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When should you start thinking about the health of your baby? Ideally, before you even get pregnant. “About three months before trying to conceive, I’d suggest going for a preconception check-up [with],” says Batya Grundland, maternity care lead at Women’s College Hospital’s Family Practice Health Centre. Though it’s not mandatory, this appointment is a great first step toward optimal health for you and your baby. Here’s what your doctor will do during this visit.
“We want all women to be on prenatal vitamins, or at least folic acid, for three months prior to conceiving,” explains Grundland. That’s because folic acid helps prevent neural tube defects (problems with development of the brain, spine or spinal cord), which can develop in the first weeks of pregnancy—even before you get a positive pregnancy test.
Your doctor will also ask about any health problems that run in your family. “Your doctor will take a family history to identify if you’re at a higher risk and if you should see someone to discuss genetic counselling before you start trying to conceive,” says Deanna Telner, a family physician with the South East Toronto Family Health Team. The discussion will include your family history of congenital abnormalities, Down syndrome and cystic fibrosis.
“There are risks to taking some medications and over-the-counter herbal supplements during pregnancy, so you’ll want to switch off some and have a conversation about the benefits and risks of others,” says Telner. For example, certain types of medications for high blood pressure and diabetes are unsafe during pregnancy. Your doctor will also want to talk to you about any antidepressants and anti-anxiety medications you’re taking. Some are safer for pregnancy than others: Certain antidepressants have been linked with a slightly increased risk of miscarriage, premature delivery and low birth weight, while others have been associated with postpartum hemorrhaging and heart defects in the baby.
“Most antidepressants and anti-anxiety medications are not associated with congenital malformations, but a lot of women feel uncomfortable on them,” says Grundland. “Of course, being terribly depressed or anxious during pregnancy isn’t good for the baby either, so this is really a risk-benefit discussion.” Seeing your doctor ahead of time lets you make a plan for all your medications and switch to safer drugs or taper off them if that’s what you decide to do.
Now is the time to make sure that you’re up to date on all your shots, including two important immunizations: the measles, mumps and rubella (MMR) vaccine and, if you need it, the chickenpox vaccine. That’s because if you catch rubella or chickenpox while you’re pregnant, it can lead to significant complications for the baby. You can’t get these shots during pregnancy because they are live vaccines, which means they contain a weakened form of the virus, not a dead one, so they could, theoretically, harm your fetus if you get them while pregnant.
You don’t have to be in the best shape of your life to start trying to get pregnant, but your doctor will talk about the key lifestyle factors that affect pregnancy. One of those is obesity (having a body mass index over 30), which increases the risk of miscarriage and common complications during pregnancy, such as diabetes and pre-eclampsia (a potentially serious condition marked by high blood pressure during pregnancy). Your doctor may advise you to try to lose weight before getting pregnant or make other recommendations (for example, obese women have a higher recommended daily dose of folic acid).
If you smoke, your doctor may talk to you about options around quitting. This is also time to discuss if you should modify your drinking habits or coffee consumption while trying to conceive. If you have any medical conditions, such as asthma or thyroid disease, your doctor will ensure that these are as well controlled as possible.
Finally, get ready for a birds-and-bees refresher. “Even among educated women, there are still many misconceptions around sex and pregnancy,” says Grundland. Your doctor can explain how to know when you’re ovulating and optimize timing to when you’re most likely to conceive.
You doctor may also review any personal risk factors that might make it harder for you to conceive, such as age or a family history of infertility, and let you know what to expect (like how many months you should try to get pregnant on your own before you come back for a referral to a fertility specialist).
Don’t forget that this appointment is a great time for you to ask any of your own questions about getting pregnant, from how to find an OB-GYN to what to expect after going off the birth control pill. After that, it’s time for the fun part: trying to make a baby!