Optimizing Your Health Prior to Pregnancy

This week is National Women's Health Week which is a great opportunity for patients to be reminded of the importance of a healthy lifestyle. Although experiencing infertility can be one of the most stressful times in a woman's life, it provides a unique opportunity to optimize both partners' health and, therefore, the health of future pregnancies.

Placental and fetal growth are most susceptible to maternal nutrition and lifestyle choices during pre-implantation and the first 3 to 7 weeks after the last menstrual period. Since many women do not know that they are pregnant this early, they may be inadvertently making poor lifestyle choices at a critical time for their baby. Although it is reassuring to know that isolated incidences of poor health choices are not as important as sustained good health, there are certain things you can do before conception that may increase your fertility potential and optimize you and your baby's health.

Achieve a healthy weight. Neither extreme in weight is ideal prior to or during pregnancy. Being overweight (BMI >30 kg/ml) puts women at risk for many obstetrical complications, such as gestational diabetes, neural tube defects, preterm delivery and an increased risk of c-section. Pre-eclampsia (high blood pressure in pregnancy) is often worsened by insulin resistance, a condition prevalent in many overweight women or women with polycystic ovarian syndrome. Since it is not recommended to lose weight during pregnancy, weight loss endeavors should be initiated prior to conception.

Being underweight (BMI less than 18.5 kg.ml) is also problematic. These women are at risk for nutrient deficiencies, osteoporosis, preterm birth, low birth weight, and intrauterine growth retardation.

Achieving a healthy weight is also important for the male partner. Increasing obesity is directly associated with male infertility1. It contributes to lower testosterone levels, poorer sperm quality and reduced fertility. Couples attempting to conceive should make nutritious meals part of the household plan.

Start building important vitamin stores. If not already taking prenatal vitamins, start taking them now. Folic acid supplementation is particularly important since studies have shown that adequate stores of folic acid can greatly reduce the risk of neural tube defects in the fetus. Assure proper iron intake from foods and prenatal vitamins to prevent anemia. Another important vitamin is vitamin D. Studies show that up to 70% of pregnant women do not have adequate vitamin D levels 2. Vitamin D is not only protective against several cancers, but also helps to prevent osteoporosis, hypertension and diabetes3. Babies and children who have adequate levels of Vitamin D have a lower risk of type 1 diabetes4. The current recommendation for vitamin D supplementation ranges from 400 to 1000 IU/day.

Inventory and prioritize medications taken prior to pregnancy. When making a decision to use medications prior to or during pregnancy, one must consider the risk/benefit ratio. The Food and Drug Administration (FDA) provides a classification of medication safety during pregnancy. These classifications range from category A (The safest medications) to category X (studies have demonstrated fetal abnormalities and/or fetal risk while taking these medications). Most medications fall somewhere in between. Most practitioners are comfortable prescribing category A and B medications, but prescribing or continuing a category C medication requires some consideration. For women who have chronic conditions, such as seizure disorders, bipolar disease, and some gastrointestinal disorders, the risk of stopping the medications might be greater than continuing them even though they are category C.

See your internist and/or OB/GYN to assure your health is current. Make sure you are up to date with your pap smear and mammogram since screening and treatment options during pregnancy can be somewhat limited. Assure that you are up to date with your immunizations. Get the flu and H1N1 vaccines if during flu season, and check your immunity to rubella (German measles) and varicella (chicken pox). The vaccinations for these diseases contain a live virus, so you cannot attempt pregnancy for 1-3 months after getting vaccinated. Determine if you carry a genetic disease based on your ethnicity. For example, if you are Caucasian your risk for Cystic Fibrosis is approximately 1/25. Other ethnicities, such as Mediterranean and Ashkenazi Jews, are at risk for thalassemia and Tay Sachs, respectively. It is also important to visit the dentist regularly. Women with uncontrolled gingivitis have a greater incidence of preterm labor.

Start and maintain good habits. Employ frequent hand washing. There are certain viruses that have no available vaccine but can be prevented by good hygiene. Take off your shoes when you enter the house. This will reduce your chance of introducing environmental toxins into your home. Enjoy and thoroughly wash fruits and vegetables. It is not necessary to buy a certain washing agent, but more important to use gentle friction while rinsing. Properly clean utensils and cooking services after your meal prep. If you have cutting boards that are damaged or have rivets in them, discard them and get new ones. These will decrease the chance of contracting a bacterial infection. One of the easiest, but most important interventions is to drink enough water. 8 glasses a day is suggested and 2-3 of these can be decaffeinated beverages. Caffeinated drinks don't count toward your quota and can actually cause you to lose water. Dehydration can exacerbate stress, cause fatigue, headaches, sluggishness, and constipation. Lastly, it is important to get enough sleep. How much sleep you need varies per person, but good quality sleep can keep hormone levels balanced and help with conception.

Start exercising now. Start a program to strengthen your cardiovascular system. Besides helping to reduce or maintain weight, exercise has the added advantage of reducing stress and keeping the bowels moving well. If you have not been exercising regularly prior to pregnancy, you should always check with your health care practitioner before starting an exercising program in pregnancy.

Find ways to reduce stress. For many women experiencing infertility, this is incredibly important. Since some forms of stress release, such as intense exercise or drinking a glass of wine are not recommended during treatment cycles, it would be helpful now to work on alternate outlets. These can include meditation, participating in a yoga class, gardening, walking a dog, or getting frequent massages. Chiropractors can help alleviate muscle tension and studies show that acupuncture may help with the stress of infertility as well as relaxing smooth muscle (which is important for implantation). Just be sure that whatever practitioner that you utilizes specializes in pregnancy or women's health.

Most importantly, use the time prior to conception as a time to concentrate on you, your physical and mental health. Assuring that you have balance in your life is essential for emotional well-being during this pivotal time in your life.

1. Sallmen et al. Reduced fertility among overweight and obese men. Epidemiology; 17(5): 520-523.
2. Lee, JM, et al. Vitamin D deficiency ina healthy group of mothers and newborn infants. Clinical Pediatrics; 46(1): 42-44.
3. Holick, MF. Vitamin D deficiency. New England Journal of Medicine; 357(3): 266-281.
4. Hypponen, E et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet; 358: 1500-1503.