The Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) recommends that pregnant women take the following precautions to reduce their risk of CMV infection during pregnancy:
- Do not share food, drinks or utensils used by children under the age of 3 years
- Do not put a child’s dummy/soother into your mouth
- Avoid contact with saliva when kissing a child
- Thoroughly wash your hands with soap and water for 15-20 seconds after changing nappies, feeding a young child or wiping a young child’s nose or saliva
- Clean toys, countertops and other surfaces that come into contact with children’s urine or saliva
- Influenza - Influenza can cause serious illness, especially during pregnancy. The risk to pregnant women of serious complications is up to 5 times higher than for non-pregnant women. The flu vaccine is recommended for all pregnant women (the cost is covered by Medicare). The influenza vaccine is safe during all stages of pregnancy. Having the influenza vaccine during your pregnancy will also provide ongoing protection to your baby for the first 6 months after birth. See your GP to discuss vaccination against the flu.
- Rubella – Testing for immunity is recommended prior to pregnancy. If not immune, immunization is recommended prior to pregnancy. After immunization, you should wait for a minimum of four weeks before trying to conceive.
- Toxoplasmosis – This infection usually causes mild symptoms but can cause serious problems in an unborn baby if a pregnant woman becomes infected. Cats are the main hosts of the parasite toxoplasma gondii. Humans become infected through contact with cat faeces which may result from direct contact with cat faeces or by touching or eating raw or undercooked meat. The Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) recommends that pregnant women take the following precautions to reduce their risk becoming infected with toxoplasmosis during pregnancy:
- Wash hands before handling food
- Thoroughly wash all fruit and vegetables, including ready-prepared salads, before eating
- Thoroughly cook raw meat and ready-prepared chilled meals
- Wear gloves and thoroughly wash hands after handling soil and gardening
- Avoid cat faeces in cat litter or in soil
- Varicella Zoster (Chicken Pox) – Testing for immunity is recommended prior to pregnancy. If not immune, immunization is recommended prior to pregnancy. After immunization, you should wait for a minimum of four weeks before trying to get pregnant.
- Zika – information relating to Zika can be found at the Australian Department of Health website. The Centre for Disease Control (CDC) provides an up-to-date map of countries affected by Zika.
Pre-pregnancy genetic screening options for you and your partner:
- Expanded carrier screening – There are hundreds of (mostly rare) recessive diseases that can cause serious illnesses in babies and children. If you and your partner are both carriers of a recessive genetic disease, you may be unaware of it, however there a chance that your baby could be affected by it. It is possible to test whether you or your partners are carriers of many genetic diseases prior to pregnancy. The more common genetic diseases in the Australian population include Cystic Fibrosis (CF), Spinal Muscular Atrophy (SMA), Fragile X and Thalassaemia. Contact
- Preimplantation genetic screening (PGS) – This is an option for women undergoing IVF. It involves taking a small biopsy from each embryo (usually 5-6 cells) at day 5 to determine whether the chromosomes are normal in the embryo.
- Preimplantation genetic diagnosis (PGD) – This is an option for couples undergoing IVF when one or both partners are known to have genes capable of causing a genetic disease.