Simpsons fans will remember the episode where Homer and Marge rekindle their passion. In one scene they recall great lovemaking moments of the past and Homer remembers the day he “knocked up” Marge. “We drank so much that night I thought Bart would be born a dimwit,” he tells Marge. Marge laughs uncomfortably.
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Homer may be in denial about Bart’s abilities, but he’s certainly not in the dark about the possible effects of alcohol on the development of a baby. And drinking is only one thing to think about when you begin to plan a pregnancy. There are other habits and lifestyle practices that both you and your partner may want to adjust to enhance your fertility, increase your well-being during pregnancy and make growing a healthy baby more likely. Because we can rarely predict the moment of conception, before pregnancy is the best time to begin making these changes.
Visit Your Doctor Dr. Claire Murphy, a Toronto family physician, strongly encourages women to book a preconception appointment when they are planning a pregnancy. She asks their partners to attend the appointment as well. In this half-hour visit she takes a medical history, provides information and invites the couple to ask questions.
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Murphy reviews the genetic history and ethnic background of both partners, asking about incidences of Down’s syndrome, muscular dystrophy, spina bifida, sickle cell anemia and other diseases. From this discussion some couples decide on testing, which can be done before or after conception, to learn if they are carriers of a genetic disease. Eileen Bogris*, the mother of a one-year-old daughter, has known since childhood that she is a carrier of thalassemia. “It is common among people originating from the Mediterranean, making my husband unlikely to be a carrier, but he was tested and we were reassured that he was not a carrier.” If they had both carried the gene, they ran the risk of passing this blood disease to their child, who might then suffer from symptoms such as severe anemia.
A later appointment may include a physical, Pap smear, testing for sexually transmitted diseases, and testing for immunities to rubella and chicken pox, two diseases which may harm the unborn child. “If a woman is not immune to these diseases, we offer her vaccinations. Then she would need to wait three months before getting pregnant,” explains Murphy.
Say No to Alcohol and Drugs Sarah Liddell, the coordinator of the Mothercraft Parent-Infant Program in Toronto, works with families whose children have been exposed prenatally to alcohol. Liddell stresses, “Fetal alcohol syndrome is a leading cause of learning and behavioural difficulties in children. It is not curable, but is preventable. No amount of alcohol is known to be safe for a fetus. Take control of what you can control and stop drinking before you conceive.” Very early pregnancy is one time when alcohol can have devastating effects on the fetus, so giving up drinking when you’re trying to get pregnant is important. Conception is followed by very rapid development of the fetus and even small amounts of alcohol can have serious effects. As we do not know other specific times in pregnancy when alcohol may affect the fetus, the best practice is to give up drinking completely from the time you plan a pregnancy until after the baby is born.
While you’re at it, quit smoking, advises public health nurse Marilyn Lemon of Grey Bruce Health Unit in Owen Sound, Ontario: “Smoking can decrease fertility. If you smoke during pregnancy, there is a greater chance of miscarriage, premature birth and having a low-birth-weight baby.” That goes for your partner, too, she says, explaining that “exposure to second-hand smoke can have similar effects.”
Liddell points out that recreational drugs, and some prescribed and over-the-counter medications, also cross the placenta and may affect the baby. Talk to your doctor about the risk to a fetus of any medications you are using versus the risk of discontinuing them. Before becoming pregnant, Bogris asked her doctor about the safety of her asthma medication and was reassured that it would not harm her unborn child.
Do you have to give up coffee as well? Not completely. According to registered dietitian Nancy Geronazzo, of the Region of Peel Health Department in Ontario, the current Health Canada recommendation for safe amounts of caffeine for pregnant women is no more than 300 mg a day, or about two cups. Larger amounts of caffeine can increase the chance of miscarriage, premature birth and a low-birth-weight baby. High caffeine consumption may also delay conception and affect your nutritional status, since the polyphenols in coffee and tea reduce absorption of iron. Caffeine is also found in some soft drinks, teas, cocoa, chocolate, some medications and even some new fruit drinks that contain guarana bean.
What about Birth Control? When Natasha Vanderpluym and her husband wanted to get pregnant, they went off the pill for a three-month period before trying to conceive and used condoms and foam during that time. But Murphy counters, “You don’t need to wait for three months. We usually recommend that you have one normal period to allow the body to get back to its own natural rhythms, but it’s safe to get pregnant before your first returned period.” No waiting period is necessary after discontinuing barrier methods or after removal of an IUD.
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Lifestyle Inventory What else can you do to increase the likelihood of conceiving and carrying a healthy baby to term?
You may be relieved to find out that if you have a healthy diet already, one that follows Canada’s Food Guide to Healthy Eating, you may need to do nothing more than take a folic acid supplement daily, found in prenatal multivitamins. If you need to improve your diet, do it together with your partner. Good nutrition improves sperm health.
There are a few aspects of your diet that you should pay special attention to if you’re trying to conceive. Geronazzo encourages women to build healthy iron stores before pregnancy. The best-absorbed sources of iron come from meat. Enriched grains and beans, such as lentils, chickpeas and soybeans, are also good sources but should be eaten with a vitamin C source (red peppers, strawberries, orange juice, or kiwis) to promote absorption.
If you are a vegetarian or a vegan (one who eats no animal products), Geronazzo advises consulting a dietitian. Your doctor can refer you to one. “You may be low in some nutrients which may affect your success in getting pregnant or your health in pregnancy,” she says. Vegans should talk to their doctor about vitamin B12 and calcium supplementation.
Now is a good time to start avoiding foods which might have bacterial contamination. “Listeria bacteria found in soft cheeses may cause the infection listeriosis,” warns Geronazzo. Soft cheeses are cheeses with a high moisture content, such as brie and Camembert. In hard cheeses the moisture level is not as high so the bacteria don’t thrive as well.
You might want to forgo the steak tartare, as well. “Toxoplasmosis is an infection caused by a parasite. It can be picked up by eating raw or undercooked foods such as meat and eggs, or through exposure to cat feces,” Lemon explains. “If a woman becomes infected during pregnancy, it could result in miscarriage, stillbirth or ill health in the newborn baby.” Take precautions by wearing gloves when you change cat litter or work in the garden, and by washing your hands well after handling raw meat or eggs. Cat owner Vanderpluym found an easy way to avoid contact with cat feces: “I delegated the litter box duties to my husband. He loved that!”
Are you in a healthy weight range for pregnancy? Geronazzo notes that an underweight woman is at risk of a preterm or low-birth-weight baby. She suggests that a woman with a body mass index under 20 should try to gain some weight before pregnancy or be prepared to gain more in pregnancy. Bogris, a small, fine-boned woman with a BMI of about 18, knew that she fell into this category. “I was concerned that I might lose weight due to morning sickness in the first trimester, so I put on a few pounds by eating more.” She regularly added almond butter to her toast and made herself more smoothies.
Geronazzo has advice for the overweight woman as well. If you are overweight, there is a greater risk of developing high blood pressure and diabetes during pregnancy, but women should not try to lose weight once they are pregnant. “A woman with a BMI over 27 should try to eat healthier and become more active,” says Geronazzo. Consult your doctor before starting a new exercise program.
Exercise is good for everyone, of course. Here’s how Vanderpluym approached it. “I began short walks and bought a pregnancy workout video. I started doing it so that once pregnant I would be used to the routine. Along with the video came a relaxation exercise that I did faithfully in preparation for the birth.”
Once you are pregnant, continued exercise will be beneficial, given a few common-sense precautions. “Make sure you don’t get dehydrated or overheated enough to raise your core body temperature,” says Murphy. And check with your doctor as to whether you should modify your routine, especially if you have a history of pregnancy complications.
Before you relax in a hot tub, consider this information from Lemon: “Avoid hot tubs and whirlpools if you’re trying to conceive or may already be pregnant, and check that the temperature of a heated pool is not above 35°C.” The high heat can increase your body temperature. Research has shown that high heat may increase the risk of birth defects especially during the first trimester. Heat may also affect sperm quality and quantity so that keeps both of you out of the hot tub.
Making all these changes may seem daunting right now. Try to approach them one at a time and see how many you can accomplish. Ask your partner to make the changes with you. Whether you start before pregnancy or after, you’ll not only improve your own health but chances are you’ll grow a healthier baby as well. And later, as you cope with the emotional and physical demands of a new baby, you and your partner will appreciate the resilience and stamina that come from a healthier lifestyle.
*Name changed by request.
Can My Environment Harm My Unborn Baby? Wendy Burgoyne, a health promotion consultant for Ontario’s Best Start Resource Centre, suggests couples consider the following aspects of their environment when anticipating a pregnancy:
Find out what chemicals you are exposed to at work Wear gloves and a mask if you may be in contact with pesticides, lead, solvents or asbestos. Be aware that renovations may result in exposure to lead-based paint and asbestos. Exposure to some chemicals may impair fertility as well as harm the fetus.
Avoid contact with diseases Chicken pox, German measles and cytomegalovirus (CMV) may cause birth defects. Daycare workers, teachers and hospital workers are at higher risk.
Develop strategies to reduce and cope with stress Stress is associated with difficulties in conceiving, miscarriage, nausea in pregnancy and premature birth.
Avoid exposure to excessive heat Heat may reduce sperm count and harm an unborn baby.
Reduce your exposure to second-hand smoke Avoid it in your workplace or home.
Standing for more than four hours at a time and heavy lifting This may affect your ability to carry a pregnancy to term. If these are requirements at work, consider how you might change them after you conceive.
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There is no conclusive evidence that computer use negatively affects the outcome of pregnancy. If you have a particular concern about something in your environment, contact Motherisk (416) 813-6780, Best Start at 1-800-397-9567 or visit beststart.org.
Why should I take folic acid supplements? “A daily supplement of 0.4 mg of folic acid can reduce the risk of neural tube defects (NTDs) by as much as 70 percent if taken at least three months before conception,” says registered dietitian Nancy Geronazzo of the Region of Peel Health Department in Ontario. Folic acid is necessary for healthy cell development during the early weeks of pregnancy. Poor development may affect the brain, causing anencephaly, or the spine, resulting in spina bifida.
In Canada, white flour, pasta and cornmeal are fortified with folic acid; this fortification supplies an average of 0.2 mg of folic acid to most people. Eating plenty of foods rich in folic acid will boost your intake, but Geronazzo says that even the best food choices will not supply all the folic acid you need to significantly reduce the risk of NTDs. That’s why a daily supplement is recommended for all women who might possibly become pregnant.
Physicians may recommend a higher dose to women at a greater risk of having a baby with an NTD. Check with your doctor if you have a family history of NTDs, have insulin-dependent diabetes, use certain anti-seizure medications or have clinically diagnosed obesity.
Understanding BMI The body mass index (BMI) is a ratio of your body weight and height and can be a useful tool in determining whether your weight is within a healthy range. The BMI is not applicable to women who are pregnant or breastfeeding. A BMI between 19 and 25 indicates a healthy weight.
Calculate your BMI BMI = weight (Kg) ÷ height (m)2 For more information, or to calculate your BMI without doing the math, visit the Food and Nutrition page of Health Canada’s website: hc-sc.gc.ca.